Version July 2025
CBT: cognitive behavioral therapy; MBSR: mindfulness-based stress reduction; NSAIDs: nonsteroidal antiinflammatory drugs; SNRIs: serotonin-norepinephrine reuptake inhibitors; TENS: transcutaneous electrical nerve stimulation.
* For patients with very impactful pain, multimodal therapy with early addition of pharmacologic therapy may be appropriate.
¶ Nociceptive pain is caused by stimuli that threaten or result from body tissue damage and is associated with a range of musculoskeletal and visceral conditions that involve inflammatory, ischemic, infectious, or mechanical/compressive injury.
Neuropathic pain consists of a central and/or peripheral disorder of pain modulation. Patients often describe neuropathic pain as tingling or pins and needles, burning, and shooting or electric shock. Physical examination often reveals allodynia or hyperalgesia.
Nociplastic pain is the result of central sensitization, which involves altered central pain processing and modulation and can cause allodynia, hyperalgesia, and reduced effectiveness of pain therapies.
Δ The choice among treatments for neuropathic pain should be based on the pain condition (if known), patient comorbid conditions, concurrent medications, medication side effect profile, cost, and patient preference regarding dosing frequency.
◊ If NSAIDs are ineffective in patients with presumed nociceptive pain, the possibility of neuropathic or nociplastic pain should be considered. A trial of a pain-relieving antidepressant or antiseizure medication may be appropriate.
