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One of the main challenges that rheumatologists face in their daily encounters with patients is their ability to differentiate between nociplastic pain and pain related to underlying autoimmune diseases. This can affect their care plan and might lead to additional testing and immunosuppressive therapy with potential major side effects.

Another challenge is to educate patients about the different types of pain they could be experiencing. Although this might be time consuming in busy practices, it is crucial for multiple reasons. First, it can help improve a patient's level of satisfaction by setting common expectations and goals for the physician and patients. It also helps solidify the level of trust and can lead to more efficient visits in which both parties are on the same page and working toward the same goal. Second, patient education can improve the physicians' ability to objectively assess overall disease activity of the underlying rheumatologic disease, knowing that comprehensive disease activity measures do not specifically differentiate between different types of pain.

The study by Murphy et al. in highlights some important clues in the history and physical exam that can help rheumatologists identify nociplastic pain in a timely and efficient way. The authors also list potential effective interventions that help target nociplastic pain. One of the key non-pharmacologic interventions is to validate a patient's symptoms and provide a clear tracking strategy with well-established goals and expectations. Behavioral therapy, sleep management, and assessing for available social support are also important elements in the care plan. While pharmacologic treatments are also helpful, time is needed to explain potential side effects of some medications, particularly with those patients who are sensitive to and vigilant for minor side effects. Patients need to understand that it may take several weeks to start noticing positive effects from any of these interventions, and they need encouragement not to give up due to the lack of immediate symptomatic improvement.

Johny Fares, MD, is a senior rheumatology fellow at Cedars-Sinai Medical Center in Los Angeles.

Read the study here and a Q&A of study highlights here.