Treatment of central sensitization in patients with 'unexplained' chronic pain: what options do we have?
BACKGROUND
Central sensitization accounts for chronic 'unexplained' pain in a wide variety of disorders, including chronic whiplash-associated disorders, temporomandibular disorders, chronic low back pain, osteoarthritis, fibromyalgia, chronic fatigue syndrome and chronic tension-type headache among others. Given the increasing evidence supporting the clinical significance of central sensitization in those with unexplained chronic pain, the awareness is growing that central sensitization should be a treatment target in these patients.


METHODS
This article provides an overview of the treatment options available for desensitizing the CNS in patients with chronic pain due to central sensitization. It focuses on those strategies that specifically target pathophysiological mechanisms known to be involved in central sensitization. In addition, pharmacological options, rehabilitation and neurotechnology options are discussed.


CONCLUSIONS
Acetaminophen, serotonin-reuptake inhibitor drugs, selective and balanced serototin and norepinephrine-reuptake inhibitor drugs, the serotonin precursor tryptophan, opioids, N-methyl-d-aspartate (NMDA)-receptor antagonists, calcium-channel alpha(2)delta (a2δ) ligands, transcranial magnetic stimulation, transcutaneous electric nerve stimulation (TENS), manual therapy and stress management each target central pain processing mechanisms in animals that - theoretically - desensitize the CNS in humans. To provide a comprehensive treatment for 'unexplained' chronic pain disorders characterized by central sensitization, it is advocated to combine the best evidence available with treatment modalities known to target central sensitization.
Artesis University College Antwerp, Antwerp, Belgium. Jo.Nijs@vub.ac.be
Jo
J
Nijs
Mira
M
Meeus
Jessica
J
Van Oosterwijck
Nathalie
N
Roussel
Margot
M
De Kooning
Kelly
K
Ickmans
Milica
M
Matic
D002490:Central Nervous System / Q000187:drug effects* / Q000503:physiopathology*; D002493:Central Nervous System Diseases / Q000188:drug therapy* / Q000503:physiopathology*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D016503:Drug Delivery Systems; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D059408:Pain Management; D050781:Transcranial Magnetic Stimulation