Frontiers in Medicine
Mixed pain: has pain medicine overlooked Its most common phenotype for over 20 years? A perspective on mechanistic interaction, the nociplastic paradox, and the future of pain classification
Pain medicine has progressively evolved from a binary classification of nociceptive and neuropathic pain toward a broader mechanistic framework that now includes nociplastic pain. While this evolution has substantially improved our understanding of chronic pain, it has not resolved a persistent clinical reality: most patients do not present with mechanistically pure pain states. Instead, nociceptive, neuropathic, and nociplastic mechanisms frequently coexist within the same individual and interact in ways that chal …