Phenotypingnociceptive,neuropathic,andnociplasticpain:who,how,&why?

Chronic pain affects millions of people worldwide, but not all pain is the same. Traditionally, pain has been broadly categorized without considering the specific underlying mechanisms driving each person's pain experience. This editorial addresses a critical gap in pain management: the need to move beyond one-size-fits-all approaches toward precision medicine that tailors treatment based on the specific type of pain mechanism involved. The authors argue that understanding whether someone has nociceptive pain (from tissue damage), neuropathic pain (from nerve damage), or nociplastic pain (from altered pain processing) is crucial for effective treatment.

This concept, called pain phenotyping, represents a shift toward more personalized care that could dramatically improve outcomes for people with chronic pain conditions.

This editorial is part of a comprehensive pain management series that builds on previous work about central sensitization and nociplastic pain. The authors drew from established International Association for the Study of Pain (IASP) clinical criteria and grading systems to create practical guidance for clinicians. They synthesized current research and expert consensus to explain why pain phenotyping matters, which patients might benefit from this approach, and how clinicians can practically implement it. The authors developed a framework called the PSCEBSM model (Pain-Somatic-Cognitive-Emotional-Behavioral-Social-Motivation) to guide comprehensive assessment.

They also created practical guidelines for differentiating between the three main pain types and provided specific recommendations for tailoring treatment approaches based on the predominant pain phenotype.

The authors identified that pain phenotyping is particularly valuable for patients with chronic pain lasting more than three months, especially those with conditions where neuropathic or nociplastic features are common. These include fibromyalgia, rheumatoid arthritis, whiplash, low back pain, osteoarthritis, and many other musculoskeletal conditions. They found that each pain type has distinct characteristics: nociceptive pain is typically localized and corresponds to identifiable tissue damage; neuropathic pain follows nerve distribution patterns and includes symptoms like numbness and tingling; nociplastic pain spreads beyond anatomical boundaries and often includes fatigue, cognitive problems, and sleep issues. The editorial revealed that current 'nonspecific pain' labels can be stigmatizing and may generate nocebo effects, whereas proper phenotyping connects patients' experiences to scientific evidence and more targeted treatments.

This framework has significant implications for both patients and clinicians. For patients, proper pain phenotyping means receiving more targeted, effective treatments instead of generic approaches that may not address their specific pain mechanisms. It also means better explanations of their condition, reducing stigma and improving understanding. For clinicians, this approach provides clearer guidance on treatment selection: surgery might help nociceptive pain but won't impact nociplastic pain; neurodynamic mobilizations are only relevant for neuropathic pain; exercise approaches should be pain-contingent for nociceptive pain but time-contingent for nociplastic pain.

The editorial suggests that complex cases with neuropathic, nociplastic, or mixed pain types often require multidisciplinary care. While the evidence base for this stratified approach is still developing, especially in physical therapy, this framework represents a crucial step toward precision pain medicine that could transform chronic pain management.