Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain.
Jo Nijs,Rafael Torres-Cueco,C. Paul van Wilgen,Enrique Lluch Girbés,Filip Struyf,Nathalie Roussel,Nathalie Roussel,Jessica Van Oosterwijck,Jessica Van Oosterwijck,Liesbeth Daenen,Liesbeth Daenen,Kevin Kuppens,Kevin Kuppens,Luc Vanderweeën,Linda Hermans,David Beckwée,Lennard Voogt,Lennard Voogt,Jacqui Clark,Niamh Moloney,Niamh Moloney,Mira Meeus,Mira Meeus +22 more
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TLDR
Clinicians can use the proposed classification algorithm for differentiating neuropathic, nociceptive, and central sensitization pain for each individual patient with chronic pain.Abstract:
Background: The awareness is growing that central sensitization is of prime importance for the assessment and management of chronic pain, but its classification is challenging clinically since no gold standard method of assessment exists.
Objectives: Designing the first set of classification criteria for the classification of central sensitization pain.
Methods: A body of evidence from original research papers was used by 18 pain experts from 7 different countries to design the first classification criteria for central sensitization pain.
Results: It is proposed that the classification of central sensitization pain entails 2 major steps: the exclusion of neuropathic pain and the differential classification of nociceptive versus central sensitization pain. For the former, the International Association for the Study of Pain diagnostic criteria are available for diagnosing or excluding neuropathic pain. For the latter, clinicians are advised to screen their patients for 3 major classification criteria, and use them to complete the classification algorithm for each individual patient with chronic pain. The first and obligatory criterion entails disproportionate pain, implying that the severity of pain and related reported or perceived disability are disproportionate to the nature and extent of injury or pathology (i.e., tissue damage or structural impairments). The 2 remaining criteria are 1) the presence of diffuse pain distribution, allodynia, and hyperalgesia; and 2) hypersensitivity of senses unrelated to the musculoskeletal system (defined as a score of at least 40 on the Central Sensitization Inventory).
Limitations: Although based on direct and indirect research findings, the classification algorithm requires experimental testing in future studies.
Conclusion: Clinicians can use the proposed classification algorithm for differentiating neuropathic, nociceptive, and central sensitization pain.
Key words: Chronic pain, diagnosis, hypersensitivity, classification, neuropathic painread more
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Assessment and manifestation of central sensitisation across different chronic pain conditions.
Lars Arendt-Nielsen,Bart Morlion,Serge Perrot,Albert Dahan,Anthony H. Dickenson,Hans G. Kress,Chris Wells,Didier Bouhassira,A. Mohr Drewes +8 more
TL;DR: Some common fundamental central pain mechanisms are introduced and how they may translate into the clinical signs and symptoms across different chronic pain conditions, how to evaluate gain and loss of function using quantitative pain assessment tools, and the implications for optimising prevention and management of pain are discussed.
Journal ArticleDOI
Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain.
Jo Nijs,Adri Apeldoorn,H. J. M. Hallegraeff,Jacqui Clark,Rob J. E. M. Smeets,Anneleen Malfliet,Enrique Lluch Girbés,Enrique Lluch Girbés,Margot De Kooning,Margot De Kooning,Kelly Ickmans +10 more
TL;DR: The pain classification system for L BP should be an addition to available classification systems and diagnostic procedures for LBP, as it is focussed on pain mechanisms solely.
Journal ArticleDOI
Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory
TL;DR: The aim of this study was to create and validate severity levels for the central sensitization inventory (CSI), a valid and reliable patient‐reported outcome instrument designed to identify patients whose presenting symptoms may be related to a central sensitivity syndrome.
Journal ArticleDOI
Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education
TL;DR: The purpose of this article is to describe the use of the Pain – Somatic factors – Cognitive factors – Emotional factors – Behavioral factors – Social factors – Motivation – model (PSCEBSM-model) during the intake, as well as a pain analysis sheet.
Journal ArticleDOI
Brain-derived neurotrophic factor as a driving force behind neuroplasticity in neuropathic and central sensitization pain: a new therapeutic target?
TL;DR: This section focuses on combining pharmacotherapy with multimodal rehabilitation for balancing the deleterious and therapeutic effects of BNDF treatment in chronic pain patients, as well as accounting for the complex and biopsychosocial nature of chronic pain.
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