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Treatment of central sensitization in patients with 'unexplained' chronic pain: an update

(2014) EXPERT OPINION ON PHARMACOTHERAPY. 15(12). p.1671-1683
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Abstract
Introduction: Central sensitization (CS) is present in a variety of chronic pain disorders, including whiplash, tennporomandibular disorders, low back pain, osteoarthritis, fibromyalgia, headache, lateral epicondylalgia among others. In spite of our increased understanding of the mechanisms involved in CS pain, its treatment remains a challenging issue. Areas covered: An overview of the treatment options we have for desensitising the CNS in patients with CS pain is provided. These include strategies for eliminating peripheral sources of nociception, as well as pharmacotherapy and conservative interventions that primarily address top-down (i.e., brain-orchestrated) mechanisms. Expert opinion: A combination of different strategies, each targeting a different 'desensitizing' mechanism, might prove superior over monotherapies. Such combined therapy may include both bottom-up and top-down (e.g., opioids, combined mu-opioid receptor agonist and noradrenaline reuptake inhibitor drugs) strategies. Topically applied analgesic therapies have strong potential for (temporally) decreasing peripheral nociceptive input (bottom-up approach). Targeting metabolic (e.g., ketogenic diets) and neurotrophic factors (e.g., decreasing brain-derived neurotrophic factor) are promising new avenues for diminishing hyperexcitability of the CNS in central sensitization pain patients. Addressing conservative treatments, pain neuroscience education, cognitive behavioural therapy and exercise therapy are promising treatments for CS pain.
Keywords
cognitive behavioural therapy, whiplash, WHIPLASH-ASSOCIATED DISORDERS, rehabilitation, LOW-BACK-PAIN, NMDA-RECEPTOR ANTAGONISTS, CHRONIC MUSCULOSKELETAL PAIN, NOXIOUS INHIBITORY CONTROL, COGNITIVE-BEHAVIORAL THERAPY, chronic pain, pharmacotherapy, education, exercise therapy, fibromyalgia, osteoarthritis, TOTAL KNEE REPLACEMENT, RANDOMIZED CLINICAL-TRIAL, EXPERIMENTAL MUSCLE PAIN, CHRONIC-FATIGUE-SYNDROME

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Citation

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Chicago
Nijs, Jo, Anneleen Malfliet, Kelly Ickmans, Isabel Baert, and Mira Meeus. 2014. “Treatment of Central Sensitization in Patients with ‘Unexplained’ Chronic Pain: An Update.” Expert Opinion on Pharmacotherapy 15 (12): 1671–1683.
APA
Nijs, Jo, Malfliet, A., Ickmans, K., Baert, I., & Meeus, M. (2014). Treatment of central sensitization in patients with “unexplained” chronic pain: an update. EXPERT OPINION ON PHARMACOTHERAPY, 15(12), 1671–1683.
Vancouver
1.
Nijs J, Malfliet A, Ickmans K, Baert I, Meeus M. Treatment of central sensitization in patients with “unexplained” chronic pain: an update. EXPERT OPINION ON PHARMACOTHERAPY. 2014;15(12):1671–83.
MLA
Nijs, Jo, Anneleen Malfliet, Kelly Ickmans, et al. “Treatment of Central Sensitization in Patients with ‘Unexplained’ Chronic Pain: An Update.” EXPERT OPINION ON PHARMACOTHERAPY 15.12 (2014): 1671–1683. Print.
@article{5701255,
  abstract     = {Introduction: Central sensitization (CS) is present in a variety of chronic pain disorders, including whiplash, tennporomandibular disorders, low back pain, osteoarthritis, fibromyalgia, headache, lateral epicondylalgia among others. In spite of our increased understanding of the mechanisms involved in CS pain, its treatment remains a challenging issue.
Areas covered: An overview of the treatment options we have for desensitising the CNS in patients with CS pain is provided. These include strategies for eliminating peripheral sources of nociception, as well as pharmacotherapy and conservative interventions that primarily address top-down (i.e., brain-orchestrated) mechanisms.
Expert opinion: A combination of different strategies, each targeting a different 'desensitizing' mechanism, might prove superior over monotherapies. Such combined therapy may include both bottom-up and top-down (e.g., opioids, combined mu-opioid receptor agonist and noradrenaline reuptake inhibitor drugs) strategies. Topically applied analgesic therapies have strong potential for (temporally) decreasing peripheral nociceptive input (bottom-up approach). Targeting metabolic (e.g., ketogenic diets) and neurotrophic factors (e.g., decreasing brain-derived neurotrophic factor) are promising new avenues for diminishing hyperexcitability of the CNS in central sensitization pain patients. Addressing conservative treatments, pain neuroscience education, cognitive behavioural therapy and exercise therapy are promising treatments for CS pain.},
  author       = {Nijs, Jo and Malfliet, Anneleen and Ickmans, Kelly and Baert, Isabel and Meeus, Mira},
  issn         = {1465-6566},
  journal      = {EXPERT OPINION ON PHARMACOTHERAPY},
  keywords     = {cognitive behavioural therapy,whiplash,WHIPLASH-ASSOCIATED DISORDERS,rehabilitation,LOW-BACK-PAIN,NMDA-RECEPTOR ANTAGONISTS,CHRONIC MUSCULOSKELETAL PAIN,NOXIOUS INHIBITORY CONTROL,COGNITIVE-BEHAVIORAL THERAPY,chronic pain,pharmacotherapy,education,exercise therapy,fibromyalgia,osteoarthritis,TOTAL KNEE REPLACEMENT,RANDOMIZED CLINICAL-TRIAL,EXPERIMENTAL MUSCLE PAIN,CHRONIC-FATIGUE-SYNDROME},
  language     = {eng},
  number       = {12},
  pages        = {1671--1683},
  title        = {Treatment of central sensitization in patients with 'unexplained' chronic pain: an update},
  url          = {http://dx.doi.org/10.1517/14656566.2014.925446},
  volume       = {15},
  year         = {2014},
}

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