den Boer Carine, Terluin Berend, van Wilgen C Paul
Amsterdam AMC, locatie VUmc, afd. Huisartsgeneeskunde, Amsterdam.
Contact: Carine den Boer (
Ned Tijdschr Geneeskd. 2020 Oct 1;164:D4642.
Doctors and patients are often not satisfied about the treatment of medically unexplained symptoms (MUS) and chronic pain. Central sensitization (CS) plays an important role in chronic pain and regularly also in MUS and can be used for explanation to these patients. This explanation can cause acceptance and understanding, leading to cessation of further diagnostics and unnecessary treatments. Thereafter the patient will be able to work on reduction of the symptoms, using the biopsychosocial model. The central mechanism of CS is hyperexcitability of the central nervous system. The most important symptoms of CS are: (a) an increased sensitivity to painful stimuli (hyperalgesia), (b) a painful perception of non-painful stimuli (allodynia) and (c) a reduced inhibition of signals from the brain to the body. This can be demonstrated with physical tests. CS can be explained to the patient with a simple model about the functioning of the nervous system.
医生和患者常常对医学上无法解释的症状（MUS）及慢性疼痛的治疗不满意。中枢敏化（CS）在慢性疼痛中起着重要作用，在MUS中通常也起作用，并且可用于向这些患者进行解释。这种解释能够引起患者的接受和理解，从而停止进一步的诊断和不必要的治疗。此后，患者将能够运用生物心理社会模型致力于减轻症状。CS的核心机制是中枢神经系统的过度兴奋性。CS的最重要症状包括：（a）对疼痛刺激的敏感性增加（痛觉过敏），（b）对非疼痛刺激产生疼痛感觉（感觉异常），以及（c）大脑向身体发出的信号抑制作用减弱。这可以通过体格检查来证实。可以用一个关于神经系统功能的简单模型向患者解释CS。
