How to explain central sensitization to patients with 'unexplained' chronic musculoskeletal pain : practice guidelines

Nijs, Jo; van Wilgen, Paul C.; van Oosterwijck, Jessica; van Ittersum, Miriam; Meeus, Mira

doi:10.1016/J.MATH.2011.04.005

Title

How to explain central sensitization to patients with 'unexplained' chronic musculoskeletal pain : practice guidelines

Author

Nijs, Jo

van Wilgen, Paul C.

van Oosterwijck, Jessica

van Ittersum, Miriam

Meeus, Mira

Abstract

Central sensitization provides an evidence-based explanation for many cases of 'unexplained' chronic musculoskeletal pain. Prior to commencing rehabilitation in such cases, it is crucial to change maladaptive illness perceptions, to alter maladaptive pain cognitions and to reconceptualise pain. This can be accomplished by patient education about central sensitization and its role in chronic pain, a strategy known as pain physiology education. Pain physiology education is indicated when: 1) the clinical picture is characterized and dominated by central sensitization; and 2) maladaptive illness perceptions are present. Both are prerequisites for commencing pain physiology education. Face-to-face sessions of pain physiology education, in conjunction with written educational material, are effective for changing pain cognitions and improving health status in patients with various chronic musculoskeletal pain disorders. These include patients with chronic low back pain, chronic whiplash, fibromyalgia and chronic fatigue syndrome. After biopsychosocial assessment pain physiology education comprises of a first face-to-face session explaining basic pain physiology and contrasting acute nociception versus chronic pain (Session 1). Written information about pain physiology should be provided as homework in between session 1 and 2. The second session can be used to correct misunderstandings, and to facilitate the transition from knowledge to adaptive pain coping during daily life. Pain physiology education is a continuous process initiated during the educational sessions and continued within both the active treatment and during the longer term rehabilitation program.

Language

English

Source (journal)

Manual therapy / Manipulation Association of Chartered Physiotherapists. - Edinburgh

Publication

Edinburgh : 2011

ISSN

1356-689X

DOI

10.1016/J.MATH.2011.04.005

Volume/pages

16 :5 (2011) , p. 413-418