Recognition and Treatment of Central Sensitization in Chronic Pain Patients: Not Limited to Specialized Care (original) (raw)
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Pain, 2013
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Manual Therapy, 2010
Central sensitization plays an important role in the pathophysiology of numerous musculoskeletal pain disorders, yet it remains unclear how manual therapists can recognize this condition. Therefore, mechanism based clinical guidelines for the recognition of central sensitization in patients with musculoskeletal pain are provided. By using our current understanding of central sensitization during the clinical assessment of patients with musculoskeletal pain, manual therapists can apply the science of nociceptive and pain processing neurophysiology to the practice of manual therapy. The diagnosis/assessment of central sensitization in individual patients with musculoskeletal pain is not straightforward, however manual therapists can use information obtained from the medical diagnosis, combined with the medical history of the patient, as well as the clinical examination and the analysis of the treatment response in order to recognize central sensitization. The clinical examination used to recognize central sensitization entails the distinction between primary and secondary hyperalgesia.
Journal of Clinical Medicine
Recently, the International Association for the Study of Pain (IASP) released clinical criteria and a grading system for nociplastic pain affecting the musculoskeletal system. These criteria replaced the 2014 clinical criteria for predominant central sensitization (CS) pain and accounted for clinicians’ need to identify (early) and correctly classify patients having chronic pain according to the pain phenotype. Still, clinicians and researchers can become confused by the multitude of terms and the variety of clinical criteria available. Therefore, this paper aims at (1) providing an overview of what preceded the IASP criteria for nociplastic pain (‘the past’); (2) explaining the new IASP criteria for nociplastic pain in comparison with the 2014 clinical criteria for predominant CS pain (‘the present’); and (3) highlighting key areas for future implementation and research work in this area (‘the future’). It is explained that the 2021 IASP clinical criteria for nociplastic pain are i...
Pain Practice, 2021
Chronic musculoskeletal pain affects an estimated one in three individuals worldwide, and is the leading cause of global disability. 1 Currently, the majority of treatments for musculoskeletal pain provide small effects when viewed across a large number of individuals. 2 One reason for this may be related to differences in the underlying mechanisms perpetuating chronic pain, which would suggest that not all treatments will affect pain equally. The ability to distinguish patients by their specific pain mechanisms may allow for more targeted treatment approaches, 2-4 and thus reduce the global burden of pain. Several pain mechanism classification schemes have been proposed to improve upon the management of various musculoskeletal conditions. 5-7 Acceptable reliability and validity has been reported for classification schemes that divide patients with musculoskeletal pain into nociceptive, peripheral neuropathic, or central sensitization (CS) categories. 5,6,8 Although identification of CS in humans is not
Current Rheumatology Reports, 2010
Fibromyalgia syndrome (FM) is a highly prevalent musculoskeletal disorder that is often accompanied by somatic hyperalgesia (enhanced pain from noxious stimuli). Neural mechanisms of somatic hyperalgesia have been analyzed via quantitative sensory testing of FM patients. Results of these studies suggest that FM pain is associated with widespread primary and secondary cutaneous hyperalgesia, which are dynamically maintained by tonic impulse input from deep tissues and likely by brain-to-spinal cord facilitation. Enhanced somatic pains are accompanied by mechanical hyperalgesia and allodynia in FM patients as compared with healthy controls. FM pain is likely to be at least partially maintained by peripheral impulse input from deep tissues. This conclusion is supported by results of several studies showing that injection of local anesthetics into painful muscles normalizes somatic hyperalgesia in FM patients.
Characteristics of Sensitization Associated With Chronic Pain Conditions
The Clinical Journal of Pain, 2013
Objectives: To describe and understand varieties and characteristics of sensitization contributing to hyperalgesia in participants with chronic pain conditions. Methods: Thermal stimulation was delivered to the face, forearm, and calf of pain-free participants and individuals with irritable bowel syndrome, temporomandibular pain disorder (TMD), and fibromyalgia syndrome (FM). Three-second contacts by a preheated thermode occurred at 30-second intervals in ascending and then in descending series (0.71C steps).