Open AccessApplying Modern Pain Neuroscience in Clinical Practice: Criteria for the Classification of Central Sensitization Pain
Author(s) -
Jo Nijs
Publication year - 2014
Publication title -
pain physician
Language(s) - English
Resource type - Journals
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2014/17/447
Subject(s) - medicine , central sensitization , hyperalgesia , neuropathic pain , allodynia , sensitization , chronic pain , gold standard (test) , nociception , quantitative sensory testing , referred pain , physical therapy , physical medicine and rehabilitation , anesthesia , neuroscience , psychology , sensory system , receptor , immunology
Background: The awareness is growing that central sensitization is of primeimportance for the assessment and management of chronic pain, but its classificationis challenging clinically since no gold standard method of assessment exists.Objectives: Designing the first set of classification criteria for the classification ofcentral sensitization pain.Methods: A body of evidence from original research papers was used by 18 painexperts from 7 different countries to design the first classification criteria for centralsensitization pain.Results: It is proposed that the classification of central sensitization pain entails 2 majorsteps: the exclusion of neuropathic pain and the differential classification of nociceptiveversus central sensitization pain. For the former, the International Association for theStudy of Pain diagnostic criteria are available for diagnosing or excluding neuropathicpain. For the latter, clinicians are advised to screen their patients for 3 major classificationcriteria, and use them to complete the classification algorithm for each individualpatient with chronic pain. The first and obligatory criterion entails disproportionatepain, implying that the severity of pain and related reported or perceived disability aredisproportionate to the nature and extent of injury or pathology (i.e., tissue damageor structural impairments). The 2 remaining criteria are 1) the presence of diffuse paindistribution, allodynia, and hyperalgesia; and 2) hypersensitivity of senses unrelated tothe musculoskeletal system (defined as a score of at least 40 on the Central SensitizationInventory).Limitations: Although based on direct and indirect research findings, the classificationalgorithm requires experimental testing in future studies.Conclusion: Clinicians can use the proposed classification algorithm for differentiatingneuropathic, nociceptive, and central sensitization pain.Key words: Chronic pain, diagnosis, hypersensitivity, classification, neuropathic pain