Central Sensitization

Authors
Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Central sensitization referes to increase in the excitability and responsiveness of neurons in the spinal cord. Central sensitization may explain the persistence of pain beyond the removal or resolution of the initiating stimulus1

Clinical Indicators

Subjective

  • Disproportionate, non-mechanical, unpredictable pattern of pain provocation in response to multiple/non-specific aggravating/easing factors2.
  • Pain persisting beyond expected tissue healing/pathology recovery times2.
  • Pain disproportionate to the nature and extent of injury or pathology2.
  • Widespread, non-anatomical distribution of pain2.
  • History of failed interventions (medical/surgical/therapeutic)2.
  • Strong association with maladaptive psychosocial factors (e.g. negative emotions, poor selfefficacy, maladaptive beliefs and pain behaviours, altered family/work/social life, medical conflict)2.
  • Unresponsive to NSAIDS and/or more responsive to anti-epileptic (e.g. Lyrica) /antidepressant (e.g. Amitriptyline) medication2.
  • Reports of spontaneous (i.e. stimulus-independent) pain and/or paroxysmal pain (i.e. sudden recurrences and intensification of pain)2.
  • Pain in association with high levels of functional disability2.
  • More constant/unremitting pain2.
  • Night pain/disturbed sleep2.
  • Pain in association with other dysesthesias (e.g. burning, coldness, crawling)2.
  • Pain of high severity and irritability (i.e. easily provoked, taking a long time to settle)2

Examination

  • Disproportionate, inconsistent, non-mechanical/non-anatomical pattern of pain provocation in response to movement/mechanical testing2.
  • Positive findings of hyperalgesia (primary, secondary) and/or allodynia and/or hyperpathia within the distribution of pain2.
  • Diffuse/non-anatomic areas of pain/tenderness on palpation2.
  • Positive identification of various psychosocial factors (e.g. catastrophisation, fear-avoidance behaviour, distress)2.

References

1.
Ballantyne J, Fishman S, Rathmell JP, eds. Bonica’s Management of Pain. 5th ed. Wolters Kluwer; 2019.
2.
Smart KM, Blake C, Staines A, Thacker M, Doody C. Mechanisms-based classifications of musculoskeletal pain: Part 1 of 3: Symptoms and signs of central sensitisation in patients with low back (leg) pain. Manual Therapy. 2012;17(4):336-344. doi:10.1016/j.math.2012.03.013

Citation

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