Central sensitization is an ongoing process in which duration might affect its reversibility. A very long duration of chronic pain might result in structural and functional brain changes (Kregel et al. 2017) and approaching a point in the central sensitization process where reversibility will be very difficult. However, duration of chronic pain seems not the main case.
Recent studiesindicate that the stage in the chronic pain continuum seems a more appropriate factor to take into account than duration of pain (Hermans et al. 2017, Sluka & Clauw 2016). In addition, there is no consensus in the current literature regarding the relationship of (chronic) pain duration and neuroplastic changes (Kregel et al. 2017). Chronic pain can be seen as a continuum with on the one hand a purely peripherally driven painful condition and on the other hand a purely centrally driven painful condition.(Sluka & Clauw 2016) A long duration of chronic pain may result in long lasting structural and functional changes in the central sensitization process and hence a further point in this continuum, although this is no one-to-one correlation.
It is significantly important to stay away from the purely centrally driven point at this continuum. Moreover, patients with pain might go faster to this point as thought. The positive influence of pain education, cognitive behavioural therapy, and well-managed exercise therapy is already proven and effects of sleep and stress management are promising (Nijs et al. 2014, 2017ab, Meeus et al. 2012, Malfliet et al. submitted).Thus, no matter how long the patient is experiencing chronic pain, it is time to take action today!
Linda Hermans
PhD researcher and teaching assistant at Ghent University, Ghent, Belgium
2018 Pain in Motion
References and further reading:
Kregel J, Coppieters I, DePauw R, Malfliet A, Danneels L, Nijs J, Cagnie B, Meeus M. Does Conservative Treatment Change the Brain in Patients with Chronic Musculoskeletal Pain? A Systematic Review. Pain Physician. 2017 Mar;20(3):139-154.
https://www.ncbi.nlm.nih.gov/pubmed/28339428
Hermans L, Nijs J, Calders P, De Clerck L, Moorkens G, Hans G, Grosemans S, Roman De Mettelinge T, Tuynman J, Meeus M. Influence of morphine and naloxone on pain modulation in Rheumatoid Arthritis, Chronic Fatigue Syndrome/Fibromyalgia and controls: a double blind randomized placebo-controlled cross-over study. Pain Pract.2017 Jul 19.
https://www.ncbi.nlm.nih.gov/pubmed/28722815
Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 2016;338:114-129.
https://www.ncbi.nlm.nih.gov/pubmed/27291641
Meeus M, Nijs J, Hamers V, Ickmans K, Oosterwijck JV. The efficacy of patient education in whiplash associated disorders: a systematic review. Pain Physician. 2012;15:351-361.
https://www.ncbi.nlm.nih.gov/pubmed/22996847
Malfliet A, Kregel J, Coppieters I, De Pauw R, Meeus M, Roussel N, Cagnie B, Danneels L, Nijs J. Pain neuroscience education and cognition-targeted exercise therapy improves pain, disability and pain cognitions, but not brain morphology in people with chronic spinal pain: a multicentre, randomized controlled trial. Submitted
Nijs J, Clark J, Malfliet A, Ickmans K, Voogt L, Don S, den Bandt H, Goubert D, Kregel J, Coppieters I, Dankaerts W. In the spine or in the brain? Recent advances in pain neuroscience applied in the intervention for low back pain. Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 107(5):108-115.
https://www.ncbi.nlm.nih.gov/pubmed/28967357
Nijs J, Loggia ML, Polli A, Moens M, Huysmans E, Goudman L, Meeus M, Vanderweeën L, Ickmans K, Clauw D. Sleep disturbances and severe stress as glial activators: key targets for treating central sensitization in chronic pain patients?
Expert Opin Ther Targets. 2017 Aug;21(8):817-826.
https://www.ncbi.nlm.nih.gov/pubmed/28685641
Nijs J, Malfliet A, Ickmans K, Baert I, Meeus M. Treatment of central sensitization in patients with 'unexplained' chronic pain: an update. Expert Opin Pharmacother. 2014 Aug;15(12):1671-83.
