Applying modern pain neuroscience in physiotherapy practice

APPLYING MODERN PAIN NEUROSCIENCE IN PHYSIOTHERAPY PRACTICE: DIFFERENTIAL DIAGNOSIS BETWEEN NOCICEPTIVE, NEUROPATHIC AND CENTRAL SENSITIZATION PAIN

Presenter: Jo Nijs

The awareness is growing that central sensitization is of prime importance

for the assessment and management of chronic pain, but its classification is

challenging clinically since no gold standard method of assessment exists.

In order to select an effective and preferably also efficient treatment

in daily clinical practice, pain patients should be classified clinically as

either predominantly nociceptive, neuropathic or central sensitization

pain. Therefore a body of evidence from original research papers was

used by 18 pain experts from seven different countries to design the first

classification criteria for central sensitization pain. It is proposed that

the mechanism-based classification of pain entails two major steps: the

diagnosis or exclusion of neuropathic pain and the differential classification

of predominant nociceptive versus central sensitization pain. For the

former, the International Association for the Study of Pain diagnostic

criteria are available for diagnosing or excluding neuropathic pain. For

the latter, clinicians are advised to screen their patients for three major

classification criteria, and use them to complete the classification algorithm

for each individual patient with chronic pain. The first and obligatory

criterion entails disproportionate pain, implying that the severity of pain

are disproportionate to the nature and extent of injury or pathology (i.e.

tissue damage or structural impairments). The two remaining criteria are:

1) the presence of diffuse pain distribution (i.e. neuroanatomical illogical

pain pattern), allodynia and hyperalgesia; and 2) hypersensitivity of senses

unrelated to the musculoskeletal system (defined as a score of at least

40 on the Central Sensitization Inventory). Although based on direct and

indirect research findings (i.e. several original research findings including

a Delphi survey, a study of a large group of low back pain patients, and

validation studies of the Central Sensitization Inventory), the classification

algorithm requires experimental testing in future studies. Clinicians can

use the proposed classification algorithm for differentiating predominant

neuropathic, nociceptive and central sensitization pain. The classification

criteria were recently adopted to the low back pain population and cancer

survivors suffering from pain .

CPD Points: 0.5