title: The prevalence of widespread central hypersensitivity in chronic pain patients.
abstract: BACKGROUND
  Chronic pain is associated with generalized hypersensitivity and impaired endogenous pain modulation (conditioned pain modulation; CPM). Despite extensive research, their prevalence in chronic pain patients is unknown. This study investigated the prevalence and potential determinants of widespread central hypersensitivity and described the distribution of CPM in chronic pain patients.
  
  
  METHODS
  We examined 464 consecutive chronic pain patients for generalized hypersensitivity and CPM using pressure algometry at the second toe and cold pressor test. Potential determinants of generalized central hypersensitivity were studied using uni- and multivariate regression analyses. Prevalence of generalized central hypersensitivity was calculated for the 5th, 10th and 25th percentile of normative values for pressure algometry obtained by a previous large study on healthy volunteers. CPM was addressed on a descriptive basis, since normative values are not available.
  
  
  RESULTS
  Depending on the percentile of normative values considered, generalized central hypersensitivity affected 17.5-35.3% of patients. 23.7% of patients showed no increase in pressure pain threshold after cold pressor test. Generalized central hypersensitivity was more frequent and CPM less effective in women than in men. Unclearly classifiable pain syndromes showed higher frequencies of generalized central hypersensitivity than other pain syndromes.
  
  
  CONCLUSIONS
  Although prevalent in chronic pain, generalized central hypersensitivity is not present in every patient. An individual assessment is therefore required in order to detect altered pain processing. The broad basic knowledge about central hypersensitivity now needs to be translated into concrete clinical consequences, so that patients can be offered an individually tailored mechanism-based treatment.
authors.affiliation: University Department of Anesthesiology and Pain Therapy, Inselspital Bern, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Schliessbach
authors.forename: A
authors.initials: A
authors.lastname: Siegenthaler
authors.forename: K
authors.initials: K
authors.lastname: Streitberger
authors.forename: U
authors.initials: U
authors.lastname: Eichenberger
authors.forename: E
authors.initials: E
authors.lastname: Nüesch
authors.forename: P
authors.initials: P
authors.lastname: Jüni
authors.forename: L
authors.initials: L
authors.lastname: Arendt-Nielsen
authors.forename: M
authors.initials: M
authors.lastname: Curatolo
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D017288:Pain Threshold / Q000502:physiology; D011312:Pressure; D015995:Prevalence