Vol. 33 Núm. 2 (2026), Artículo de la revista EJP
Vol. 33 Núm. 2 (2026)

Dolor nociplástico: hechos, controversias y retos futuros

Artículo de la revista EJP
Publicado 24-07-2026
Winfried Häuser
Centro de Salud para la Medicina del Dolor y la Salud Mental Saarbrücken St. Johann, Saarbrücken, Alemania; Departamento de Medicina Psicosomática y Psicoterapia, Universidad Técnica de Múnich, Múnich, Alemania
Eva Kosek
Departamento de Neurociencia Clínica, Instituto Karolinska, Estocolmo, Suecia; Departamento de Ciencias Quirúrgicas, Universidad de Uppsala, Uppsala, Suecia

Resumen

Antecedentes: El dolor nociplástico, un tercer descriptor mecánico del dolor además del dolor nociceptivo y el neuropático, se define como “el dolor que surge de una nocicepción alterada” y que no se explica completamente mediante los mecanismos del dolor nociceptivo o neuropático.
Métodos: Resumimos y ampliamos algunos debates de una sesión principal sobre el dolor nociplástico celebrada en la conferencia de la Federación Europea del Dolor (EFIC) en Lyon el 26 de abril de 2025.
Resultados: Recomendamos no confundir conceptos y términos: el dolor nociplástico no es sinónimo de dolor crónico primario ni de sensibilización central. El dolor nociplástico no es un nuevo término para el dolor de origen desconocido. Identificamos estas controversias: “nociplástico” podría no ser el mejor término. Otras especialidades (p. ej., medicina interna) utilizan términos y conceptos diferentes para afecciones clínicas denominadas “afecciones de dolor nociplástico” por la medicina del dolor. El síndrome de fibromialgia no siempre es el prototipo de una afección de dolor nociplástico puro. La “nociplasticidad” puede ser un componente continuo (y no independiente) del dolor; por lo tanto, se ha cuestionado el requisito de “excluir” el dolor nociceptivo y el dolor neuropático para diagnosticar el dolor nociplástico.
Conclusiones: Las tareas futuras incluyen pruebas de campo adicionales y la eventual modificación de los criterios para el dolor nociplástico; el desarrollo de guías de tratamiento farmacológico y psicológico, basadas en los tres tipos de dolor; el desentrañamiento de los mecanismos fisiopatológicos que impulsan la nocicepción alterada en afecciones dolorosas con componentes nociplásticos sustanciales; y el desarrollo de conceptos generales que unifiquen las diferentes perspectivas de la medicina somática, la medicina psicosocial y la medicina del dolor.
Declaración de importancia: El concepto de dolor nociplástico ha adquirido una importancia creciente en la medicina del dolor y se ha introducido en otras especialidades, como la ginecología y la reumatología. Los médicos deben esforzarse siempre por identificar los principales mecanismos del dolor para orientar el tratamiento.

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