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Central Sensitization in Musculoskeletal Pain: Lost in Translation?
The Journal of Orthopaedic and Sports Physical Therapy
|November 2, 2020
Summary
Central sensitization, a key pain mechanism, is challenging to diagnose directly in humans. Physical therapists should consider its top-down and bottom-up influences within a biopsychosocial framework.
Area of Science:
- Neuroscience
- Pain Science
- Physical Therapy
Background:
- Central sensitization involves heightened pain responses.
- Direct clinical diagnosis of central sensitization in humans is currently not possible.
- Increasing clinical attention risks blurring important distinctions regarding central sensitization.
Purpose of the Study:
- To summarize current knowledge on central sensitization physiology and clinical manifestations.
- To inform the debate on the relevance of central sensitization for physical therapists.
- To address challenges in applying central sensitization concepts in clinical practice.
Main Methods:
- Literature review and synthesis of current knowledge.
- Identification of clinical manifestations suggestive of central sensitization.
- Analysis of challenges in clinical application.
- Formulation of recommendations for assessment, treatment, and terminology.
Main Results:
- Central sensitization is a physiological mechanism impacting pain sensitivity.
- While not directly measurable, suggestive signs and symptoms exist.
- Six key challenges in clinical application were identified.
- Suggestions for assessment, treatment, and terminology were proposed.
Conclusions:
- Physical therapists must be aware of central sensitization.
- Consideration of both top-down and bottom-up drivers is crucial.
- A person-centered, biopsychosocial approach is recommended for managing central sensitization.
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