Updates & Features
Central Sensitisation: From Physical Examination To Clinical Significance
July 2019
Dr Emilio Quetglas, The PainSolve Team
One of the mechanisms used to describe the genesis of chronic pain is peripheral sensitisation. This constitutes a decreased threshold and increased responsiveness of nociceptors due to post-translational changes in, and altered trafficking of, transducer receptors and ion channels. Clinincal characteristics of peripheral clinical pain are pain after the end of a stimulus and a spread of sensitivity to normal tissue induced by local inflammatory mediators. This is referred to as the zone of primary hyperalgesia.1
In contrast, in chronic neuropathic pain the mechanically sensitive skin area often extends beyond the area of the initially involved root or nerve to create a zone of secondary hyperalgesia. This area is unaffected by the primary nerve lesion, which often becomes independent of the initial noxious event.
Diagnostic Challenges of Small Fibre Neuropathy | PainSolve
Diagnostic Challenges of Small Fibre Neuropathy | PainSolve
References
- Vardeh D, Mannion RJ, Woolf CJ, et al. J Pain. 2016;17(9 Suppl):T50–69
- IASP Task Force. Classification of chronic pain. The IASP taxonomy. Merskey H, Bogduk N, ed. 2012
- Latremoliere A, Woolf CJ. J Pain. 2009; 10(9): 895–926
- Devor M. In: Weinstein J, Gordon S, editors. Low Back Pain: A Scientific and Clinical Overview. Rosemont, IL: AAOS, 1986;187-208
- Cook AJ, Woolf CJ, Wall PD, et al. Nature 1987;325:151-3
- Arendt-Nielsen L, Brennum J, Sindrup S, et al. Eur J Appl Physiol Occup Physiol. 1994;68(3):266-73
- Stacey BR. Am J Phys Med Rehabil. 2005;84(3 Suppl):S4–16
- Meeus M, Nijs J. Clin Rheumatol 2007; 26: 465– 473
- Woolf CJ. Pain 2011; 152: S2– S15
- Goncalves L, Dickenson AH. Eur J Neurosci 2012; 36: 3204– 3213
- Navratilova E, Xie JY, Okun A, et al. Proc Natl Acad Sci USA 2012; 109: 20709– 20713
- Rocha AP, Kraychete DC, Lemonica L, et al. Rev Bras Anestesiol 2007; 57: 94– 105
- Nijs J, Paul van Wilgen C, Van Oosterwijck J, et al. Man Ther 2011; 16: 413– 418
- Aykanat V, Gentgall M, Briggs N, et al. Br J Clin Pharmacol 2012;73, 37–4
- Konopka K, Harbers M, Houghton A, et al. PLoS ONE 2012;7, e37524
- Baron R, Saguer M. Neurosci Lett 1994;165, 97–100
- Eide, PK, Jørum E, Stubhaug A, et al. Pain 1994;58, 347–35
- Nikolajsen L, Hansen CL, Nielsen J, et al. Pain 1996;67, 69–77
- Huge V, Lauchart M, Forderreuther S, et al. PLoS ONE 2008 ;3, e2742
- De-la-Llave-Rincón AI, Fernández-de-las-Peñas C, Palacios-Ceña D, et al. J Orthop Sports Phys Ther. 2009;39(9):658-64
- Bouhassira D, Danziger N, Attal N, et al. Brain 2003;126, 1068–1078
- Gruener H, Zeilig G, Laufer Y, et al. Pain 2016;157, 1415–1424
- Yarnitsky D, Granot M, Nahman-Averbuch H, et al. Pain 153, 1193–1198
