Psychogenic (nociplastic) pain: Current state of diagnosis, treatment options, and potentials of neurosurgical management.

Classification of pain syndromes is quite multifaceted. However, pathogenetic classification by which chronic pain syndromes are usually divided into nociceptive, neuropathic and psychogenic, is crucial in choosing treatment tactics. In modern classifications, psychogenic pain is distinguished from nociceptive pain (associated with direct tissue injury or damage) and neuropathic pain (in which lesion can only be determined morphologically). Mental disorders play a leading role in psychogenic pain. Here, somatic/neurological disorders, if any, are of no pathogenetic significance in the dynamics of pain syndrome. There are certain algorithms (though not yet fully developed) and even guidelines for diagnosing and treating nociceptive and neuropathic pain, whereas psychogenic pain has been and still is almost out of sight for a long time. Despite its considerable prevalence, attitude towards it is still uncertain. Until now, it has no single classification, nor any strategy with regards to diagnosis, treatment and prevention.

Occipital Nerve Stimulation.

Although the first publications on clinical use of peripheral nerve stimulation for the treatment of chronic pain came out in the mid-1960s, it took 10 years before this approach was used to stimulate the occipital nerves. The future for occipital nerve stimulation is likely to bring new indications, devices, stimulation paradigms, and a decrease in invasiveness. As experience increases, one may expect that occipital nerve stimulation will eventually gain regulatory approval for more indications, most likely for occipital neuralgia, migraines and cluster headaches. This process may require additional studies, at least for approval from the US Food and Drug Administration.