Types of pain: nociceptive, neuropathic, and nociplastic pain
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What do these terms mean?
Pain can be described in several ways: by duration, diagnosis, distribution, or the processes thought to contribute to it. These descriptions serve different purposes and should not be used interchangeably.
This page focuses on three terms used by the International Association for the Study of Pain (IASP): nociceptive, neuropathic, and nociplastic pain. They are often called mechanistic descriptors because they describe broad processes thought to contribute to pain. They are not diagnoses, and using a descriptor does not mean that a specific biological mechanism has been directly measured or confirmed in an individual.
These descriptors can help clinicians organise information from the history, examination, and relevant investigations. However, they do not identify a single mechanism with certainty or provide a complete explanation of a person's pain.
How can mechanistic descriptors help?
Describing pain as nociceptive, neuropathic, or nociplastic complements classification by duration, distribution, or diagnosis. Each describes a different aspect of the clinical presentation.
Mechanistic descriptors can help clinicians organise findings from the history, examination, and relevant investigations. They may support differential diagnosis and highlight areas requiring further assessment. They also recognise that people with the same diagnosis can have different pain presentations.
The descriptors are not mutually exclusive. More than one may apply, and their relevance may change over time. In many cases, it will not be possible to identify a predominant descriptor with confidence. No single symptom, examination finding, questionnaire, or investigation establishes the mechanism responsible for a person's pain.
Mechanistic descriptors may inform clinical reasoning and management, but they should not be treated as stand-alone treatment algorithms or as reliable predictors of treatment response.
Pain and nociception
Pain and nociception are related, but they are not the same. IASP defines nociception as the neural process of encoding noxious stimuli. Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
Nociceptive activity does not always result in pain. The relationship between nociception, tissue damage, and pain is not fixed: similar nociceptive input may be experienced differently by different people, or by the same person at different times. Pain therefore cannot be understood solely from the extent of tissue damage or from measures of nociceptive activity.
Nociceptive pain
IASP defines nociceptive pain as pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors. Nociceptors are sensory receptors that detect potentially or actually tissue-damaging stimuli.
Nociceptive pain is commonly associated with acute injury, inflammation, and surgery. It may also contribute to pain in conditions such as osteoarthritis and inflammatory arthritis. These diagnoses do not, however, establish that a person's pain is exclusively nociceptive.
Clinical assessment considers whether there is a plausible relationship between the pain and actual or threatened tissue damage. Localised pain, tenderness, and pain related to movement or loading may support a nociceptive contribution, but these findings are not specific. The relationship between tissue changes, nociceptive activity, and pain varies between people.
Peripheral or central sensitisation may occur alongside nociceptive pain. Their possible presence does not automatically mean that the pain should be assigned to a different descriptor.
Management depends on the underlying condition and the person's clinical presentation. It may include treatment of injury or inflammation, rehabilitation, and symptom relief. The nociceptive descriptor alone does not determine treatment.
Neuropathic pain
IASP defines neuropathic pain as pain caused by a lesion or disease of the somatosensory nervous system. It may be peripheral, as in painful diabetic polyneuropathy or postherpetic neuralgia, or central, as in central post-stroke pain.
Symptoms such as burning, shooting, or electric-shock-like pain may raise suspicion of neuropathic pain. Other features can include numbness, altered sensation, and allodynia (pain caused by a stimulus that does not normally provoke pain). None of these features is specific to neuropathic pain. The distribution should be neuroanatomically plausible, and the history should support a relevant lesion or disease.
The Neuropathic Pain Special Interest Group grading system classifies neuropathic pain as possible, probable, or definite according to the available clinical and investigative evidence. Questionnaires such as the DN4, LANSS, and painDETECT may help identify neuropathic features, but they do not establish the diagnosis or replace clinical assessment.
Radicular pain should not automatically be classified as neuropathic. Classification as neuropathic requires evidence supporting a lesion or disease affecting the somatosensory nervous system.
Management depends on the underlying condition, the clinical presentation, and relevant clinical guidance. Some treatments used for neuropathic pain differ from those commonly used for acute nociceptive pain, but the descriptor alone does not predict how an individual will respond.
Nociplastic pain
IASP defines nociplastic pain as pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain. The term was introduced for pain that cannot be adequately described as nociceptive or neuropathic.
Nociplastic pain is a mechanistic descriptor, not a diagnosis. It does not mean that the pain lacks a biological basis. Nor does it establish that nociceptive or neuropathic processes are absent. More than one descriptor may apply.
The mechanisms underlying nociplastic pain are still being studied. Changes in nociceptive processing within the peripheral and central nervous systems may contribute. Central sensitisation is one proposed process, but nociplastic pain and central sensitisation are not interchangeable terms. Symptoms, examination findings, and questionnaire scores may be consistent with central sensitisation, but they cannot confirm its presence in an individual.
