Tomašević-Todorović Snežana, Spasojević Tijana
University of Novi Sad, Faculty of Medicine Novi Sad, Medical Rehabilitation Clinic, University Clinical Center of Vojvodina, Novi Sad, Serbia.
Acta Clin Croat. 2023 Nov;62(Suppl4):102-106. doi: 10.20471/acc.2023.62.s4.15.
Central sensitization is the mechanism of nociplastic pain and leads to an overemphasized response to a painful stimulus (hyperalgesia) or pain to stimuli that do not otherwise cause pain (allodynia). Persistent nociceptive pain is a risk factor for nociplastic pain, which can often occur in isolation or combination with other types of pain, most often in patients with chronic musculoskeletal pain (osteoarthritis, lumbar and cervical syndrome, fibromyalgia, rheumatoid arthritis, complex regional pain syndrome, tendinopathy, etc.). Diagnosis of central sensitization is established through clinical examination, questionnaires and quantitative sensory testing (QST), which serves to assess and quantify sensory functions, i.e., determine the threshold for detection of sensory stimuli (heat-cold, pressure, vibration). Conditioned Pain Modulation (CPM) testing is important for clarifying pain modulation profiles, which can be pro-nociceptive (less effective CPM facilitation) and anti-nociceptive (effective, inhibitory CPM effect). In the pronociceptive modulation profile that is common in patients with musculoskeletal disorders, there is a higher risk of developing chronic pain, a higher prevalence of pain conditions and higher pain associated with injury. CPM testing is also important in the individualization of drug therapy for pain, based on predicting the effectiveness of drugs in the treatment.
中枢敏化是伤害性感受性疼痛的机制，会导致对疼痛刺激的反应过度增强（痛觉过敏），或对原本不会引起疼痛的刺激产生疼痛（痛觉异常）。持续性伤害性疼痛是伤害性感受性疼痛的一个危险因素，后者通常可单独出现或与其他类型的疼痛合并出现，最常见于慢性肌肉骨骼疼痛患者（骨关节炎、腰颈综合征、纤维肌痛、类风湿关节炎、复杂性区域疼痛综合征、肌腱病等）。中枢敏化的诊断通过临床检查、问卷和定量感觉测试（QST）来确定，QST用于评估和量化感觉功能，即确定感觉刺激（热-冷、压力、振动）的检测阈值。条件性疼痛调制（CPM）测试对于明确疼痛调制模式很重要，疼痛调制模式可为促伤害性感受性（CPM促进作用较弱）和抗伤害性感受性（有效、抑制性CPM效应）。在肌肉骨骼疾病患者中常见的促伤害性感受性调制模式下，发生慢性疼痛的风险更高、疼痛状况的患病率更高，且与损伤相关的疼痛更严重。基于预测药物治疗的有效性，CPM测试在疼痛药物治疗的个体化方面也很重要。
