Central sensitisation: another label or useful diagnosis?

Nijs, Jo; Polli, Andrea; Willaert, Ward; Malfliet, Anneleen; Huysmans, Eva; Coppieters, Iris

doi:10.1136/dtb.2018.000035

Cited by 21 publications

(23 citation statements)

References 49 publications

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“…A direction for future research is to compare scores on the L-VISS and VDS in people with chronic pain (regardless of diagnosis) to metrics that are thought to reflect central sensitization (e.g., from Quantitative Sensory Testing, questionnaires, or functional magnetic resonance imaging; den Boer et al., 2019). Nevertheless, our results comparing groups of patients with different conditions are in line with previous studies in which it was stated that deep somatic or visceral chronic conditions have the most profound effect on the development of central sensitization, which is less the case for other chronic pain conditions (Arendt-Nielsen et al., 2018; Nijs et al., 2019).…”

Section: Discussionsupporting

confidence: 92%

“…The regression analyses showed positive relationships between visual discomfort and having received a diagnosis of CRPS, fibromyalgia, irritable bowel syndrome/inflammatory bowel disease, or migraine, whereas no such relationships were seen with the diagnoses of osteoarthritis and back pain. Although this was a secondary analysis and not hypothesis-driven, it is notable that the pain conditions that showed a positive relationship with visual discomfort are those in which central sensitization plays the largest role (i.e., CRPS, fibromyalgia, irritable bowel syndrome/inflammatory bowel disease, and migraine; e.g., Adams & Turk, 2015; Littlejohn & Guymer, 2019; Moshiree, 2006; Nijs et al., 2019; Verne & Price, 2002; Yunus, 2008). However, there is also evidence of central sensitization in subgroups of people with osteoarthritis and chronic lower back pain, and chronic pain in general (e.g., Arendt-Nielsen et al., 2018; Nijs et al., 2017; O’Neill & Felson, 2018).…”

Section: Discussionmentioning

confidence: 99%

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Validation of the Leiden Visual Sensitivity Scale and Visual Discomfort Scale in Chronic Pain Conditions

2021

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Discomfort provoked by normally innocuous visual stimuli has been reported by people with chronic pain. Visual discomfort may be higher in pain conditions in which central sensitization is implicated, such as Complex Regional Pain Syndrome (CRPS) and fibromyalgia. In an online study, we validated the Leiden Visual Sensitivity Scale (L-VISS) and Visual Discomfort Scale (VDS) in people with CRPS ( n = 57), fibromyalgia ( n = 75), and general chronic pain ( n = 53); investigated whether these groups and pain-free controls ( n = 125) differed in visual discomfort; and evaluated the effect of age. The L-VISS and VDS had good internal consistency. Both scales were positively related with experimentally induced visual distortions for mid-spatial frequency striped patterns, suggesting good construct validity. The scales were positively related with each other, and dissociated between the pain and pain-free groups in similar ways, suggesting good construct validity. There was no relationship between age and L-VISS scores and a small negative relationship between age and VDS scores. Visual discomfort was highest in the fibromyalgia group, followed by the CRPS group. This research confirms the utility of the L-VISS and VDS for measuring visual sensitivity in chronic pain and adds to evidence that central sensitization is an important mechanism of visual discomfort.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Validation of the Leiden Visual Sensitivity Scale and Visual Discomfort Scale in Chronic Pain Conditions

2021

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“…It is worth highlighting that small effect sizes were obtained in the group of subjects who received the usual physiotherapy treatment. However, as other studies have shown, the existence of CS predicts poor outcomes obtained with classic local treatments, such as electrotherapy, motor control exercises, and surgery [107,108]. Sometimes PE can increase symptoms because descending inhibitory systems are not working properly [83], and some authors even point out that exercise can induce hyperalgesia if psychosocial factors such as fear of pain, catastrophism, and erroneous beliefs are not previously addressed, and this was not done in the CG [109].…”

