Central hyperexcitability in chronic musculoskeletal pain: A conceptual breakthrough with multiple clinical implications
Recent investigations of dysfunctional pain processing in the
central nervous system have contributed much knowledge
about the development of chronic musculoskeletal pain.
Many common chronic musculoskeletal pain syndromes -
including regional myofascial pain syndromes, whiplash
pain syndromes, refractory work-related neck-shoulder
pain, certain types of chronic low back pain, fibromyalgia
and others - may essentially be explained by abnormalities
in central pain modulation.
The growing awareness of dysfunctional central pain
modulation may be a conceptual breakthrough leading
to a better understanding of common chronic pain disorders.
A new paradigm will have multiple clinical implications,
including re-evaluation of clinical practice routines
and rehabilitation methods, and will focus on controversial
issues of medicolegal concern. The concept of dysfunctional
central pain processing will also necessitate a mechanism-based
classification of pain for the selection of individual
treatment and rehabilitation programs for subgroups
of patients with chronic musculoskeletal pain due to
different pathophysiological mechanisms.