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Central sensitization: implications for the diagnosis and treatment of pain

Open access
Woolf, Clifford J.·2011·Pain

Abstract

Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization. Central sensitization manifests as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. It can be readily and rapidly elicited in human volunteers by diverse experimental noxious conditioning stimuli to skin, muscles or viscera, and in addition to producing pain hypersensitivity, results in secondary changes in brain activity that can be detected by electrophysiological or imaging techniques. Studies in clinical cohorts reveal changes in pain sensitivity that have been interpreted as revealing an important contribution of central sensitization to the pain phenotype in patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, visceral pain hypersensitivity disorders and post-surgical pain. The comorbidity of those pain hypersensitivity syndromes that present in the absence of inflammation or a neural lesion, their similar pattern of clinical presentation and response to centrally acting analgesics, may reflect a commonality of central sensitization to their pathophysiology. An important question that still needs to be determined is whether there are individuals with a higher inherited propensity for developing central sensitization than others, and if so, whether this conveys an increased risk in both developing conditions with pain hypersensitivity, and their chronification. Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity. We have certainly come a long way since the first discovery of activity-dependent synaptic plasticity in the spinal cord and the revelation that it occurs and produces pain hypersensitivity in patients. Nevertheless, discovering the genetic and environmental contributors to and objective biomarkers of central sensitization will be highly beneficial, as will additional treatment options to prevent or reduce this prevalent and promiscuous form of pain plasticity.

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Crossref · 10.1016/j.pain.2010.09.030

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  • Central changes are observed in endometriosis: alterations in behavioral and central response to noxious stimulation, changes in brain structure, altered activity of both HPA and autonomic nervous system and psychological distress, with larger volume in regions involved in pain modulation and endocrine function regulation.

    “a number of central changes are observed: alterations in the behavioral and central response to noxious stimulation, changes in brain structure, altered activity of both the HPA and the autonomic nervous system and psychological distress [131], with larger volume in regions involved in pain modulation and endocrine function regulation [137–139].”

    From Hormonal treatments for endometriosis: The endocrine background (2022) · cites this paper as [137]

    Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured
  • Endometriotic lesions send noxious signals to dorsal root spinal cord neurons and activate spinal microglia to maintain pain stimuli, resulting in central sensitization.

    “Endometriotic lesions themselves send noxious signals to dorsal root spinal cord neurons and activate spinal microglia to maintain pain stimuli, resulting in a central sensitization [137].”

    From Hormonal treatments for endometriosis: The endocrine background (2022) · cites this paper as [137]

    In “Visceral Pain Hypersensitivity Syndromes” (page unavailable), the paper identifies pain hypersensitivity in endometriosis but says that central sensitization is only hypothesized to contribute and that little data are available. In “What is central sensitization?” (page unavailable), it says nociceptive input can sensitize spinal neurons and microglial changes can help maintain central sensitization. It does not establish that endometriotic lesions activate spinal microglia through the specific pathway claimed. (LLM, conf=0.89)

    Experimental — accuracy not yet measured
  • Central pain sensitization results from neuronal plasticity involving structural and functional changes in the central nervous system.

    “Central pain sensitization (CPS) results from neuronal plasticity that involves structural and functional changes in the central nervous system (CNS).”

    From Effectiveness of acceptance and commitment therapy in central pain sensitization syndromes: A systematic review (2021) · cites this paper as [2]

    The Introduction identifies central sensitization as neuronal plasticity, and “What is central sensitization?” describes changes in synaptic strength and neuronal function. “Central sensitization in human volunteers” mentions structural changes after inflammation or nerve injury, but distinguishes these from the activity-dependent changes studied in volunteers. The claim omits that qualification and presents structural changes as a general feature. (LLM, conf=0.82)

    Experimental — accuracy not yet measured
  • Central pain sensitization explains the occurrence and maintenance of spontaneous pain, as well as hypersensitivity to innocuous (allodynia) or low-intensity (hyperalgesia) stimulation in central pain sensitization syndromes.

    “CPS explains the occurrence of spontaneous pain, and maintenance thereof, as well as hypersensitivity to innocuous (allodynia) or low-intensity (hyperalgesia) stimulation in the so-called central pain sensitization syndromes (CPSS) [2,8,9].”

    From Effectiveness of acceptance and commitment therapy in central pain sensitization syndromes: A systematic review (2021) · cites this paper as [2]

    The Introduction and Conclusions describe central sensitization as causing allodynia, hyperalgesia, and prolonged pain responses; the clinical discussion also identifies it as a possible contributor to several pain-hypersensitivity syndromes. The cited passages do not establish that it explains the occurrence and maintenance of spontaneous pain in those syndromes, so the sentence states that part more strongly than the source does. Page numbers are unavailable in our copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Predictive coding can also be applied to existing concepts such as central sensitisation, nociplastic pain, and somatosensory amplification.

    “can also be applied to existing concepts such as central sensitisation, 83,84 nociplastic pain, 81 and somatosensory amplification”

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  1. [234]Torres Tortosa M Roman Rico D Risk of transmission of human immunodeficiency virus type 1 after accidents with needles from drug addicts, occurred in the community Rev Clin Esp 1991 189 2 95 96 1784793

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Authors
Woolf, C. J.
Affiliations
Boston Children's Hospital (US)
Corresponding author
Woolf, Clifford J.
Venue
Pain
Published
2011-03
Volume
152
Issue
3
Pages
S2-S15
ISSN
0304-3959 (ISSN-L)
OpenAlex
W2116230226
Cited by
4,771
References
282
Citations by year
2026: 521 · 2025: 389 · 2024: 345 · 2023: 297 · 2022: 337 · 2021: 376 · 2020: 353 · 2019: 320 · 2018: 319 · 2017: 302 · 2016: 267 · 2015: 278 · 2014: 241 · 2013: 217 · 2012: 134
FWCI
13.70
Type
journal article
Language
en
Open access
Locations
  • Pain (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • 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
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Keywords
central sensitization, hyperalgesia, activity-dependent synaptic plasticity, nociceptive pathways, fibromyalgia, osteoarthritis, headache, temporomandibular disorders, neuropathic pain, visceral pain, postoperative pain, temporal summation, mechanical allodynia, pain chronification, genetic susceptibility, biomarkers, centrally acting analgesics, pain diagnosis
MeSH terms
Animals, Humans, Hyperalgesia, Models, Neurological, Neuronal Plasticity, Pain, Spinal Cord, Pain Management

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