CENTRAL SENSITIZATION IN CHRONIC PAIN: NEUROPHYSIOLOGICAL MECHANISMS AND CLINICAL IMPLICATIONS

Keywords: Central Sensitization, Chronic Pain, Neuroplasticity, Diagnosis, Clinical Implications

Abstract

The definition of central sensitization encompasses enhanced processing and transmission of neural impulses within the central nervous system, ultimately leading to increased pain sensitivity. It is a key mechanism contributing to the development of chronic pain. This phenomenon is of great clinical relevance and plays a role in such conditions as migraine, chronic low back pain, fibromyalgia, and irritable bowel syndrome. The main aim of this review is to present the mechanisms underlying central sensitization, diagnostic methods, and potential therapeutic interventions in patients with chronic pain. Diagnostic tools that allow for the identification of patients with sensitization-related pain, as well as key neurophysiological mechanisms necessary for maintaining central sensitization, are also discussed. Future research should focus on developing therapeutic protocols targeting CS, identifying sensitization biomarkers, and improving diagnostic precision.

References

Cohen, S. P., Vase, L., & Hooten, W. M. (2021). Chronic pain: An update on burden, best practices, and new advances. The Lancet, 397(10289), 2082–2097. https://doi.org/10.1016/S0140-6736(21)00393-7

Scholz, J., Finnerup, N. B., Attal, N., Aziz, Q., Baron, R., Bennett, M. I., ... & Treede, R. D. (2019). The IASP classification of chronic pain for ICD-11. Pain, 160(1), 19–27. https://doi.org/10.1097/j.pain.0000000000001367

Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2–S15. https://doi.org/10.1016/j.pain.2010.09.030

Nijs, J., George, S. Z., Clauw, D. J., Skou, S. T., & Lluch Girbés, E. (2021). Central sensitisation in chronic pain conditions: Latest discoveries and their potential for precision medicine. The Lancet Rheumatology, 3(11), e834–e845. https://doi.org/10.1016/S2665-9913(21)00203-0

Latremoliere, A., & Woolf, C. J. (2009). Central sensitization: A generator of pain hypersensitivity by central neural plasticity. The Journal of Pain, 10(9), 895–926. https://doi.org/10.1016/j.jpain.2009.06.012

Yarnitsky, D., Granot, M., Nahman-Averbuch, H., Khamaisi, M., & Granovsky, Y. (2019). Conditioned pain modulation predicts duloxetine efficacy in painful diabetic neuropathy. Pain, 160(3), 570–575. https://doi.org/10.1097/j.pain.0000000000001428

Clauw, D. J. (2015). Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism. Best Practice & Research Clinical Rheumatology, 29(1), 6–19. https://doi.org/10.1016/j.berh.2015.04.024

Ji, R. R., Nackley, A., Huh, Y., Terrando, N., & Maixner, W. (2018). Neuroinflammation and central sensitization in chronic pain. Nature Reviews Neuroscience, 19(11), 655–673. https://doi.org/10.1038/s41583-018-0071-2

Kosek, E., Cohen, M., Baron, R., Gebhart, G. F., Mico, J. A., Rice, A. S., & Woolf, C. J. (2016). Do we need a third mechanistic descriptor for chronic pain states? Pain, 157(7), 1382–1386. https://doi.org/10.1097/j.pain.0000000000000507

Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., ... & Wang, S. J. (2019). Chronic pain as a symptom or a disease: The IASP classification of chronic pain for the International Classification of Diseases (ICD-11). Pain, 160(1), 19–27. https://doi.org/10.1097/j.pain.0000000000001384

Woolf, C. J. (2018). Pain amplification: Central sensitization and neuropathic pain. Pain, 152(3), S2–S15.

Sluka, K. A., & Clauw, D. J. (2016). Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience, 338, 114–129.

Arendt-Nielsen, L. (2017). Central sensitization in humans: Assessment and clinical implications. Pain, 158(S1), S1–S2.

Burstein, R., Noseda, R., & Borsook, D. (2015). Migraine: Multiple processes, complex pathophysiology. Journal of Neuroscience, 35(17), 6619–6629.

Mayer, E. A., Labus, J. S., Tillisch, K., Cole, S. W., & Baldi, P. (2015). Towards a systems view of IBS. Nature Reviews Gastroenterology & Hepatology, 12(10), 592–605.

O’Sullivan, P. (2012). It’s time for change with the management of non-specific chronic low back pain. British Journal of Sports Medicine, 46(4), 224–227.

Gatchel, R. J., Peng, Y., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain. Psychological Bulletin, 133(4), 581–624.

Nijs, J., Van Houdenhove, B., & Oostendorp, R. A. (2014). Recognition of central sensitization in patients with chronic pain: Application of pain neurophysiology in manual therapy practice. Manual Therapy, 15(2), 135–141.

Moseley, G. L. (2007). Reconceptualising pain according to contemporary pain science. Physical Therapy Reviews, 12(3), 169–178.

Phillips, C. J. (2009). The cost and burden of chronic pain. Reviews in Pain, 3(1), 2–5.

Arnold, L. M., Clauw, D. J., & Dunegan, L. J. (2019). Pharmacologic treatment of fibromyalgia and other chronic musculoskeletal pain. JAMA, 322(4), 356–366.

Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain—misconceptions and mitigation strategies. New England Journal of Medicine, 374(13), 1253–1263.

Williams, A. C. de C., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache). Cochrane Database of Systematic Reviews, 11, CD007407.

Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., Hansen, K. E., & Turner, J. A. (2016). Effect of mindfulness-based stress reduction vs cognitive behavioral therapy on chronic low back pain. JAMA, 315(12), 1240–1249.

Ellingson, L. D., Stegner, A. J., & Schwabacher, I. J. (2016). Exercise strengthens central nervous system modulation of pain in fibromyalgia. Pain, 157(1), 70–79.

Mallari, B., Spaeth, E. K., Goh, H., & Boyd, L. (2021). Virtual reality as an analgesic for acute and chronic pain: A systematic review. Pain Medicine, 22(1), 82–96.

Views:

114

Downloads:

18

Published
2025-12-12
Citations
How to Cite
Jakub Przerwa. (2025). CENTRAL SENSITIZATION IN CHRONIC PAIN: NEUROPHYSIOLOGICAL MECHANISMS AND CLINICAL IMPLICATIONS. International Journal of Innovative Technologies in Social Science, (4(48). https://doi.org/10.31435/ijitss.4(48).2025.4428

Most read articles by the same author(s)