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


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
    • "In fact, fibromyalgia pain is consistently felt in deep tissues including ligaments, joints and muscles . Increasing evidence points towards these tissues as part of relevant contributors of nociceptive input that might either initiate or maintain central sensitization, or both [17] [34] [35] [39]. Indeed, nociceptive stimuli from painful foci in muscles are increasingly recognized as being relevant to the development of fibromyalgia [5] [39]. "
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    ABSTRACT: Muscle fatigue is prevalent in acute and chronic musculoskeletal pain conditions in which myofascial trigger points (MTPs) are involved. The aim of this study was to investigate the association of latent MTPs with muscle fatigue. Intramuscular electromyographic (EMG) recordings were obtained from latent MTPs and non-MTPs together with surface EMG recordings from the upper trapezius muscles during sustained isometric muscle contractions in 12 healthy subjects. Normalized root mean square (RMS) EMG amplitude and mean power frequency (MNF) were analyzed. The rate of perceived exertion and pain intensity from MTP side and non-MTP side were recorded. Pain intensity on the MTP side was significantly higher than the non-MTP side (P < 0.05). Intramuscular EMG from latent MTPs showed an early onset of decrease in MNF and a significant decrease at the end of fatiguing contraction as compared with non-MTPs (P < 0.05). Surface EMG from muscle fibers close to latent MTPs presented with an early onset of the increase in RMS amplitude and the increase was significantly higher than that from non-MTPs at the end of sustained isometric contraction (P < 0.05). A latent MTP is associated with an accelerated development of muscle fatigue and simultaneously overloading active motor units close to an MTP. Elimination of latent MTPs and inactivation of active MTPs may effectively reduce accelerated muscle fatigue and prevent overload spreading within a muscle.
    Pain Medicine 06/2012; 13(7):957-64. DOI:10.1111/j.1526-4637.2012.01416.x · 2.30 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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