Kapernaros E, Koumantakis GA. Nociplastic chronic neck pain: From mechanisms to physical therapy clinical practice. World J Orthop 2026; 17(8): 122158 [DOI: 10.5312/wjo.122158]
Corresponding Author of This Article
George A Koumantakis, Associate Professor, Laboratory of Advanced Physiotherapy, Department of Physiotherapy, University of West Attica, 28 Agiou Spyridonos Street, Athens 12243, Attica, Greece. gkoumantakis@uniwa.gr
Research Domain of This Article
Rehabilitation
Article-Type of This Article
review-article
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World J Orthop. Aug 18, 2026; 17(8): 122158 Published online Aug 18, 2026. doi: 10.5312/wjo.122158
Nociplastic chronic neck pain: From mechanisms to physical therapy clinical practice
Emmanouil Kapernaros, George A Koumantakis
Emmanouil Kapernaros, Department of Physiotherapy, University of West Attica, Athens 12243, Attica, Greece
George A Koumantakis, Laboratory of Advanced Physiotherapy, Department of Physiotherapy, University of West Attica, Athens 12243, Attica, Greece
Author contributions: Kapernaros E contributed to performing the majority of the writing; Koumantakis GA contributed to providing supervision and assisted with literature organization; Kapernaros E and Koumantakis GA contributed to conceptualizing and designing the study, developing the research framework; drafted the initial manuscript; and reviewed and approved the final manuscript as submitted.
AI contribution statement: The authors used a generative AI tool (Claude 3.5 Sonnet, Anthropic) as assistive technology during preparation of this manuscript, including for translation from the authors’ original Greek draft, English language refinement and grammar correction. The authors agree to accountability for all content of this manuscript, including any portions for which AI tools were used. All AI-assisted outputs have been carefully reviewed, verified, and validated by the authors, who take full responsibility for the accuracy, integrity, and originality of the manuscript. AI tools were not used to generate data, perform analyses, or draw scientific conclusions.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: George A Koumantakis, Associate Professor, Laboratory of Advanced Physiotherapy, Department of Physiotherapy, University of West Attica, 28 Agiou Spyridonos Street, Athens 12243, Attica, Greece. gkoumantakis@uniwa.gr
Received: April 13, 2026 Revised: June 2, 2026 Accepted: July 2, 2026 Published online: August 18, 2026 Processing time: 125 Days and 17 Hours
Abstract
Chronic neck pain represents a major public health burden with rising prevalence, significant functional impact, and unfavorable projections over the coming decades. Its clinical presentation is heterogeneous and often not adequately explained by structural or imaging findings, highlighting the limitations of the traditional biomedical model. According to the International Association for the Study of Pain, nociplastic pain is defined as pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory nervous system. In chronic neck pain, nociplastic features may manifest to varying degrees through a bidirectional interaction between peripheral input and central processing, potentially involving reduced endogenous inhibition, pain hypersensitivity, attenuated exercise-induced hypoalgesia, and sensorimotor control disturbances. Classification based on the predominant pain mechanism integrates chronicity, symptom distribution, absence of adequate nociceptive or neuropathic explanation, documented hypersensitivity, and associated comorbidities. Rehabilitation is organized according to the predominant mechanism and functional status, emphasizing patient education and reconceptualization, graded exposure and load tolerance regulation, sensorimotor retraining, and functionally targeted exercise, while passive interventions maintain an adjunctive and time-limited role. Future studies incorporating mechanism-based stratification and mechanism-aligned outcomes are needed.
Core Tip: This review integrates the concept of nociplastic pain, a mechanistic pain descriptor recognized by the International Association for the Study of Pain, into the understanding and rehabilitation of chronic neck pain. It encompasses the pathophysiological framework of altered nociception, proposes a clinical reasoning approach based on the predominant pain mechanism, and translates these concepts into rehabilitation principles including patient education, graded exposure, sensorimotor retraining, and functionally targeted exercise. This mechanism-based framework supports individualized clinical decision-making beyond structural explanations and may reduce the risk of misdirected interventions.
