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Central sensitisation: another label or useful diagnosis?
  1. Jo Nijs12,
  2. Andrea Polli13,
  3. Ward Willaert14,
  4. Anneleen Malfliet1234,
  5. Eva Huysmans1235,
  6. Iris Coppieters124
  1. 1Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
  2. 2Chronic pain rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
  3. 3Research Foundation – Flanders (FWO), Brussels, Belgium
  4. 4Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Belgium
  5. 5Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
  1. Correspondence to Jo Nijs; Jo.Nijs{at}vub.be

https://doi.org/10.1136/dtb.2018.000035

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    Key learning points

    • Chronic pain is a significant problem not only in the number of people affected but also in terms of health-related costs.

    • Central sensitisation, a proposed physiological phenomenon is characterised by widespread hypersensitivity resulting from an augmented response of central neurons to receptor activity, is present in many patients with chronic pain.

    • Central sensitisation can be recognised by screening for disproportionate pain, assessing the distribution of pain through patient pain drawing and using the Central Sensitisation Inventory questionnaire.

    • If central sensitisation is present, it predicts poor outcome following classical local treatments such as electrotherapy, motor control exercises and surgery.

    • Treatment of patients in whom central sensitisation is present should address the (lifestyle) factors that sustain the process of central sensitisation, including illness beliefs, stress, sleep, physical activity and diet.

    Background

    Chronic pain affects up to 30% of the Western population with a prevalence higher than any other chronic disease.1 Chronic pain is often of a non-specific nature, implying that there is no tissue damage, or that tissue damage is not severe enough to explain the pain experience and/or related symptoms. This non-specific nature accounts for non-cancer pain as well as post-cancer pain (ie, pain in cancer survivors). Chronic pain has a significant personal and socioeconomic impact: among long-term conditions, it is responsible for the highest number of years lived with disability and is the most expensive cause of work-related disability.2–4 Chronic pain also decreases life expectancy, in part due to excess deaths from cancer and cardiovascular disease.5–7

    Over the past decades, neuroscience has advanced our understanding about pain, including the role of CNS sensitisation—more briefly termed central sensitisation (CS). The original definition for CS—‘an amplification of neural signaling within the CNS that elicits pain hypersensitivity’—originated from laboratory research, but nowadays the chronic pain management field has more or less …

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