Treatment Options for Central Sensitization Pain in Clinical Practice   January 1st, 2014

In 2011, Pain in Motion published a paper explaining to clinicians the various options we have for treating the mechanisms involved in central sensitization. Back then we focussed on the various pharmacological options as well as electrotherapy (i.e. transcranial magnetic stimulation, direct current stimulation, transcutaneous electric nerve stimulation), manual therapy and stress management, as each of them target central pain processing mechanisms in animals that – theoretically – desensitize the central nervous system in humans. More recently, the journal Expert Opinion on Pharmacotherapy asked us to update the paper. In addition to updating the pharmacological treatment options, targeting metabolic (e.g. ketogenic diets), pain neuroscience education, cognitive behavioural therapy and exercise therapy are addressed. Of particular interest are the discussions regarding the eliminating of peripheral nociceptive input for the treatment of central sensitization pain, and the combined top-down and bottom-up approach for treating central sensitization pain. Here you can read the article highlights: 

  • Various pharmacological and conservative treatments, with established clinical effectiveness in a variety of central sensitization pain disorders, target mechanisms involved in central sensitization.
  • Acetaminophen, serotonin reuptake inhibitor drugs, selective and balanced serototin and norepinephrine reuptake inhibitor drugs, the serotonin precursor tryptophan, opioids, combined µ-opioid receptor agonist and noradrenaline reuptake inhibitor drugs, NMDA-receptor antagonists, and calcium channel a2d ligands each target central pain processing mechanisms in animals, that theoretically desensitize the central nervous system in humans.
  • Topically applied analgesic therapies have strong potential for (temporally) decreasing peripheral nociceptive input (bottom-up approach to central sensitization pain). 
  • Targeting metabolic factors, for instance by using low-carbohydrate or ketogenic diets, are promising new avenues for diminishing hyperexcitability of the central nervous system in central sensitization pain patients.
  • Cervical radiofrequency neurotomy for cervical facet joint pain, joint replacement surgery for osteoarthritis pain, and local therapy for myofascial pain are promising strategies for treating central sensitization by eliminating peripheral sources of nociceptive input.
  • Pain neuroscience education and cognitive behavioural therapy target cognitive and emotional sensitization. 
  • Exercise therapy addresses both cognitive emotional sensitization and aims at activating endogenous analgesia in patients with central sensitization pain. 

Further reading: 

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Jo Nijs