Types of back pain.
Which type do you have?
The BACPAP consensus (Lancet Rheumatology, 2024), drawn up by 36 clinicians and researchers from 13 countries, distinguishes three types of back pain based on the underlying pain mechanism. Thinking about which type fits your pain helps you make sense of it.
Nociceptive pain
A local signal from the tissue itself
Nociceptive pain results from actual or threatened tissue damage. This is the most "classic" type of pain: your body detects a problem and sends a pain signal.
Features
- Clear trigger (lifting, sudden movement, fall)
- Pain is local and proportional to the trigger
- Responds well to rest, ice/heat and NSAIDs
- Usually heals within 6-12 weeks
Examples: acute muscle strain, ligament sprain, facet joint irritation.
Neuropathic pain
Pain travels along the path of a nerve
Neuropathic pain is caused by damage to or compression of a nerve. The nervous system itself is the source of the pain, not the surrounding tissue.
Features
- Shooting, burning or stabbing pain
- Radiating to buttock, leg or foot (sciatica)
- Tingling, numbness or muscle weakness
- Often follows the course of a specific nerve (dermatome)
Examples: herniated disc (HNP) with nerve compression, lumbar spinal stenosis, diabetic neuropathy.
Nociplastic pain
A small signal, amplified by the pain system
Nociplastic pain is the newest and most revolutionary concept in pain science. The term was introduced in 2017 by the IASP (International Association for the Study of Pain). With this type of pain, there is no clear tissue damage or nerve injury, but the pain system itself has become hypersensitive.
Features
- No clear structural cause on scans
- Pain is widespread, varying in location and intensity
- Amplified by stress, sleep deprivation, anxiety and catastrophising
- Does not or poorly responds to standard pain medication
- Benefits from pain education, CBT, PRT and graded exposure
Important: This is the most relevant type for chronic back pain. Many people with long-lasting back complaints have a nociplastic pain mechanism, even if there was once a clear physical trigger. The pain system has essentially "stayed on".
A caveat: the types overlap
The three types are not standalone diagnoses. In practice they often overlap: several pain mechanisms can play a role at the same time, and mixed presentations are common. Treat this classification as a tool for thinking about your pain, not as boxes you have to fit into exactly.
Nociplastic pain, moreover, is the name of a pain mechanism, not a demonstrable abnormality: anatomically it cannot yet be clearly pinpointed. The label says something about how the pain works, not about structural damage that shows up on a scan.
The consortium that wrote this classification says the same thing about treatment. There are early signs that these types respond differently to different treatments, but BACPAP states explicitly that more research is needed before specific recommendations can be attached to them. So if someone offers you a treatment because you supposedly have “nociplastic pain”, that reasoning is ahead of the evidence.
Key message
Pain is always real, regardless of the type. The three pain types can coexist and change over time. Understanding which mechanism is dominant helps in choosing the most effective treatment. In chronic back pain, nociplastic pain often plays a larger role than expected.
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