Nociplastic chronic neck pain: From mechanisms to physical therapy clinical practice

Table 1 Summary of pain mechanisms based on the predominant mechanism of transmission and maintenance (International Association for the Study of Pain)

Pain mechanism	Brief description	Illustrative clinical examples1
Nociceptive	Pain arising from the activation of peripheral nociceptors due to actual or threatened tissue damage. Typically well-localized with a predictable relationship to loading	Whiplash-type injury, facet joint arthropathy
Neuropathic	Pain caused by a lesion or disease of the somatosensory nervous system. Distribution consistent with neuroanatomy, often with burning/electric character and sensory deficits	Cervical radiculopathy from disc herniation, right C5 foraminal stenosis
Nociplastic	Pain associated with altered nociception without adequate evidence of active tissue damage or neural disease. Often accompanied by widespread distribution, pain hypersensitivity, and disproportionate functional burden	Chronic neck pain with widespread hypersensitivity, neck pain with diffuse back pain and headache

¹Examples are illustrative and do not imply a “pure” mechanistic category, as mixed features frequently coexist in clinical practice.