Cited by 227Pain Mechanisms and TreatmentsFibromyalgia and Chronic Fatigue Syndrome ResearchPain Management and Treatment

Potential Mechanisms Underlying Centralized Pain and Emerging Therapeutic Interventions

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Eller-Smith, Olivia C., Nicol, Andrea L., Christianson, Julie A.·2018·Frontiers in Cellular Neuroscience

Abstract

Centralized pain syndromes are associated with changes within the central nervous system that amplify peripheral input and/or generate the perception of pain in the absence of a noxious stimulus. Examples of idiopathic functional disorders that are often categorized as centralized pain syndromes include fibromyalgia, chronic pelvic pain syndromes, migraine, and temporomandibular disorder. Patients often suffer from widespread pain, associated with more than one specific syndrome, and report fatigue, mood and sleep disturbances, and poor quality of life. The high degree of symptom comorbidity and a lack of definitive underlying etiology make these syndromes notoriously difficult to treat. The main purpose of this review article is to discuss potential mechanisms of centrally-driven pain amplification and how they may contribute to increased comorbidity, poorer pain outcomes, and decreased quality of life in patients diagnosed with centralized pain syndromes, as well as discuss emerging non-pharmacological therapies that improve symptomology associated with these syndromes. Abnormal regulation and output of the hypothalamic-pituitary-adrenal (HPA) axis is commonly associated with centralized pain disorders. The HPA axis is the primary stress response system and its activation results in downstream production of cortisol and a dampening of the immune response. Patients with centralized pain syndromes often present with hyper- or hypocortisolism and evidence of altered downstream signaling from the HPA axis including increased Mast cell (MC) infiltration and activation, which can lead to sensitization of nearby nociceptive afferents. Increased peripheral input via nociceptor activation can lead to "hyperalgesic priming" and/or "wind-up" and eventually to central sensitization through long term potentiation in the central nervous system. Other evidence of central modifications has been observed through brain imaging studies of functional connectivity and magnetic resonance spectroscopy and are shown to contribute to the widespreadness of pain and poor mood in patients with fibromyalgia and chronic urological pain. Non-pharmacological therapeutics, including exercise and cognitive behavioral therapy (CBT), have shown great promise in treating symptoms of centralized pain.

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Crossref · 10.3389/fncel.2018.00035

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  • Local infiltration and migration of mast cells, leading to sensitization of nearby nociceptive afferents, are considered vital contributors to nociplastic pain pathogenesis.

    “Local infiltration and migration of mast cells, leading to sensitization of nearby nociceptive afferents, are considered vital contributors to NPP pathogenesis (69).”

    From Nociplastic pain: the prominent role of non-neuronal cells in central and peripheral sensitization (2026) · cites this paper as [69]

    The HPA Axis sections report increased mast-cell infiltration in several centralized pain syndromes and describe mast-cell activation as a possible cause of sensitization in nearby sensory nerve endings (page not available). They discuss migration of mast-cell precursors generally, but do not establish local migration as a vital contributor to nociplastic pain pathogenesis; the proposed causal mechanism is more tentative. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • Nociplastic pain is widely reported to be correlated with mast cell activation.

    “NPP is widely reported to be correlated with mast cell activation.”

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Authors
Eller-Smith, O. C., Nicol, A. L., & Christianson, J. A.
Affiliations
University of Kansas Medical Center (US)
Corresponding author
Christianson, Julie A.
Venue
Frontiers in Cellular Neuroscience
Published
2018-02-13
Volume
12
Pages
35-35
ISSN
1662-5102 (ISSN-L)
OpenAlex
W2793570991
Cited by
227
References
235
Citations by year
2026: 31 · 2025: 24 · 2024: 20 · 2023: 31 · 2022: 31 · 2021: 31 · 2020: 26 · 2019: 23 · 2018: 10
FWCI
2.95
Type
journal article
Language
en
Open access
Locations
  • Frontiers in Cellular Neuroscience (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Institutes of Health (DK099611, DK103872, GM123320, HD057850)
Topics
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
fibromyalgia, chronic pelvic pain, migraine, temporomandibular disorders, central sensitization, HPA axis dysregulation, mast cells, hyperalgesic priming, wind-up, long-term potentiation, functional connectivity, non-pharmacological treatment, physical activity, cognitive behavioral therapy, comorbidities, quality of life

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