The International Association for the Study of Pain has classified pain into nociceptive pain, neuropathic pain, and nociplastic pain based on the cause of the pain. At present, nociplastic pain is pain that is not nociceptive pain and has the following characteristics: no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain. If there is tissue damage, disease or lesion, it is neuropathic pain; if there is none, it is nociplastic pain. In other words, the difference in diagnosis is whether or not tissue damage, disease, or lesion can be found at the current medical level (testing equipment). The treatment of nociplastic pain is almost the same as the treatment of neuropathic pain. Fibromyalgia is included in nociplastic pain. To my knowledge, of the nociplastic pain and neuropathic pain, fibromyalgia is the disease with the highest number of pharmacological and non-pharmacological treatments with evidence of efficacy. Effective treatments for fibromyalgia are often given to neuropathic pain. This expands treatment options. I presume that tissue damage, disease or lesion will be found in fibromyalgia through advances in the medical science by the time humans emigrate to Mars. The distinction between nociplastic pain and neuropathic pain complicates the diagnosis of chronic pain. However, the distinction does not improve the treatment outcomes. Medical science is the discipline to find a treatment method that can produce better outcomes. In the event of a medical controversy, the medical theory with better treatment outcomes should be adopted. It is desirable to combine nociplastic pain and neuropathic pain into one pain. This will simplify diagnosis and increase treatment options (improve treatment outcomes) in nociplastic pain and neuropathic pain.

In a guideline for the pharmacological treatment, the priority is usually based on the strength of the evidence of efficacy. This is academically correct, but not clinically appropriate. Adverse effects are as important as efficacy in clinical practice. There are guidelines for the pharmacological treatment that take adverse effects into account. However, most adverse effects considered are those obtained in double-blind studies of pharmacological treatment performed to prove efficacy. In the treatment guidelines of various diseases, too little effort is spent on pharmacological adverse effects compared to the effort spent on pharmacological efficacy. I would like to make recommendations in the guidelines for the pharmacological treatment of all diseases. The guidelines for the pharmacological treatment of various diseases should be developed with increased efforts to investigate adverse effects. Some guidelines for the pharmacological treatment use systematic reviews and meta-analyses to examine the efficacy of medicine, and similar methods should be used to examine the adverse effects of medicine. It is easy to prioritize medicines based on evidence of efficacy. However, it is not appropriate to prioritize medicines in clinical practice based solely on evidence of efficacy. Adverse effects should also be considered in priority ranking of medicine in clinical practice. In addition to efficacy and adverse effects, price and the degree of off-label prescribing also affect the priority ranking of medicine in clinical practice.

MUP (medically unexplained pain) is a pain whose cause cannot be determined by diagnostic imaging, blood test, physical examination and past medical history, etc. Many departments have independently created the concept, definition, and diagnostic criterion in MUP. This leads to an abnormal situation in which each department has different disease concepts and diagnostic criteria. It is out-of-the-ordinary that physicians from the different departments make different diagnoses in the same patient. MUP has caused confusion in clinical practice. The medical community should make the unified disease concept, definition, and diagnostic criterion of MUP. For this purpose, the various scientific organizations involved in MUP need to discuss. In this case, the first priority should not be the majority vote, but the treatment outcomes. The solution to a medical controversy is to choose a medical theory or treatment method that produces better long-term results.