Abstract
OBJECTIVE: To familiarize family physicians with new and emerging evidence regarding the underlying central nervous system (nociplastic) pathogenesis of many chronic pain conditions and review modalities of psychotherapy that can specifically target nociplastic pain and other symptoms. QUALITY OF EVIDENCE: Psychotherapy modalities for the treatment of patients with nociplastic chronic pain (eg, pain reprocessing therapy, emotional awareness and expression therapy, intensive short-term dynamic psychotherapy) have level I evidence to support their efficacy in treating patients with various pain conditions as well as those with other chronic symptoms lacking clear structural causes. MAIN MESSAGE: Family physicians should be aware that many patients with chronic pain and other persistent symptoms may benefit from therapeutic approaches that target the central nervous system rather than the site where symptoms are felt. Meta-analyses have shown that older nonspecific modalities of psychotherapy (eg, cognitive behavioural therapy, acceptance and commitment therapy) have limited efficacy in treating patients with these conditions. Recent trial evidence and systematic reviews have shown that pain reprocessing therapy, emotional awareness and expression therapy, and intensive short-term dynamic psychotherapy can be helpful for many patients with nociplastic symptoms and may also help improve comorbid mood and anxiety symptoms. CONCLUSION: Psychotherapy is a safe and effective way to treat patients with chronic pain conditions that have nociplastic components. Access to effective therapy modalities may be a limiting factor, but self-treatment using online or virtual resources can be helpful for many patients.