- Giesecke T, Gracely RH, Grant MA, et al. Arthritis Rheum 2004;50, 613–623
- Puta C, Schulz B, Schoeler S, Magerl W, et al. BMC Neurol 2012;12, 98
- Owens MA, Bulls HW, Trost Z, et al. Pain Med 2016;17, 1452–1464
- Arendt-Nielsen L, Nie H, Laursen, MB, et al. Pain 2010;149, 573–581
- Imamura M, Imamura ST, Kaziyama HH, et al. Arthritis Rheum 2008;59, 1424–1431
- Skou ST, Graven-Nielsen T, Rasmussen S, et al. Eur J Pain 2014 ;18, 1024–1031
- Lundblad H, Kreicbergs A, Jansson KA. J Bone Joint Surg Br 2008;90, 166–171
- Meeus M, Vervisch S, De Clerck LS, et al. Semin Arthritis Rheum. 2012;41(4):556-67
- Verne G, Price DD. Curr Rheumatol Rep 2002;4, 322–328
- Bouin M, Meunier P, Riberdy-Poitras M, et al. Dig Dis Sci 46, 2542–2548
- Drewes AM, Petersen P, Qvist P, et al. Scand J Gastroenterol 1999;34, 765–771
- Munakata J, Naliboff B, Harraf F, et al. Gastroenterology 1997;112, 55–63
- Wilder-Smith CH, Schindler D, Lovblad K, et al. Gut 2004;53,1595–1601
- Bouwense SA, de Vries M, Schreuder LT, et al. World J Gastroenterol. 2015;21(1):47-59
- Anand P, Aziz Q, Willert R, et al. Neurogastroenterol Motil. 2007;19 (1 Suppl):29-46
- He W, Liu X, Zhang Y, et al. Reprod Sci. 2010;17(12):1099-111
- Stratton P, Khachikyan I, Sinaii N, et al. Obstet Gynecol. 2015;125(3):719-28
- Giesecke J, Reed BD, Haefner HK, et al. Obstet Gynecol. 2004;104(1):126–33
- Pukall CF, Binik YM, Khalife S, et al. Pain. 2002;96(1–2):163–75
- Lai H, Gardner V, Ness T, et al. J Pain 2014; 15 (4, Supplement) : S36
- Do TP, Heldarskard GF, Kolding LT, et al. J Headache Pain. 2018;19(1):84
- Van Oosterwijck J, Nijs J, Meeus M, et al. Eur J Pain. 2013;17(3):299-31
- Garrigós-Pedrón M, La Touche R, Navarro-Desentre P, et al. Acta Odontol Scand. 2019;77(3):224-231
- Sato H, Saisu H, Muraoka W, et al. J Orofac Pain 2012;26, 288–295
- Bragdon EE, Light KC, Costello NL, et al. Pain 2002;96, 227–237
- Petersen KK, Graven-Nielsen T, Simonsen O, et al. Pain 2016;157, 1400–1406
- Wylde V, Sayers A, Lenguerrand E, et al. Pain 2015;156, 47–54
- van Helmond N, Steegers MA, Filippini-de Moor GP, V, et al. PLoS ONE 2016;11(12): e0166601
- Arendt‐Nielsen L, Nie H, Laursen MB, et al. Pain, 2010;149( 3), 573– 581
- Staud R, Craggs JG, Perlstein WM, et al. Eur J Pain, 2008;12( 8), 1078– 1089
- Weissman‐Fogel I, Granovsky Y, Crispel Y, et al. J Pain, 2009; 10( 6), 628– 636
- Izumi M, Petersen KK, Laursen MB, et al. Pain, 2017;158( 2), 323– 332
- Petersen KK, Arendt‐Nielsen L, Simonsen O, et al. Pain, 2015;156( 1), 55– 61
- Skou ST, Graven‐Nielsen T, Rasmussen S, et al. Pain, 2013;154( 9), 1588– 1594
- Vaegter HB, Graven‐Nielsen T. Pain, 2016;157( 7), 1480– 1488
- Yarnitsky D, Crispel Y, Eisenberg E, et al. Pain, 2008 ;138( 1), 22– 28
- Edwards RR. Neurology, 2005;65( 3), 437– 443
- Yarnitsky D. Pain, 2015;156( Suppl 1), S24– S31