Non-nociceptive aspects of persistent musculoskeletal pain.

Persistent pain is often difficult to understand and to treat. Clinical and neurophysiological evidence is offered, suggesting that this often occurs because persistent pain is partially or wholly of non-nociceptive afferent origin. The concept of non-nociceptive pain and the potential roles of proprioceptive afferents in the production of non-nociceptive pain are particularly emphasized. It is suggested that non-nociceptive pain is often an important component of pain associated with peripheral and central neuropathy, fibromyalgia, trauma-induced pain, idiopathic low back pain, and chronic regional pain syndrome. Non-nociceptive pain is often dependent upon central sensitization induced by prior or ongoing nociception. Therapeutic methods which minimize nociceptive afferent activity are important in the prevention and/or elimination of often intractable non-nociceptive pain.