Editorial Review (Thematic Issue: An Update on Central Sensitivity Syndromes and the Issues of Nosology and Psychobiology)
Muhammad B. Yunus.
Central sensitization (CS), simply defined as an amplified response of the central
nervous system to peripheral input, is a concept of great importance in clinical medicine. It has
helped to explain aspects of the pathophysiology of common diseases, e.g. fibromyalgia
syndrome (FMS), irritable bowel syndrome, vulvodynia, headaches, chronic pelvic pain and other
overlapping conditions (collectively called central sensitivity syndromes, or CSS). It also applies
to pain of complex regional pain syndrome, osteoarthritis (OA), rheumatoid arthritis (RA) and
post-operative pain. The pathology-pain gap in CSS is readily explained by CS. Many FMS and
other CSS patients have peripheral pathology, e.g. nociceptive areas in the muscles, arthritis,
small fiber neuropathy and inflammation. Pro-inflammatory cytokines are elevated in some patients. Identification
of CS in patients with structural pathology, e.g. OA and RA, has helped to explain why not all patients benefit from
nonsteroidal anti-inflammatory drugs or joint replacement surgery, and require therapy directed at CS. Glial cells are
important in pain processing. Remarkable advances have been achieved in neuroimaging, including visualization of
grey matter and white matter, not only during provoked pain but also pain at rest. Based on CS mechanisms,
targeted individual therapy may now be possible. Appropriate nosology is important particularly for effective patient
care. Dichotomy of neurochemical-structural (“functional”) and structural (“organic”) pathology should be
abandoned; many patients have both. Psychobiology is also biology. Patient-blaming terms like somatization,
somatizer and catastrophizing should be avoided. For therapy, both pharmacological and non- pharmacological
approaches are important, including recognition of subgroups and person/patient-centered care.
Keywords: Central sensitization, central sensitivity syndromes, fibromyalgia, nosology, overlapping syndromes, psychology,
somatization, peripheral pathology, small fiber neuropathy, chronic pain, functional syndromes.
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