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Part of pain labelled neuropathic in rheumatic disease might be rather nociplastic
  1. Florian Bailly1,2,
  2. Alain Cantagrel3,
  3. Philippe Bertin4,
  4. Serge Perrot5,6,
  5. Thierry Thomas7,
  6. Thibaud Lansaman8,
  7. Laurent Grange9,
  8. Daniel Wendling10,
  9. Calogera Dovico11 and
  10. Anne-Priscille Trouvin6,12
  1. 1 Pain Department, Pitie-Salpetriere Hospital, Assistance Publique - Hopitaux De Paris, Paris, France
  2. 2 Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
  3. 3 Rheumatology, C.H.U. Purpan, Toulouse, France
  4. 4 Hopital Dupuytren, Limoges, France
  5. 5 Centre d’Evaluation Et Traitement De La Douleur, Université Paris Descartes, Hopital Cochin, Paris, France
  6. 6 U987, INSERM, Boulogne Billancourt, France
  7. 7 Rheumatology, CHU De St-Etienne, Saint-Etienne,France
  8. 8 Médecine Physique Et Réadaptation, Hôpital Raymond-Poincaré - Assistance Publique Hôpitaux De Paris, Garches, France
  9. 9 CHU Grenoble, Grenoble, France
  10. 10 Rheumatology, CHRU (University Hospital), Besançon, France
  11. 11 Service De Médecine Physique Et Réadaptation, Dispositif IEM APF FRANCE HANDICAP, Belfort, France
  12. 12 Pain Evaluation and Treatment, Hopital Cochin, Paris, France
  1. Correspondence to Florian Bailly; florian.bailly{at}


Pain in rheumatic diseases is primarily due to mechanical or inflammatory mechanism, but neuropathic pain (NP) component is also occurring in many conditions and is probably underdiagnosed. The purpose of this article is to provide an overview of prevalence, pathophysiological and currently available treatment of NP in rheumatic diseases. When associated with clinical evaluation assessing neurological clinical signs and neuroanatomical distribution, Douleur Neuropathique 4 Questions, painDETECT, Leeds assessment of neuropathic symptoms and signs and Neuropathic Pain Questionnaire can detect NP component. Inflammatory or connective diseases, osteoarthritis, back pain or persistent pain after surgery are aetiologies that all may have a neuropathic component. Unlike nociceptive pain, NP does not respond to usual analgesics such as paracetamol and non-steroidal anti-inflammatory drugs. Entrapment neuropathy, peripheral neuropathy or small-fibre neuropathy are different aetiologies that can lead to NP. A part of the pain labelled neuropathic is rather nociplastic, secondary to a central sensitisation mechanism. Identifying the right component of pain (nociceptive vs neuropathic or nociplastic) could help to better manage pain in rheumatic diseases with pharmacological and non-pharmacological treatments.

  • Analgesics
  • Arthritis
  • Low Back Pain
  • Osteoarthritis
  • Outcome Assessment
  • Health Care

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  • Twitter Florian Bailly @baillyflo.

  • Acknowledgements The authors would like to thank the Grünenthal laboratory for its logistical support.

  • Contributors All authors have substantially contributed to conducting the underlying research and drafting this manuscript.

  • Funding The scientific writing of the article was carried out independently of the Grünenthal Laboratories, without financial compensation. Grünenthal Laboratories funded the submission of this manuscript.

  • Competing interests FB reports personal fees from Grünenthal, during the conduct of the study; personal fees from Lilly, Boston and Novartis, outside the submitted work; AC reports personal fees from Grunhental, outside the submitted work; PB reports personal fees from Grünenthal, during the conduct of the study; SP reports personal fees from Grünenthal, grants and personal fees from Sanofi and Pfizer, during the conduct of the study; TT reports personal fees from Grünenthal, during the conduct of the study; grants and personal fees from Amgen, Chugai, UCB, Pfizer, MSD and Novartis, personal fees from Gilead, Arrow, Biogen, BMS, Expanscience, Gilead, LCA, Lilly, Medac, Nordic, Sandoz, Sanofi, Theramex, Thuasne and TEVA, grants from Bone Therapeutics, outside the submitted work; TL reports personal fees from Grunenthal, Allergan, IPSEN and MERZ, outside the submitted work; LG reports personal fees from Grünenthal, during the conduct of the study; DW reports personal fees from Grünenthal, during the conduct of the study, personal fees from AbbVie, BMS, MSD, Pfizer, Roche Chugai, Amgen, Nordic Pharma, UCB, Novartis, Janssen, Celgene, Hospira, Lilly and Sandoz, outside the submitted work, indirect interests: AbbVie, Pfizer, Roche Chugai, MSD, UCB, Mylan, Fresenius Kabi. CD reports personal fees from Grünenthal, during the conduct of the study; A-PT reports personal fees from Menarini, personal fees from Recordati, outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval No ethics committee was solicited due to the review format of this manuscript, in accordance with the French laws.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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