Central sensitization pain : Where are we now and which options do we have for treatment?   January 1st, 2015

Conventional rehabilitation for people with chronic pain is often unsuccessful and frustrating for clinicians. What it is becoming clear more and more is that new therapeutic approaches are needed in view of current understanding of neural mechanisms underpinning chronic pain. In this regard, three papers aiming to summarize the role of central sensitization in chronic musculoskeletal pain and looking for guide clinicians in the rehabilitation of patients with chronic pain have been recently published. 

Firstly, Curatolo and Arendt-Nielsen have summarized in an interesting paper which are the methods available for detecting widespread central hypersensitivity (central sensitization) in humans. In addition, authors highlight the lack of construct validity for central sensitization due to lack of gold standards and encourage researchers to investigate about some aspects related to central sensitization, such as its prognostic value. 

On the other hand, in a perspective paper by Lotze and Moseley , recommendations are given in order to substitute conventional pain treatments for chronic pain by a truly biopsychosocial approach where clinicians, through the reconceptualization of the pain itself by explaining pain, provide the patient with the knowledge and the skills to manage by themselves pain and disability. 

Finally, Pelletier and colleagues present the available interventions clinicians have at their disposition to address neuroplastic changes of the central nervous system. Specifically, both top down and bottom up physical therapy interventions able to impact outcome measures of patients with chronic pain are presented, including novel approaches such as the use of transcranial direct current stimulation or repetitive transcranial magnetic stimulation. This manuscript could be a good complement for the paper about options for central sensitization treatment published by some members of the Pain in Motion research group last year.

Enrique Lluch