Central sensitization: a generator of pain hypersensitivity by central neural plasticity
Open accessAbstract
Unlabelled Central sensitization represents an enhancement in the function of neurons and circuits in nociceptive pathways caused by increases in membrane excitability and synaptic efficacy as well as to reduced inhibition and is a manifestation of the remarkable plasticity of the somatosensory nervous system in response to activity, inflammation, and neural injury. The net effect of central sensitization is to recruit previously subthreshold synaptic inputs to nociceptive neurons, generating an increased or augmented action potential output: a state of facilitation, potentiation, augmentation, or amplification. Central sensitization is responsible for many of the temporal, spatial, and threshold changes in pain sensibility in acute and chronic clinical pain settings and exemplifies the fundamental contribution of the central nervous system to the generation of pain hypersensitivity. Because central sensitization results from changes in the properties of neurons in the central nervous system, the pain is no longer coupled, as acute nociceptive pain is, to the presence, intensity, or duration of noxious peripheral stimuli. Instead, central sensitization produces pain hypersensitivity by changing the sensory response elicited by normal inputs, including those that usually evoke innocuous sensations.Perspective In this article, we review the major triggers that initiate and maintain central sensitization in healthy individuals in response to nociceptor input and in patients with inflammatory and neuropathic pain, emphasizing the fundamental contribution and multiple mechanisms of synaptic plasticity caused by changes in the density, nature, and properties of ionotropic and metabotropic glutamate receptors.
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Chronic pain and attendant psychosocial distress can change the structure of the brain's widespread cognitive and affective structures in ways that perpetuate pain perception.
“Undergirding the chronicity is that chronic pain and attendant psychosocial distress can change the structure of the brain's widespread cognitive and affective structures in ways that perpetuate pain perception (Latremoliere and Woolf, 2009).”
From Physiological feelings (2019) · cites this paper as Latremoliere and Woolf, 2009
The Conclusion says central neuronal plasticity can increase pain sensitivity, and “The Discovery of Central Sensitization” reports changes compatible with increased excitability in several brain regions, including the amygdala, anterior cingulate and prefrontal cortex (page numbers unavailable). The paper does not establish that chronic pain and attendant psychosocial distress structurally change widespread cognitive and affective brain regions. (LLM, conf=0.87)
Experimental — accuracy not yet measuredChanges in central synaptic plasticity involved in regulating the development and maintenance of chronic pain are considered a primary cause of central sensitization in nociplastic pain.
“Changes in central synaptic plasticity, which are involved in regulating the development and maintenance of chronic pain, are considered a primary cause of central sensitization in NPP (10).”
From Nociplastic pain: the prominent role of non-neuronal cells in central and peripheral sensitization (2026) · cites this paper as [10]
The Abstract describes central sensitization as arising from changes in synaptic efficacy, excitability, and inhibition, and the ‘Central Sensitization in Pathological Settings’ section links these mechanisms to persistent pain hypersensitivity. The paper does not specifically address nociplastic pain or establish synaptic plasticity as its primary cause of central sensitization; the ‘Global Features’ section instead says several processes can mediate central sensitization. Page numbers were not provided in our copy. (LLM, conf=0.86)
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- Authors
- Latremoliere, A., & Woolf, C. J.
- Affiliations
- Harvard University (US)
- Corresponding author
- Woolf, Clifford J.
- ORCID
- Woolf, Clifford J.
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2009-09
- Volume
- 10
- Issue
- 9
- Pages
- 895-926
- ISSN
- 1526-5900 (ISSN-L)
- PMC
- PMC2750819
- OpenAlex
- W2155524482
- Cited by
- 3,913
- References
- 416
- Citations by year
- 2026: 318 · 2025: 343 · 2024: 295 · 2023: 330 · 2022: 284 · 2021: 306 · 2020: 275 · 2019: 230 · 2018: 217 · 2017: 219 · 2016: 198 · 2015: 189 · 2014: 176 · 2013: 162 · 2012: 141
- FWCI
- 13.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (R01NS058870, R01NS038253, R01NS039518)
- National Institute of Dental and Craniofacial Research (R01DE017821)
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- central sensitization, hyperalgesia, synaptic plasticity, nociceptive pathways, glutamate receptors, metabotropic glutamate receptors, ionotropic glutamate receptors, inflammatory pain, neuropathic pain, chronic pain, membrane excitability
- MeSH terms
- Afferent Pathways, Animals, Central Nervous System, Humans, Hyperalgesia, Synaptic Transmission, Neuronal Plasticity, Nociceptors, Pain, Sensory Receptor Cells, Pain Threshold
About these checks
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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