Central sensitisation

Chronic pain has become a significant problem in the Western world, not only in relation to the number of people affected but also in terms of health-related costs. Central sensitisation (CS) is a proposed physiological phenomenon characterised by widespread hypersensitivity resulting from an augmented response of central neurons to receptor activity. CS implies increased excitability of the central nervous system and may be present in many patients with chronic pain. It can be recognised in the clinic by the presence of disproportionate pain, the distribution of pain identified through patient pain drawing and self-reported symptoms of CS using the Central Sensitisation Inventory. The presence of CS predicts poor outcomes using classical local therapy such as electrotherapy, motor control exercises and surgery. Hence, patients having CS should be identified and receive adapted treatment. Treatment of patients having CS should not focus on targeting local anatomical structures, but instead should address the (lifestyle) factors that sustain the process of CS, including illness beliefs, stress, poor sleep, physical activity and an unhealthy diet.