Central sensitization in humans: assessment and pharmacology
Abstract
It is evident that chronic pain can modify the excitability of central nervous system which imposes a specific challenge for the management and for the development of new analgesics. The central manifestations can be difficult to quantify using standard clinical examination procedures, but quantitative sensory testing (QST) may help to quantify the degree and extend of the central reorganization and effect of pharmacological interventions. Furthermore, QST may help in optimizing the development programs for new drugs.Specific translational mechanistic QST tools have been developed to quantify different aspects of central sensitization in pain patients such as threshold ratios, provoked hyperalgesia/allodynia, temporal summation (wind-up like pain), after sensation, spatial summation, reflex receptive fields, descending pain modulation, offset analgesia, and referred pain areas. As most of the drug development programs in the area of pain management have not been very successful, the pharmaceutical industry has started to utilize the complementary knowledge obtained from QST profiling. Linking patients QST profile with drug efficacy profile may provide the fundamentals for developing individualized, targeted pain management programs in the future. Linking QST-assessed pain mechanisms with treatment outcome provides new valuable information in drug development and for optimizing the management regimes for chronic pain.
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Depression, anxiety, general emotional distress, and negative affect are probably the most commonly assessed psychological factors in persistent pain patients.
“Depression, anxiety, and general indices of emotional distress along with a cluster of negative emotions, thoughts, and behaviors termed, “negative affect,” are probably the most commonly-assessed psychological factors in patients with persistent pain 11, 32, 33.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [11]
Depression and anxiety are linked to chronic pain and increased pain sensitivity.
“An abundance of evidence links depression and anxiety to chronic pain and increased pain sensitivity 11, 13, 32, 41.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [11]
Recent reviews identify catastrophizing as a key phenotypic factor to assess in trials of analgesic treatments for chronic pain.
“Recent reviews have identified catastrophizing as a key phenotypic factor to assess in trials of analgesic treatments in patients with chronic pain 11.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [11]
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Referred muscle pain/hyperalgesia and central sensitisation
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Effects of Gabapentin on Experimental Somatic Pain and Temporal Summation
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Self-citationThe prevalence of widespread central hypersensitivity in chronic pain patients
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Fernández‐Carnero, J., Fernández‐de‐las‐Peñas, C., Sterling, M. M., Souvlis, T., Arendt‐Nielsen, L., & Vicenzino, B. (2009) · Journal of Pain · doi:10.1016/j.jpain.2009.04.015 · Cited by 64 · see citing works
Self-citationHyperalgesia and functional sensory loss in restless legs syndrome
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Self-citationExpansion of nociceptive withdrawal reflex receptive fields in spinal cord injured humans
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Self-citationAn Endogenous Pain Control System is Altered in Subjects with Interstitial Cystitis
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Dimcevski, G. G., Staahl, C., Andersen, S. D., Thorsgaard, N., Funch-Jensen, P. M., Arendt‐Nielsen, L., & Drewes, A. M. (2007) · Pancreas · doi:10.1097/mpa.0b013e31805c1762 · Cited by 57 · see citing works
Self-citationModular Organization of Spinal Nociceptive Reflexes: A New Hypothesis
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Reflex receptive fields are enlarged in patients with musculoskeletal low back and neck pain
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Self-citationThe association of osteoarthritis risk factors with localized, regional and diffuse knee pain
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Targeting novel peripheral mediators for the treatment of chronic pain
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Effects of dexmedetomidine on conditioned pain modulation in humans
Baba, Y., Kohase, H., Oono, Y., Fujii‐Abe, K., & Arendt‐Nielsen, L. (2012) · European Journal of Pain · doi:10.1002/j.1532-2149.2012.00129.x · Cited by 43 · see citing works
Self-citationTherapeutic outcome in neuropathic pain: relationship to evidence of nervous system lesion
Rasmussen, P. V., Sindrup, S. H., Jensen, T. S., & Bach, F. W. (2004) · European Journal of Neurology · doi:10.1111/j.1468-1331.2004.00843.x · Cited by 43 · see citing works
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Generalized vibrotactile allodynia in a patient with temporomandibular disorder
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Healthy Volunteers Can Be Phenotyped Using Cutaneous Sensitization Pain Models
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Self-citationNeural representation of cutaneous aftersensations by spinothalamic tract neurons.
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Self-citationIncreased Capsaicin-induced Secondary Hyperalgesia in Patients With Multiple Chemical Sensitivity
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An Experimental Pain Model Based on Electric Stimulations of the Colon Mucosa
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Somatosensory changes in the referred pain area in patients with cholecystolithiasis
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Multiple mechanisms have been tested in pain—how can we improve the chances of success?
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Self-citationPain Comorbidities: Understanding and Treating the Complex Patient
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Self-citationFrequency-dependent conduction delay of motor-evoked potentials in multiple sclerosis
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Evaluating psychosocial contributions to chronic pain outcomes
Meints, S. M., & Edwards, R. R. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.01.017 · Cited by 719 · see citing works
Assessment and manifestation of central sensitisation across different chronic pain conditions
Arendt‐Nielsen, L., Morlion, B., Perrot, S., Dahan, A., Dickenson, A., Kress, H. G., Wells, C., Bouhassira, D., & Drewes, A. M. (2018) · European Journal of Pain · doi:10.1002/ejp.1140 · Cited by 695 · see citing works
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Schreiber, K. L., Loggia, M. L., Kim, J., Cahalan, C. M., Napadow, V., & Edwards, R. R. (2017) · The Journal of Pain · doi:10.1016/j.jpain.2017.02.437 · Cited by 54 · see citing works
- Authors
- Arendt-Nielsen, L.
- Venue
- Handbook of Experimental Pharmacology
- Publisher
- Springer Berlin Heidelberg
- Published
- 2015
- Volume
- 227
- Pages
- 79-102
- ISSN
- 0171-2004 (ISSN-L)
- 1865-0325
- OpenAlex
- W213693423
- Cited by
- 125
- References
- 163
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 7 · 2023: 13 · 2022: 14 · 2021: 17 · 2020: 14 · 2019: 8 · 2018: 13 · 2017: 11 · 2016: 10 · 2015: 2
- FWCI
- 39.56
- Type
- book chapter
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Handbook of experimental pharmacology (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- central sensitization, chronic pain, quantitative sensory testing, pharmacological evaluation, drug development, temporal summation, spatial summation, descending pain modulation, referred pain, allodynia, hyperalgesia, personalized pain management
- MeSH terms
- Humans, Central Nervous System Sensitization, Chronic Pain, Pain Management
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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