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Beyond Structural Pathology: Central Sensitization and Chronic Pain with Reference to Lumbar Disc Herniation-A
Igor Kordowski1, Maciej Chroboczek2
1Faculty of Physiotherapy, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland.
Brain Sciences
|July 28, 2026
Summary
Central sensitization (CS) transforms protective pain into a disorder, dissociating pain from tissue damage. Lumbar disk herniation (LDH) illustrates this, requiring multimodal assessment and mechanism-based rehabilitation for persistent pain management.
Area of Science:
- Neuroscience
- Pain Research
- Rehabilitation Medicine
Background:
- Chronic pain can transition from a protective signal to a maladaptive disorder.
- Central sensitization (CS) is a key mechanism involving heightened neural responsiveness and reduced pain inhibition.
- Lumbar disk herniation (LDH) serves as a model for the disconnect between imaging findings and clinical presentation.
Purpose of the Study:
- To review evidence on CS as a mechanism for persistent pain in LDH.
- To discuss implications for identifying sensitized phenotypes.
- To explore multimodal assessment and rehabilitation strategies for CS.
Main Methods:
- Narrative review synthesizing 77 sources (2006-2026).
- Focus on CS mechanisms in persistent pain.
- Utilized LDH as a clinical model for radiological-clinical mismatch.
Main Results:
- Sensitized phenotypes require multimodal assessment (e.g., Central Sensitization Inventory, quantitative sensory testing, conditioned pain modulation).
- Cognitive-emotional factors like kinesiophobia impact LDH outcomes.
- Mechanism-based interventions (PNE, graded exercise) and adjunctive therapies (DN, SNRIs, CBT) are effective.
Conclusions:
- A sensitization-informed approach integrates contemporary pain models with structural views in LDH care.
- Preoperative sensitization doesn't always predict poor surgical outcomes.
- Multimodal assessment and targeted rehabilitation are crucial for managing CS in persistent pain.
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