Central sensitization, chronic pain, and other symptoms: Better understanding, better management

Volcheck, Mary M; Graham, Stephanie M.; Fleming, Kevin C.; Mohabbat, Arya B.; Luedtke, Connie A.

doi:10.3949/ccjm.90a.22019

Cited by 38 publications

(18 citation statements)

References 38 publications

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“…The “train” of joint nociceptor inputs results in an excessive CNS activation with functional and structural CNS changes. Central sensitization may lead to a combination of three phenomena: hyperalgesia, allodynia, and global sensory hyperresponsiveness [ 81 ] in response to any sensory input coming from the body’s periphery or external environment. Finally, central sensitization can explain spontaneous joint pain without sensory input from the periphery [ 81 ].…”

Section: The Gut–joint Axis: How Dysbiosis Leads To Osteoarthritismentioning

confidence: 99%

Microbial Symphony: Exploring the Role of the Gut in Osteoarthritis-Related Pain. A Narrative Review

Corriero,

Giglio,

Soloperto

et al. 2024

Pain Ther

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One of the most common musculoskeletal disorders, osteoarthritis (OA), causes worldwide disability, morbidity, and poor quality of life by degenerating articular cartilage, modifying subchondral bone, and inflaming synovial membranes. OA pathogenesis pathways must be understood to generate new preventative and disease-modifying therapies. In recent years, it has been acknowledged that gut microbiota (GM) can significantly contribute to the development of OA. Dysbiosis of GM can disrupt the “symphony” between the host and the GM, leading to a host immunological response that activates the “gut–joint” axis, ultimately worsening OA. This narrative review summarizes research supporting the “gut–joint axis” hypothesis, focusing on the interactions between GM and the immune system in its two main components, innate and adaptive immunity. Furthermore, the pathophysiological sequence of events that link GM imbalance to OA and OA-related pain is broken down and further investigated. We also suggest that diet and prebiotics, probiotics, nutraceuticals, exercise, and fecal microbiota transplantation could improve OA management and represent a new potential therapeutic tool in the light of the scarce panorama of disease-modifying osteoarthritis drugs (DMOADs). Future research is needed to elucidate these complex interactions, prioritizing how a particular change in GM, i.e., a rise or a drop of a specific bacterial strain, correlates with a certain OA subset to pinpoint the associated signaling pathway that leads to OA.

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Section: The Gut–joint Axis: How Dysbiosis Leads To Osteoarthritismentioning

confidence: 99%

Microbial Symphony: Exploring the Role of the Gut in Osteoarthritis-Related Pain. A Narrative Review

Corriero,

Giglio,

Soloperto

et al. 2024

Pain Ther

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show abstract

“…Both groups have also demonstrated an increased risk for other psychiatric disorders, such as anxiety and depression [ 40 , 41 ]. More recently, it has been suggested that central sensitization—a recognized risk factor in the development and maintenance of chronic pain [ 9 , 11 , 12 , 13 ]—may also play a role in eating disorders [ 42 ].…”

Section: Restrictive Eds In Adolescents With Chronic Functional Abdom...mentioning

confidence: 99%

“…For example, multiple surgeries and/or infections in the same abdominal region could impact the sensitivity of nerve receptors in the gut [ 9 ]. Similarly, central sensitization—when the central nervous system undergoes changes that alter its processing of pain and other sensory stimuli, resulting in a lower pain threshold [ 9 , 10 ] is recognized as a contributor to the development and maintenance of chronic pain [ 11 , 12 , 13 ]. Abdominal pain may lead to food avoidance and dietary restriction, which places individuals at higher risk for developing an eating disorder pathology [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Advancing the Assessment and Treatment of Comorbid Pediatric Chronic Functional Abdominal Pain (CFAP) and Restrictive Eating Disorders

Beckmann,

Aarnio-Peterson,

Jastrowski Mano

2023

Children

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The aim of this review is to heighten awareness of the association between chronic functional abdominal pain (CFAP) and restrictive eating disorders (ED) in adolescents. We describe current diagnostic practices and propose future research efforts to improve the assessment and treatment of comorbid CFAP and restrictive EDs. A narrative review of the literature on CFAP and EDs was performed using PubMed, JSTOR, ScienceDirect, and PsycINFO and the following search terms: ‘restrictive eating disorders’, ‘chronic functional abdominal pain’, ‘chronic pain’ ‘treatment’ ‘diagnosis’ and ‘adolescents’. Published studies on restrictive EDs and CFAP from May 2008 to March 2023 were included. Ascribable to the overlap in etiology and symptom presentation, adolescents with chronic pain are significantly less likely to have their ED pathology promptly identified by providers compared to adolescents without comorbid chronic pain. This highlights the importance of the time sensitive and accurate identification of EDs in adolescents with CFAP. Overall, assessment methods are limited and EDs take longer to be identified in adolescents with comorbid CFAP. Future efforts should address diagnostic practices in pediatric settings and improve the communication among medical and mental health providers in order to promote the rapid and effective diagnosis and treatment of comorbid CFAP and EDs.

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“…Chronic centralized pain syndromes are extremely important, common, and vexing for both patients and clinicians. In this issue of the Journal, Volcheck et al 1 present a framework that I believe is useful for understanding chronic centralized pain and for developing an actionable treatment plan for patients.…”

mentioning

confidence: 99%

“…While it is always important to keep an open mind and avoid the clinical sin of premature closure, making the diagnosis with confi dence is important. Reassurance and behavioral treatment approaches can be provided, 1,3 and previous patient experiences and symptoms can be explained and even described by the clinician without hearing them from the patient. For example, on "less-bad" days, patients try to accomplish many tasks that they could not do the preceding few days and then end up almost disabled by pain or fatigue for the next several days, by the development of intolerance to touch, strong odors, or noises, by dyspareunia (in women), and by the sensation of pain from frequent culture-negative urinary tract infections (interstitial cystitis).…”

mentioning

confidence: 99%

Chronic centralized pain syndromes: A rheumatologist’s perspective

Mandell¹

2023

CCJM

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Central sensitization, chronic pain, and other symptoms: Better understanding, better management

Cited by 38 publications

References 38 publications

Microbial Symphony: Exploring the Role of the Gut in Osteoarthritis-Related Pain. A Narrative Review

Microbial Symphony: Exploring the Role of the Gut in Osteoarthritis-Related Pain. A Narrative Review

Advancing the Assessment and Treatment of Comorbid Pediatric Chronic Functional Abdominal Pain (CFAP) and Restrictive Eating Disorders

Chronic centralized pain syndromes: A rheumatologist’s perspective

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