Chronic nonbacterial osteitis (CNO) is a rare musculoskeletal disease causing chronic bone pain. It is known that chronic musculoskeletal pain may involve other mechanisms than nociceptive pain only. We investigate the prevalence of neuropathic and nociplastic pain in adult CNO and their association with clinical characteristics and treatment outcomes. Survey study among the Dutch adult CNO cohort (n = 84/195 participated), including PAIN-detect for neuropathic pain, and the Central Sensitization Inventory (CSI), Fibromyalgia Rapid Screening Tool (FiRST), and ACTTION-APS Pain Taxonomy (AAPT) for nociplastic pain. Clinical characteristics and CNO-related bone pain scores were compared between patients with exclusive nociceptive pain and those with nociceptive pain plus neuropathic and/or nociplastic pain (mixed pain). 31% (95% CI 21–41) of patients classified as likely having neuropathic pain according to PAIN-detect. 53% (41–64) of patients displayed central sensitization on CSI, 61% (50–72) screened positive for fibromyalgia on FiRST and 14% (7–23) of patients fulfilled the AAPT criteria, all indicative of nociplastic pain. Mixed pain was associated with longer diagnostic delay (mean difference 2.8 years, 95% CI 0.4–5.2, p = 0.023), lower educational level (72% versus 20%, p < 0.001), and opioid use (37% versus 13%, p = 0.036). Despite comparable disease severity and extent, patients with mixed pain reported significantly higher CNO-related bone pain scores. This study demonstrates the high prevalence of mixed pain in adult CNO, in which neuropathic and nociplastic pain exist alongside nociceptive inflammatory bone pain. Disease burden in CNO may extend beyond inflammatory activity, highlighting the need for a multifaceted management approach.

慢性非细菌性骨炎（CNO）是一种罕见的肌肉骨骼疾病，会导致慢性骨痛。已知慢性肌肉骨骼疼痛可能涉及除伤害性疼痛之外的其他机制。我们调查了成人 CNO 中神经性疼痛和伤害性疼痛的患病率及其与临床特征和治疗结果的关系。对荷兰成人 CNO 队列（n  = 84/195 参与）的调查研究，包括神经性疼痛的 PAIN 检测、中枢敏化量表 (CSI)、纤维肌痛快速筛查工具 (FiRST) 和 ACTTION-APS 疼痛分类法 (AAPT) ）用于伤害性疼痛。对纯伤害性疼痛患者和伤害性疼痛加神经性疼痛和/或伤害性疼痛（混合疼痛）患者的临床特征和 CNO 相关骨痛评分进行比较。根据 PAIN 检测，31% (95% CI 21-41) 的患者被归类为可能患有神经性疼痛。 53% (41-64) 的患者在 CSI 上表现出中枢敏化，61% (50-72) 在 FiRST 上筛查出纤维肌痛呈阳性，14% (7-23) 的患者符合 AAPT 标准，所有这些都表明伤害性疼痛。混合性疼痛与较长的诊断延迟（平均差异 2.8 年，95% CI 0.4-5.2，p  = 0.023）、较低的教育水平（72% vs 20%，p  < 0.001）和阿片类药物使用（37% vs 13%）相关。 ，p  = 0.036）。尽管疾病严重程度和程度相当，但混合疼痛患者报告的 CNO 相关骨痛评分显着较高。这项研究表明，成人 CNO 中混合性疼痛的患病率很高，其中神经性疼痛和伤害性疼痛与伤害性炎性骨痛同时存在。 CNO 的疾病负担可能超出炎症活动范围，这凸显了多方面管理方法的必要性。