How to explain central sensitization to patients with ‘unexplained’chronic musculoskeletal pain: Practice guidelines
Open accessAbstract
Central sensitization provides an evidence-based explanation for many cases of 'unexplained' chronic musculoskeletal pain. Prior to commencing rehabilitation in such cases, it is crucial to change maladaptive illness perceptions, to alter maladaptive pain cognitions and to reconceptualise pain. This can be accomplished by patient education about central sensitization and its role in chronic pain, a strategy known as pain physiology education. Pain physiology education is indicated when: 1) the clinical picture is characterized and dominated by central sensitization; and 2) maladaptive illness perceptions are present. Both are prerequisites for commencing pain physiology education. Face-to-face sessions of pain physiology education, in conjunction with written educational material, are effective for changing pain cognitions and improving health status in patients with various chronic musculoskeletal pain disorders. These include patients with chronic low back pain, chronic whiplash, fibromyalgia and chronic fatigue syndrome. After biopsychosocial assessment pain physiology education comprises of a first face-to-face session explaining basic pain physiology and contrasting acute nociception versus chronic pain (Session 1). Written information about pain physiology should be provided as homework in between session 1 and 2. The second session can be used to correct misunderstandings, and to facilitate the transition from knowledge to adaptive pain coping during daily life. Pain physiology education is a continuous process initiated during the educational sessions and continued within both the active treatment and during the longer term rehabilitation program.
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Adding a cognition-targeted active approach to pain science is considered critical in achieving larger long-term therapy effects, given that pain science as a stand-alone treatment only demonstrates small to medium effect sizes.
“Indeed, adding a cognition-targeted active approach to pain science (e.g., progression to the next phase of education is preceded by an intermediate phase of imagery or work on cognitions that might hinder progression) is considered critical in achieving larger long-term therapy effects, given that pain science as a stand-alone treatment only demonstrates small to medium effect sizes [62,63].”
From Best-evidence for the rehabilitation of chronic pain part 1: Pediatric pain (2019) · cites this paper as [63]
Section 3.5 recommends continuing pain-physiology education into active rehabilitation and maintaining adaptive pain cognitions for long-term adherence. But the paper does not report that stand-alone pain science has small-to-medium effect sizes or establish that adding a cognition-targeted active approach produces larger long-term effects; Section 2 instead notes a short-term trial in which education alone outperformed education plus group exercise. (LLM, conf=0.86)
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- Authors
- Nijs, J., Paul van Wilgen, C., Van Oosterwijck, J., van Ittersum, M., & Meeus, M.
- Affiliations
- Vrije Universiteit Brussel (BE)
- Corresponding author
- Nijs, Jo
- ORCID
- Venue
- Manual Therapy
- Publisher
- Elsevier BV
- Published
- 2011-10
- Volume
- 16
- Issue
- 5
- Pages
- 413-418
- ISSN
- 1356-689X (ISSN-L)
- OpenAlex
- W2117902506
- Cited by
- 390
- References
- 32
- Citations by year
- 2026: 17 · 2025: 19 · 2024: 35 · 2023: 34 · 2022: 32 · 2021: 46 · 2020: 39 · 2019: 35 · 2018: 25 · 2017: 24 · 2016: 24 · 2015: 21 · 2014: 21 · 2013: 9 · 2012: 8
- FWCI
- 8.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Manual Therapy (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- research council of the Vrije Universiteit Brussel, Brussels, Belgium (OZR1596)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- central sensitization, chronic musculoskeletal pain, patient education, illness perception, pain-related cognitions, chronic low back pain, whiplash injury, fibromyalgia, chronic fatigue syndrome, biopsychosocial assessment, pain coping, educational texts
- MeSH terms
- Humans, Patient Education as Topic, Central Nervous System Sensitization, Chronic Pain, Musculoskeletal Pain
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