Affiliation:
1. Pain in Motion Research Group, Departments of Human Physiology and Physiotherapy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
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 pain
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
113 articles.
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