Landau model for illustrating the learning and unlearning process of nociplastic pain

TL;DR

This paper introduces a Landau model to explain how nociplastic pain is learned and unlearned, aiming to improve understanding and communication about this complex condition.

Contribution

The novelty lies in applying a Landau model to conceptualize the learning and unlearning of nociplastic pain through biopsychosocial factors.

Findings

Nociplastic pain is modeled as a first-order transition favoring an alert-protection state over a trust-explore state.

Biopsychosocial loops form when historical and expert information about symptoms is alarming and contradictory.

Learning and unlearning involve changes in control parameters that influence different mental states.

Abstract

Recent advancements in understanding the consolidation of nociplastic pain point to a complex, non-conscious learned process of threat perception. Neurobiological pain education is emerging as a promising approach to unlearn nociplastic pain, supported by biopsychosocial tools such as exposure to movement, mindfulness, and group sharing formats. However, this approach is still not well-known among clinicians and the society at large, creating a communication problem that unfortunately perpetuates the suffering of patients. Herein, we propose a Landau model to describe the learning and unlearning process of nociplastic pain, aiming to clarify this complex situation and facilitate communication across different sectors of the society. Nociplastic pain corresponds to a first-order transition, with attention more likely in the alert-protection state than in the trust-explore state. Two appealing results of the model are that the perception of the critical context depends on personal history regarding the symptom and that biopsychosocial loops are formed when there is alarming learned historical information about the symptom, along with confused and contradictory expert information, as seen in nocebo messages. Learning and unlearning in the model correspond to a chang in control parametrs that can weigh more on the alert-protection state, trust-explore state, uncertain state or neutral state. This description clarifies why neurobiological education is the foundational therapy from which others must be built to embody the accessible, clear, and trustworthy information.

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