Original Editor - Nathan Benson as part of the PPA Pain Project. Show
Top Contributors - Alberto Bertaggia, Nathan Benson, Laura Ritchie, Jo Etherton, Shaimaa Eldib, Uchechukwu Chukwuemeka, Jess Bell, Lucinda hampton, Kim Jackson, Admin, Michelle Lee, WikiSysop, Claire Knott and Evan Thomas Central Sensitisation[edit | edit source]Nociception is described by IASP as the neural process of encoding noxious stimuli. Central sensitisation is defined as an increased responsiveness of nociceptors in the central nervous system to either normal or sub-threshold afferent input[1] resulting in:
The image at right is of an action potential formation. Watch the 2 minute video below on central sensitisation The International Association for the Study of Pain (IASP) describes central sensitization as
The effect of this process is:
[Nerve synapse pictured at the right is a Neuromuscular junction (closer view): 1.presynaptic terminal; 2.sarcolemma; 3.synaptic vesicles; 4.Acetylcholine receptors; 5.mitchondrion} The use of the term "central sensitisation" varies referring
A discussion about the various descriptions and definitions can be found on the Body in MInd website. Activity Dependent Central sensitisation[edit | edit source]Latremoliere and Woolf describe the changes demonstrated in their group's 1983 study as "activity dependent central sensitisation".
Activation of the NMDA receptor is an essential step in initiating and maintaining the sensitisation (N-Methyl-D-Aspartate is a glutamate receptor. Glutamate is a widespread excitatory neurotransmitter in the nervous system).
Central vs Peripheral Sensitisation[edit | edit source]While descriptively central sensitisation and Peripheral sensitisation may appear to be comparable processes, they represent quite distinct and processes and clinical features[2]. 1.Peripheral sensitisation is described by the IASP as
2. Central sensitisation
Features of Central Sensitization[edit | edit source]A survey of expert clinicians in a Delphi-derived survey found the following characteristics to describe central sensitisation in the clinical setting [18]. Subjective features[edit | edit source]
Clinical features[edit | edit source]
Identification in the Clinical Setting[edit | edit source]In 2009 Schäfer et al.[19] proposed a classification of
low back-related leg pain using an examination protocol which incorporates first the subjective assessment, including the Leeds Assessment of Neuropathic Symptoms and Sign (LANSS) scale [20], and second the physical examination (neurological examination, assessment
of active movements, neural tissue provocation tests). Based on this comprehensive assessment, a LANSS score ≥ 12 is indicative of central sensitisation in their classification algorithm. In 2010 Nijs et al.[21] provided guidelines to aid the recognition of central sensitisation on musculoskeletal patients. In their paper, they suggest that a patient's medical diagnosis can offer insight into the likelihood of the presence of central sensitisation (fig 1) and this in conjunction with observable features (fig 2) can inform the therapist as to the presence of central sensitisation. fig 1. Table of Medical diagnoses likely to suggest presence of central sensitsation reproduced from Nijs et al[21].
In 2012 Mayer et al.[22] proposed the Central Sensitisation Inventory (CSI). The clinical goal of this screening instrument is to help better assess symptoms thought to be associated with CS in order to aid physicians and other clinicians in syndrome categorzsation, sensitivity, severity identification, and
treatment planning, to help minimize, or possibly avoid, unnecessary diagnostics and treatment procedures. CSI has showed good psychometric strength, the clinical utility, and the initial construct validity. Management of Central Sensitisation[edit | edit source]Central sensitisation is characterized by
the absence of peripheral sources of nociceptive input, therefore it seems more appropriate to use a treatment with a top-down mechanism, activating descending nociceptive processing together with decreasing descending nociceptive facilitation[23]. In the video below, Prof Peter O'Sullivan discusses some of the myths about back pain which are widely held and negatively impact on the perception and treatment of back pain.
Non-Pharmacological Approaches[edit | edit source]1.Patient Education In cases of central sensitisation it is important to:
This can be accomplished with pain physiology education, which is indicated when:
Face-to-face sessions of pain physiology education, in conjunction with written educational material, are effective for changing pain cognitions and improving health status in patients with various chronic musculoskeletal pain disorders (i.e. chronic low back pain, chronic whiplash, fibromyalgia and chronic fatigue syndrome)[25]. Check out the following video from Lorimer Moseley to see his approach to educating patients about managing pain.[26] [27] 2. Manual Therapy Usually Manual Therapy is used for its peripheral effects, however it also produces central analgesic effects[28][29][30] activating descending anti-nociceptive pathways for a short period of time (30 - 35 mins.)[31][32]. This limits its clinical use in the management of central sensitisation.
3.Transcranial magnetic stimulation Repetitive transcranial magnetic stimulation is more effective in suppressing centrally than peripherally originated pain states[33]. It provides short-term analgesic effects by stimulating the motor cortex or dorsolateral prefrontal cortex in various type of chronic pain patients[33][34][35]. However, the precise mechanism of action is still not clear, and the clinical utility of the technique is limited by practical obstacles (too short analgesic effects, availability of the equipment limited to few specialized centers)[23]. Pharmacological Approaches[edit | edit source]A variety of pharmacological treatments have been trialed in patients with neuropathic pain,including conditions that are known to involve central sensitisation. However, some of these treatments are still under investigation and are not in widespread clinical use.
Often used drugs to treat central sensitisation
include[23]:
Resources[edit | edit source]
References[edit | edit source]
Which kinds of pain would be considered maladaptive physiologically?Maladaptive pain encompasses numerous types of pain, including peripheral and central neuropathic pain, fibromyalgia, irritable bowel syndrome, interstitial cystitis and inherited pain disorders such as paroxysmal extreme pain disorder.
Which of the following is a physiologic response to pain?Physiological signs of pain may include: dilatation of the pupils and/or wide opening of the eyelids. changes in blood pressure and heart rate. increased respiration rate and/or depth.
Which condition is a heightened response that occurs after exposure to a noxious stimulus?Hyperalgesia. Hyperalgesia is an increased painful sensation in response to additional noxious stimuli.
How do you deal with severe chronic pain?Tips on coping with chronic pain. Manage your stress. Emotional and physical pain are closely related, and persistent pain can lead to increased levels of stress. ... . Talk to yourself constructively. Positive thinking is a powerful tool. ... . Become active and engaged. ... . Find support. ... . Consult a professional.. |