“Many chronic pain patients, including those with persisting neck pain (1-4), pelvic pain (5,6), low back pain (7-9), fibromyalgia (8,10,11), subacromial impingement syndrome (12), chronic fatigue syndrome (13), tension-type headache (14), migraine (15), osteoarthritis (8,16,17), rheumatoid arthritis (18), tennis elbow (19,20), nonspecific arm pain (21), and patella tendinopathy (22) show features suggestive of central sensitization (CS), a process characterized by generalized hypersensitivity of the somatosensory system (23-25). According to Woolf (26), CS is “operationally defined as an amplification of neural signaling within the central nervous system that elicits pain hypersensitivity.” These studies provide evidence supporting the presence of CS in patients with chronic pain through observational brain imaging studies, psychophysical testing with various stimuli, and cerebral metabolism studies (5,7,8,12-16,19,20,27). CS reflects increased activity of pain facilitation pathways (11,27) and malfunctioning of descending pain inhibitory pathways which result in dysfunctional endogenous analgesic control (13). In addition, the pain neuromatrix is likely to be overactive in patients with CS: Increased activity is present in brain areas known to be involved in acute pain sensations and emotional representations like the insula, anterior cingulate cortex, and the prefrontal cortex, but not in the primary or secondary somatosensory cortex (28).” Ref.: Pain Physician. 2014 Sep-Oct;17(5):447-57.Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain.Nijs J1, Torres-Cueco R, van Wilgen CP, Girbes EL, Struyf F, Roussel N, van Oosterwijck J, Daenen L, Kuppens K, Vanwerweeen L, Hermans L, Beckwee D, Voogt L, Clark J, Moloney N, Meeus M.
Posted on: Sun, 07 Dec 2014 15:02:48 +0000
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