title: Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain.
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.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  Although based on direct and indirect research findings, the classification algorithm requires experimental testing in future studies.
  
  
  CONCLUSIONS
  Clinicians can use the proposed classification algorithm for differentiating neuropathic, nociceptive, and central sensitization pain.
authors.affiliation: Pain in Motion Research Group, Departments of Human Physiology and Physiotherapy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgiu.
authors.forename: Jo
authors.initials: J
authors.lastname: Nijs
authors.forename: Rafael
authors.initials: R
authors.lastname: Torres-Cueco
authors.forename: C Paul
authors.initials: CP
authors.lastname: van Wilgen
authors.forename: Enrique Lluh
authors.initials: EL
authors.lastname: Girbes
authors.forename: Filip
authors.initials: F
authors.lastname: Struyf
authors.forename: Nathalie
authors.initials: N
authors.lastname: Roussel
authors.forename: Jessica
authors.initials: J
authors.lastname: van Oosterwijck
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Daenen
authors.forename: Kevin
authors.initials: K
authors.lastname: Kuppens
authors.forename: Luc
authors.initials: L
authors.lastname: Vanwerweeen
authors.forename: Linda
authors.initials: L
authors.lastname: Hermans
authors.forename: David
authors.initials: D
authors.lastname: Beckwee
authors.forename: Lennard
authors.initials: L
authors.lastname: Voogt
authors.forename: Jacqui
authors.initials: J
authors.lastname: Clark
authors.forename: Niamh
authors.initials: N
authors.lastname: Moloney
authors.forename: Mira
authors.initials: M
authors.lastname: Meeus
mesh_terms: D059333:Central Nervous System Sensitization / Q000502:physiology*; D059350:Chronic Pain / Q000145:classification*; D003937:Diagnosis, Differential; D006801:Humans; D009437:Neuralgia / Q000145:classification* / Q000175:diagnosis; D009488:Neurosciences / Q000379:methods; D059225:Nociception / Q000145:classification*; D017410:Practice Guidelines as Topic