Central Sensitization in Patients with Chronic Musculoskeletal Pain

Abstract

Central sensitization is the mechanism of nociplastic pain and leads to an overemphasized response to a painful stimulus (hyperalgesia) or pain to stimuli that do not otherwise cause pain (allodynia). Persistent nociceptive pain is a risk factor for nociplastic pain, which can often occur in isolation or combination with other types of pain, most often in patients with chronic musculoskeletal pain (osteoarthritis, lumbar and cervical syndrome, fibromyalgia, rheumatoid arthritis, complex regional pain syndrome, tendinopathy, etc.). Diagnosis of central sensitization is established through clinical examination, questionnaires and quantitative sensory testing (QST), which serves to assess and quantify sensory functions, i.e., determine the threshold for detection of sensory stimuli (heat-cold, pressure, vibration). Conditioned Pain Modulation (CPM) testing is important for clarifying pain modulation profiles, which can be pro-nociceptive (less effective CPM facilitation) and anti-nociceptive (effective, inhibitory CPM effect). In the pronociceptive modulation profile that is common in patients with musculoskeletal disorders, there is a higher risk of developing chronic pain, a higher prevalence of pain conditions and higher pain associated with injury. CPM testing is also important in the individualization of drug therapy for pain, based on predicting the effectiveness of drugs in the treatment.

Keywords

• central sensitization
• conditional pain modulation
• musculoskeletal pain