Title:Central Sensitization and Pain: Pathophysiologic and Clinical Insights
Volume: 22
Issue: 1
Author(s): Michele Curatolo*
Affiliation:
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
- The University of Washington Clinical Learning, Evidence and Research (CLEAR), University of Washington, WAI, USA
- Center for
Sensory-Motor Interaction, University of Aalborg, Aalborg, Denmark
- Center for Musculoskeletal Disorders, Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
Keywords:
Pain, central sensitization, pain mechanisms, pain therapy, diagnosis, translational research.
Abstract:
Central sensitization is an increased responsiveness of nociceptive neurons in the central
nervous system to their normal or subthreshold afferent input.
Aim: To explain how the notion of central sensitization has changed our understanding of pain conditions,
discuss how this knowledge can be used to improve the management of pain, and highlight
knowledge gaps that future research needs to address.
Methods: Overview of definitions, assessment methods, and clinical implications.
Results: Human pain models, and functional and molecular imaging have provided converging evidence
that central sensitization occurs and is clinically relevant. Measures to assess central sensitization
in patients are available; however, their ability to discriminate sensitization of central from peripheral
neurons is unclear. Treatments that attenuate central sensitization are available, but the limited
understanding of molecular and functional mechanisms hampers the development of target-specific
treatments. The origin of central sensitization in human pain conditions that are not associated with
tissue damage remains unclear.
Conclusion: The knowledge of central sensitization has revolutionized our neurobiological understanding
of pain. Despite the limitations of clinical assessment in identifying central sensitization, it is
appropriate to use the available tools to guide clinical decisions towards treatments that attenuate central
sensitization. Future research that elucidates the causes, molecular and functional mechanisms of
central sensitization would provide crucial progress towards the development of treatments that target
specific mechanisms of central sensitization.