Central sensitization in chronic pain and medically unexplained symptom research: A systematic review of definitions, operationalizations and measurement instruments

Carine den Boer, Linne Dries, Berend Terluin, Johannes C. van der Wouden, Annette H. Blankenstein, C. Paul van Wilgen, Peter Lucassen, Henriëtte E. van der Horst

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Objective: Central sensitization (CS), a mechanism explaining the persistence of symptoms, has been the focus of many research projects. Explanations given to patients with chronic pain are often based on this mechanism. It is hypothesized that CS also plays an important role in the persistence of medically unexplained symptoms (MUS). However, definitions and operationalizations of CS vary. We conducted a systematic review of definitions, operationalizations and measurement instruments of CS. Methods: We searched in PubMed, EMBASE, PsycINFO, Cinahl and The Cochrane Library till September 2017 and included papers that addressed CS in relation to chronic pain and/or MUS. Two reviewers independently selected, analysed and classified information from the selected publications. We performed a thematic analysis of definitions and operationalizations. We listed the measurement instruments. Results: We included 126 publications, 79 publications concerned chronic pain, 47 publications concerned MUS. Definitions of CS consistently encompass the theme hyperexcitability of the central nervous system (CNS). Additional themes are variably present: CNS locations, nature of sensory input, reduced inhibition and activation and modulation of the NDMA receptor. Hyperalgesia and allodynia are widely mentioned as operationalizations of CS. Quantitative sensory testing (QST) and (f)MRI are the most reported measurement instruments. Conclusions: There is consensus that hyperexcitability is the central mechanism of CS. Operationalizations are based on this mechanism and additional components. There are many measurement instruments available, whose clinical value has still to be determined. There were no systematic differences in definitions and operationalizations between the publications addressing MUS and those addressing chronic pain.

Original languageEnglish
Pages (from-to)32-40
Number of pages9
JournalJournal of Psychosomatic Research
Volume117
DOIs
Publication statusPublished - 1 Feb 2019

Cite this

@article{2df6ea547efa4776841f3766028a3c28,
title = "Central sensitization in chronic pain and medically unexplained symptom research: A systematic review of definitions, operationalizations and measurement instruments",
abstract = "Objective: Central sensitization (CS), a mechanism explaining the persistence of symptoms, has been the focus of many research projects. Explanations given to patients with chronic pain are often based on this mechanism. It is hypothesized that CS also plays an important role in the persistence of medically unexplained symptoms (MUS). However, definitions and operationalizations of CS vary. We conducted a systematic review of definitions, operationalizations and measurement instruments of CS. Methods: We searched in PubMed, EMBASE, PsycINFO, Cinahl and The Cochrane Library till September 2017 and included papers that addressed CS in relation to chronic pain and/or MUS. Two reviewers independently selected, analysed and classified information from the selected publications. We performed a thematic analysis of definitions and operationalizations. We listed the measurement instruments. Results: We included 126 publications, 79 publications concerned chronic pain, 47 publications concerned MUS. Definitions of CS consistently encompass the theme hyperexcitability of the central nervous system (CNS). Additional themes are variably present: CNS locations, nature of sensory input, reduced inhibition and activation and modulation of the NDMA receptor. Hyperalgesia and allodynia are widely mentioned as operationalizations of CS. Quantitative sensory testing (QST) and (f)MRI are the most reported measurement instruments. Conclusions: There is consensus that hyperexcitability is the central mechanism of CS. Operationalizations are based on this mechanism and additional components. There are many measurement instruments available, whose clinical value has still to be determined. There were no systematic differences in definitions and operationalizations between the publications addressing MUS and those addressing chronic pain.",
keywords = "Central sensitivity syndrome, Central sensitization, Chronic pain, Definition, Measurement instruments, Medically unexplained symptoms, Operationalization",
author = "{den Boer}, Carine and Linne Dries and Berend Terluin and {van der Wouden}, {Johannes C.} and Blankenstein, {Annette H.} and {van Wilgen}, {C. Paul} and Peter Lucassen and {van der Horst}, {Henri{\"e}tte E.}",
note = "Copyright {\circledC} 2018 Elsevier Inc. All rights reserved.",
year = "2019",
month = "2",
day = "1",
doi = "10.1016/j.jpsychores.2018.12.010",
language = "English",
volume = "117",
pages = "32--40",
journal = "Journal of Psychosomatic Research",
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Central sensitization in chronic pain and medically unexplained symptom research : A systematic review of definitions, operationalizations and measurement instruments. / den Boer, Carine; Dries, Linne; Terluin, Berend; van der Wouden, Johannes C.; Blankenstein, Annette H.; van Wilgen, C. Paul; Lucassen, Peter; van der Horst, Henriëtte E.