In 2021, an IASP Terminology Task Force proposed clinical criteria for chronic nociplastic pain affecting the musculoskeletal system. The criteria distinguish possible and probable nociplastic pain. They consider pain duration and distribution, whether nociceptive or neuropathic processes adequately explain the pain, and whether there are clinical signs of pain hypersensitivity. A history of hypersensitivity to touch, movement, pressure, or temperature, together with symptoms such as fatigue, disturbed sleep, cognitive difficulties, and sensitivity to other sensory stimuli, contributes to the grading of probable nociplastic pain. These features are not specific to nociplastic pain.
The criteria are intended to support clinical recognition and research. They are not a definitive diagnostic test and require further field testing. Corresponding criteria for visceral pain have not yet been established.
Nociplastic pain is often discussed in relation to fibromyalgia and some chronic primary pain conditions. These diagnoses do not establish that one mechanism is responsible for a person's pain. A nociplastic contribution has also been proposed in some people with chronic low-back pain and other conditions, although the validity and clinical usefulness of this type of phenotyping remain debated.
Management should be based on the person's diagnosis, clinical presentation, wider health, goals and preferences, and relevant clinical guidance. There is no single treatment pathway for nociplastic pain, and response to treatment should not be used to confirm the presumed mechanism.
Overlapping processes and mixed pain
More than one process may contribute to a person's pain. For example, cancer-related pain may have both nociceptive and neuropathic contributions. A person may also have more than one painful condition, with different processes contributing to each.
The term mixed pain is sometimes used when features of more than one mechanistic descriptor are present. It is a clinical description rather than a separate pain mechanism, and its definition and assessment are not standardised.
Recognising possible overlap may support a broader assessment and help clinicians avoid forcing a complex presentation into one category. However, it is not usually possible to determine the relative contribution of each process precisely. Mechanistic descriptors should therefore remain provisional and be reconsidered if the clinical presentation changes or new information becomes available.
Other ways of describing and classifying pain
Mechanistic descriptors are only one way of describing pain. Other terms may refer to:
acute or chronic pain.
localised, regional, or widespread pain.
peripheral or central, when referring to the location of a lesion or process.
for example, osteoarthritis, painful diabetic polyneuropathy, or fibromyalgia.
chronic primary or chronic secondary pain.
These terms answer different clinical questions and should not be used interchangeably. For example, regional pain describes where pain is experienced, not its mechanism. Central pain should be avoided as a stand-alone term because it can refer to different concepts. Where relevant, clinicians should use a more precise term, such as central neuropathic pain or central sensitisation.
Putting the descriptors into practice
Assessment should begin with the person's history, clinical examination, and, where indicated, relevant investigations. Clinicians should consider whether the available evidence supports a nociceptive, neuropathic, or nociplastic contribution, whether more than one descriptor may apply, and how confident that judgement can be.
The descriptors should be reviewed as new information emerges or the clinical presentation changes. Management should address the person's diagnosis, symptoms, function, wider health, circumstances, goals, and preferences, not the mechanistic descriptor alone.
References and further reading
- Raja SN, Carr DB, Cohen M, et al. The revised IASP definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982.
- Kosek E, Cohen M, Baron R, et al. Do we need a third mechanistic descriptor for chronic pain states? Pain. 2016;157(7):1382-1386.
- Kosek E, Clauw D, Nijs J, et al. Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain. 2021;162(11):2629-2634.
- Finnerup NB, Haroutounian S, Kamerman P, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain. 2016;157(8):1599-1606.
- Scholz J, Finnerup NB, Attal N, et al. The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain. 2019;160(1):53-59.
- Treede RD, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for ICD-11. Pain. 2019;160(1):19-27.
- Shraim MA, Sluka KA, Sterling M, et al. Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a Delphi expert consensus study. Pain. 2022;163(9):1812-1828.
- Treede RD, Hoheisel U, Wang D, Magerl W. Central sensitization: clinical utility of a physiological concept for the International Statistical Classification of Diseases and Related Health Problems and for nociplastic pain. Pain. 2022;163(S1):S99-S107.
- Graven-Nielsen T. Mechanisms and manifestations in musculoskeletal pain: from experimental to clinical pain settings. Pain. 2022;163(S1):S29-S45.
- Kaplan CM, Kelleher E, Irani A, et al. Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms. Nature Reviews Neurology. 2024;20(6):347-363: a current synthesis of the clinical features and mechanisms of nociplastic pain.
- Häuser W, Kosek E. Nociplastic pain: facts, controversies and future tasks. European Journal of Pain. 2026;30(1):e70175: a recent overview in the journal of the European Pain Federation.
- IASP Terminology: the authoritative source for the definitions used on this page.