Peripheral and central sensitization in musculoskeletal pain disorders: An experimental approach

Center for Sensory-Motor Interaction, Laboratory for Experimental Pain Research, Aalborg University, Fredrik Bajers Vej 7D-3, DK-9220 Aalborg E, Denmark.
Current Rheumatology Reports (Impact Factor: 2.87). 09/2002; 4(4):313-21. DOI: 10.1007/s11926-002-0040-y
Source: PubMed

ABSTRACT This report provides a brief introduction to the manifestations of peripheral and central sensitization involved in musculoskeletal pain disorders. It has become increasingly evident that muscle hyperalgesia, referred pain, referred hyperalgesia, and widespread hyperalgesia play an important role in chronic musculoskeletal pain. A better understanding of the involved basic mechanisms and better methods to assess muscle pain in the clinic may provide new possibilities for designing rational therapies and for targeting the pharmacologic intervention optimally. Peripheral sensitization plays an important role for increased sensitivity of deep tissue. However, central sensitization may be equally important but less addressed. Quantitative sensory testing provides the possibility to evaluate these manifestations in a standardized way in patients with musculoskeletal pain or in healthy volunteers (eg, experimentally induced referred pain can be used to assess the potential involvement of central sensitization in musculoskeletal pain conditions). Central sensitization may play a role in the persistence, amplification, and spread of pain. Interventions should take this aspect into consideration.

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    • "Central sensitization causing hyperalgesia may be a biological factor affecting the pain experience in children with JIA. We and others have found significantly reduced pain threshold and pain tolerance in children with arthritis compared with healthy schoolchildren [22,38-40], which supports the theory that chronic pain conditions may cause central sensitization [41,42]. The amount of pain experienced by a child with JIA may independently of the inflammatory disease be modulated by psychological and social factors as well [43,44]. "
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    ABSTRACT: Background Anti-TNF agents have proven efficacy in children with severe juvenile idiopathic arthritis (JIA) who are unresponsive to standard therapy. Therefore pain reduction or elimination could be expected. The aim of this study was to compare the pain experience in children with JIA treated with anti-TNF agents (n = 41) or non-biologic standard treatment (n = 50). Methods All children completed a 2-week pain diary and, for children treated with anti-TNF agents, measures of pain-coping and pain-specific beliefs. Parents rated the child’s level of functional disability. Clinical data were collected from the pediatric rheumatologists. Results No significant differences were found between the anti-TNF group and non-biologic standard treatment group for average pain score, number of children with daily pain reported in the pain diary, or level of functional disability. Significantly more children in the anti-TNF group reported no pain at all. Children undergoing standard treatment had significantly higher disease activity. Significant differences were found between the high pain patients treated with anti-TNF agents and the rest of the anti-TNF group in regards to their pain-specific beliefs of disability and harm, and the pain-coping strategy of catastrophizing. Conclusion These results indicate that a great proportion of children treated with anti-TNF agents respond well to the treatment in regards to disease activity and pain, but pain was still a problem for a subgroup of children though they were in remission with biological agents. More focus on pain management is needed.
    Pediatric Rheumatology 05/2013; 11(1):21. DOI:10.1186/1546-0096-11-21 · 1.61 Impact Factor
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    • "Cohen showed that angina induced by exertion results in pain referred to a prior blister injury of the right elbow or the right mammary region, or to the site of previous injury produced by hypertonic saline injection into muscles of the back [19]. Central sensitization may play a role in the persistence, amplification, and spread of pain [20]. So, any kinds of diseases that have central sensitization in common such as fibromyalgia syndrome, irritable bowel syndrome, chronic fatigue syndrome, migraine and tension-type headache can come out together [21]. "
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    ABSTRACT: Referred pain from visceral organs tends to be expressed on the specific area of body surface, called as Head's zone. Although it is well known that sympathetic referred pains of viscera appear on the body trunk, the fact that parasympathetic referred pains exist and are expressed on the head, sacrum and posterior thigh is not appreciated properly. Functional gastrointestinal diseases accompany frequently headache, and cyclic vomiting and recurrent abdominal pains in childhood progress to migraine later. Such clinical observations on relationship between headache and viscera suggest that longstanding disease processes of viscera could induce central sensitization of trigeminocervical nuclear complex, and express "parasympathetic referred pain" on the head, like sympathetic referred pain on the body trunk, that is headache.
    Medical Hypotheses 07/2009; 73(4):561-3. DOI:10.1016/j.mehy.2009.05.047 · 1.07 Impact Factor
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    • "The common transition pattern for various body regions found in our study, may be difficult to explain by variation of exposure. The mechanisms of sensitisation and disinhibition of pain shown to be important in chronic pain status [29-31] could contribute to spreading of pain but also to a common variation of pain from different regions[32,33]. "
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    ABSTRACT: The course of pain at a specific region such as the lower back has previously been shown as well as for generalized pain. However we have not found any report on the course of pain from various different specific regions. The aim of this investigation was to study the one-year transition of reported pain in different body locations. From a general population 14,555 men and women, 46-68 years, responded to an extensive health questionnaire including the standardized Nordic questionnaire. The population represented 27% of the total population within the age group in Malmö, Sweden. At the one year follow-up 12,607 responded to the questionnaire, yielding a response rate of 87%. The one year prevalence of long-lasting pain and the pattern of pain reporting from different regions were studied for men and women. The one-year prevalence of long-lasting neck pain was 14% (95% CI 13-15) among men and 25% (95% CI 24-26) among women at baseline and 15% (95% CI 14-16) for the men and 23% (95% CI 22-24) for the women at follow-up. Of those reporting neck pain "all the time" at baseline, 48% of the men and 54% of the women also reported neck pain "all the time" at the one-year follow-up. At the follow-up neck pain was reported as present "often" by 43% of the men and 47% of the women who reported neck pain "often" at baseline. Similar transition pattern were found for neck, shoulders, elbow/wrist/hand and lower back symptoms, as well as consistent prevalence rates. The one-year transition pattern of reported pain was similar in different body regions and among men and women. Furthermore the prevalence rates of long-lasting pain in the population were consistent at baseline and the follow-up. The findings of similar transition patterns support the interpretation of long-lasting pain as a generalized phenomenon rather than attributed to specific exposure. This may have implications for future pain research.
    BMC Musculoskeletal Disorders 02/2006; 7(1):17. DOI:10.1186/1471-2474-7-17 · 1.72 Impact Factor
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