In: Journal of Psychosomatic Research, Vol. 117, 01.02.2019, p. 32-40.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Central sensitization in chronic pain and medically unexplained symptom research

T2 - A systematic review of definitions, operationalizations and measurement instruments

AU - den Boer, Carine

AU - Dries, Linne

AU - Terluin, Berend

AU - van der Wouden, Johannes C.

AU - Blankenstein, Annette H.

AU - van Wilgen, C. Paul

AU - Lucassen, Peter

AU - van der Horst, Henriëtte E.

N1 - Copyright © 2018 Elsevier Inc. All rights reserved.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Objective: Central sensitization (CS), a mechanism explaining the persistence of symptoms, has been the focus of many research projects. Explanations given to patients with chronic pain are often based on this mechanism. It is hypothesized that CS also plays an important role in the persistence of medically unexplained symptoms (MUS). However, definitions and operationalizations of CS vary. We conducted a systematic review of definitions, operationalizations and measurement instruments of CS. Methods: We searched in PubMed, EMBASE, PsycINFO, Cinahl and The Cochrane Library till September 2017 and included papers that addressed CS in relation to chronic pain and/or MUS. Two reviewers independently selected, analysed and classified information from the selected publications. We performed a thematic analysis of definitions and operationalizations. We listed the measurement instruments. Results: We included 126 publications, 79 publications concerned chronic pain, 47 publications concerned MUS. Definitions of CS consistently encompass the theme hyperexcitability of the central nervous system (CNS). Additional themes are variably present: CNS locations, nature of sensory input, reduced inhibition and activation and modulation of the NDMA receptor. Hyperalgesia and allodynia are widely mentioned as operationalizations of CS. Quantitative sensory testing (QST) and (f)MRI are the most reported measurement instruments. Conclusions: There is consensus that hyperexcitability is the central mechanism of CS. Operationalizations are based on this mechanism and additional components. There are many measurement instruments available, whose clinical value has still to be determined. There were no systematic differences in definitions and operationalizations between the publications addressing MUS and those addressing chronic pain.

AB - Objective: Central sensitization (CS), a mechanism explaining the persistence of symptoms, has been the focus of many research projects. Explanations given to patients with chronic pain are often based on this mechanism. It is hypothesized that CS also plays an important role in the persistence of medically unexplained symptoms (MUS). However, definitions and operationalizations of CS vary. We conducted a systematic review of definitions, operationalizations and measurement instruments of CS. Methods: We searched in PubMed, EMBASE, PsycINFO, Cinahl and The Cochrane Library till September 2017 and included papers that addressed CS in relation to chronic pain and/or MUS. Two reviewers independently selected, analysed and classified information from the selected publications. We performed a thematic analysis of definitions and operationalizations. We listed the measurement instruments. Results: We included 126 publications, 79 publications concerned chronic pain, 47 publications concerned MUS. Definitions of CS consistently encompass the theme hyperexcitability of the central nervous system (CNS). Additional themes are variably present: CNS locations, nature of sensory input, reduced inhibition and activation and modulation of the NDMA receptor. Hyperalgesia and allodynia are widely mentioned as operationalizations of CS. Quantitative sensory testing (QST) and (f)MRI are the most reported measurement instruments. Conclusions: There is consensus that hyperexcitability is the central mechanism of CS. Operationalizations are based on this mechanism and additional components. There are many measurement instruments available, whose clinical value has still to be determined. There were no systematic differences in definitions and operationalizations between the publications addressing MUS and those addressing chronic pain.

KW - Central sensitivity syndrome

KW - Central sensitization

KW - Chronic pain

KW - Definition

KW - Measurement instruments

KW - Medically unexplained symptoms

KW - Operationalization

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U2 - 10.1016/j.jpsychores.2018.12.010

DO - 10.1016/j.jpsychores.2018.12.010

M3 - Review article

VL - 117

SP - 32

EP - 40

JO - Journal of Psychosomatic Research

JF - Journal of Psychosomatic Research

SN - 0022-3999

ER -