Nociplastic pain criteria or recognition of central sensitization? Pain phenotyping in the past, present and future

Review written by Dr Sandy Hilton info

Key Points

  1. The criteria for describing central sensitization emerged in 2010.
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BACKGROUND & OBJECTIVE

Pain remains one of the largest global burdens in time lost from work, dollars spent on treatment, and years lived with disability. To clarify the nature of pain and how to best treat pain, the scientific and clinical communities have used a variety of definitions. The definitions have not always been clear or consistent.

The global pain community dedicated to studying pain and how to treat it is the International Association for the Study of Pain (IASP). The IASP release new criteria for definitions and categorization of pain. The authors of this paper presented a view of the past, present, and future for defining pain states and causes, to better understand and treat the global burden of pain.

This paper is described around the concept of central sensitization, to explain how pain persists in a person after the period of normal healing, or in the absence of an injury. Despite varying definitions over time, the concept of central sensitization is used to describe increased responsiveness of nociceptive neurons in the central nervous system (1).

The authors suggest that IASPs addition of nociplastic pain in 2017 addresses signs of sensitization, despite not using the term central sensitization (2). This paper provided an overview of how the terms flow together.

The concept of central sensitization is used to describe increased responsiveness of nociceptive neurons in the central nervous system.
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Relying on phenotype does not remove the need to address sleep, diet, exercise, pain control, and graded exposure to normal activities to meet the patient’s goals and needs.

PAST

Central sensitization as a part of persistent pain was seen in 2010 with work by Keith Smart (3). This began a differentiation in the clinic between central sensitization, nociceptive pain, and neuropathic pain. The literature was dominated by clinical experience

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