Section: Discussionmentioning

confidence: 99%

Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial

Galán-Martín

Montero-Cuadrado²,

Lluch-Girbés

et al. 2020

JCM

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Chronic musculoskeletal pain affects more than 20% of the population, leading to high health care overload and huge spending. The prevalence is increasing and negatively affects both physical and mental health, being one of the leading causes of disability. The most common location is the spine. Most treatments used in the Public Health Services are passive (pharmacological and invasive) and do not comply with current clinical guidelines, which recommend treating pain in primary care (PC) with education and exercise as the first-line treatments. A randomized multicentre clinical trial has been carried out in 12 PC centres. The experimental group (EG) conducted a program of pain neuroscience education (6 sessions, 10 h) and group physical exercise with playful, dual-tasking, and socialization-promoting components (18 sessions in 6 weeks, 18 h), and the control group performed the usual physiotherapy care performed in PC. The experimental treatment improved quality of life (d = 1.8 in physical component summary), catastrophism (d = 1.7), kinesiophobia (d = 1.8), central sensitization (d = 1.4), disability (d = 1.4), pain intensity (d = 3.3), and pressure pain thresholds (d = 2). Differences between the groups (p < 0.001) were clinically relevant in favour of the EG. Improvements post-intervention (week 11) were maintained at six months. The experimental treatment generates high levels of satisfaction.

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“…49 Other authors [50][51][52] have recently introduced the label "pathological pain" for referring to pain lasting longer than 3 months clinically and characterized by spontaneous pain, hyperalgesia and allodynia, or "mysterious central pains" for referring to pain states (eg, fibromyalgia, noncardiac chest pain) that are not associated with a neurological deficit but still presumed to be due to central nervous system dysfunction. 37 Nijs et al 53 raised also the question on the usefulness of the term "central sensitization" as a label for a subgroup of patients with severe and spreading pain. In our opinion, they might represent interesting attempts of redefinition, drive by the poor explanatory capacity and pitfalls of the term "chronic pain" for lasting pain without actual known causes.…”

Section: The Importance To Give a Name (A Meaningful One)mentioning

confidence: 99%

Chronic Pain: What Does It Mean? A Review on the Use of the Term Chronic Pain in Clinical Practice

Raffaeli¹,

Tenti²,

Corraro³

et al. 2021

JPR

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Chronic pain is nowadays used as an umbrella term referring to a wide range of clinical conditions, such as fibromyalgia, migraine, or long-standing pain states without actual known causes. However, labeling a patient's clinical condition with the term "chronic pain", when dealing with pain lasting longer than 3 months, might be misleading. This paper aims at analyzing the possible pitfalls related to the use of the term "chronic pain" in the clinical field. It appears, indeed, that the term "chronic pain" shows a semantic inaccuracy on the basis of emerging scientific evidences on the pathogenesis of different long-standing pain states. The major pitfalls in using this label emerge in clinical settings, especially with patients having a biomedical perspective on pain or from different cultures, or with healthcare providers of other medical specialties or different disciplines. A label solely emphasizing temporal features does not help to discern the multifaceted complexity of long-standing pain states, whose onset, maintenance and exacerbation are influenced by a complex and interdependent set of bio-psycho-social factors. Thus, finding a more meaningful name might be important. We call upon the necessity of bringing awareness and implementing educational activities for healthcare providers, as well as for the public, on the biopsychosocial approach to assess, prevent and care of chronic pain. Further research on the etiopathogenetic processes of chronic pain states is also required, together with examinative diagnostic methods, to individuate the most appropriate label(s) representing the complex longstanding pain states and to avoid adopting the term "chronic pain" inappropriately.

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Central sensitisation: another label or useful diagnosis?

Cited by 21 publications

References 49 publications

Validation of the Leiden Visual Sensitivity Scale and Visual Discomfort Scale in Chronic Pain Conditions

Validation of the Leiden Visual Sensitivity Scale and Visual Discomfort Scale in Chronic Pain Conditions

Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial

Chronic Pain: What Does It Mean? A Review on the Use of the Term Chronic Pain in Clinical Practice

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