Central sensitisation: causes, therapies, and terminology

We read with interest the Review by Jo Nijs and collegues, 1 Nijs J George SZ Clauw DJ et al. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. Lancet Rheumatol. 2021; 3: e383-e392 Summary Full Text Full Text PDF Scopus (31) Google Scholar which discussed the potential of central sensitisation for precision medicine in rheumatology. The International Association for the Study of Pain (IASP) defines central sensitisation as “increased responsiveness of nociceptive neurons in the CNS to their normal or subthreshold input”. However, Nijs and colleagues do not refer to the IASP definition but instead use, without justification, the definition proposed by Woolf 2 Woolf CJ Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011; 152: S2-15 Summary Full Text Full Text PDF PubMed Scopus (2422) Google Scholar in 2011: “an amplification of neural signalling within the CNS that elicits pain hypersensitivity”. Importantly, the latter definition of central sensitisation refers to pain hypersensitivity alone, but throughout their review and in the papers cited, the authors link central sensitisation with various non-pain symptoms (eg, figure 2 of the Review 1 Nijs J George SZ Clauw DJ et al. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. Lancet Rheumatol. 2021; 3: e383-e392 Summary Full Text Full Text PDF Scopus (31) Google Scholar ). Central sensitisation: causes, therapies, and terminology – Authors' replyWe thank Sonica Minhas and colleagues, for their interest in our Review1 addressing the latest discoveries regarding central sensitisation in patients with chronic pain and the potential for applying these discoveries to precision medicine approaches. We are grateful for the opportunity to discuss the topic further with a wider audience. We fully support Minhas and colleagues in their call for population-based public health strategies to improve the prevention, surveillance, and detection of central sensitisation in pain conditions. Full-Text PDF Central sensitisation: causes, therapies, and terminologyWe were delighted to see Jo Nijs and colleagues’ Review,1 which provides an urgently needed summary of the evidence base on central sensitivity syndromes, highlighting their prevalence and associated morbidity, mortality, and socioeconomic costs. Ultimately, such an associated burden makes the management of central sensitivity syndromes no longer a single-specialty responsibility, but rather a global public health issue. Therefore, in addition to considering individual-level treatment approaches, as highlighted in the Review, we wish to stress the need for population-based public health strategies to improve the prevention, surveillance, and detection of central sensitivity syndromes. Full-Text PDF Central sensitisation: causes, therapies, and terminologyIn their Review, Jo Nijs and colleagues1 have brought together many strands of evidence towards their confident assertion that features of central sensitisation are present in many different chronic pain conditions. Although their argument is plausible, it must be seen at this time as conjecture, partly because the authors have made some errors in fundamental concepts that underlie their thesis. Full-Text PDF Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicineChronic pain is a leading cause of disability globally and associated with enormous health-care costs. The discrepancy between the extent of tissue damage and the magnitude of pain, disability, and associated symptoms represents a diagnostic challenge for rheumatology specialists. Central sensitisation, defined as an amplification of neural signalling within the CNS that elicits pain hypersensitivity, has been investigated as a reason for this discrepancy. Features of central sensitisation have been documented in various pain conditions common in rheumatology practice, including fibromyalgia, osteoarthritis, rheumatoid arthritis, Ehlers-Danlos syndrome, upper extremity tendinopathies, headache, and spinal pain. Full-Text PDF Central sensitisation: causes, therapies, and terminologyWe read with interest the Review by Jo Nijs and colleagues1 describing central sensitisation in chronic pain conditions and latest discoveries. We agree with the authors that pain represents a significant unmet need. Here, we describe the emerging nociceptive therapeutic potential of immunomodulatory strategies. Full-Text PDF