Central sensitization in musculoskeletal pain: lost in translation?

Key Points

1. Central sensitization is a normally occurring neurophysiological mechanism.

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BACKGROUND & OBJECTIVE

Musculoskeletal pain remains a global problem despite decades of research. In order to more effectively treat this global problem, it is imperative that clinicians continue to update their understanding of pain. This is a slow process, and the integration of the physiology presented in this paper is yet to be fully implemented in clinical practice.

There was a call to shift to a biopsychosocial approach in the 1990s. A part of that shift is recognizing that pain has influences from both peripheral input and central mechanisms. This is widely referred to as a “top down and bottom-up approach” where both are included in the assessment of pain. A key component of this is central sensitization, first described four decades ago and still not well defined for clinical application.

This viewpoint paper set out to define and discuss the clinical application of central sensitization in the treatment of musculoskeletal pain.

It is imperative that clinicians continue to update their understanding of pain.

We need to keep an eye on the evolving understanding of pain and not get so far down any one clinical pathway that we do not see the need to update.

METHODS

The authors provided a timely review of what is known about central sensitization including concise tables of the physiologic changes that occur during prolonged nociceptive stimulation and the options for quantitative sensory testing (see Table 1).

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