‘Central sensitization’ in chronic neck/shoulder pain

Background and purpose‘Central sensitization’ (CS) may play a major role in maintaining several chronic pain conditions. CS has been proposed to play a significant role in a range of musculoskeletal pain conditions, such as trapezius myalgia, fibromyalgia, temporomandibular disorders, and low back pain. Whether CS varies over time within an individual is not known. This study evaluated (1) whether there is an intra-individual association between clinical pain and signs of CS, and (2) whether there is an inter-individual association between clinical pain and signs of CS.MethodsTwenty-seven sedentary workers (19 women, 8 men) with varying neck/shoulder pain participated in a pre-test and in two test sessions. On one of the test sessions the subjects had weak (or no) clinical pain (weak-pain day). On the other test session the subjects had stronger clinical pain (strong-pain day). As an indicator of ‘central sensitization’, we assessed the area of secondary pinprick hyperalgesia (tested by 84.4 g/mm2 Von Frey hairs) in response to a first-degree burn to the volar forearm (contact heat, 46 °C, 5 min). While in the lab, the subjects’ current clinical pain intensity (0–10 cm VAS) and distribution was assessed (PINTlab and PDISTlab). The subjects also rated their pain intensity and distribution retrospectively from the past 30 days (PINT30 d and PDIST30 d).ResultsPINTlab was lower on the weak-pain day (1.7 ± 1.5 cm) than on the strong-pain day (4.3 ± 1.6 cm). This was also the case for the other clinical pain measures (PDISTlab, PINT30 d and PDIST30 d) and indicated that the participants were successfully recruited at days that differed in clinical pain severity. Despite a significant intra-individual difference in clinical pain between days, the area of secondary hyperalgesia did not differ between weak- and strong-pain days (50.3 ± 13.5 cm2 vs. 51.2 ± 12.6 cm2). Testing the inter-individual association between clinical pain and secondary hyperalgesia, we found a positive correlation between PINTlab and secondary hyperalgesia on the weak-pain day (rho = 0.6), but not on the strong-pain day (rho = 0.1). Given the stable secondary hyperalgesia across weak- and strong-pain days, this implies that subjects with a small secondary hyperalgesic area exhibited a relatively large variation in clinical pain between days, whereas subjects with a large secondary hyperalgesic area exhibited relatively small variation in clinical pain.ConclusionsWhen subjects are observed across days, ‘central sensitization’, measured as the area of secondary hyperalgesia after a first-degree burn, does not seem to be important for clinical pain intensity per se, but may be important for clinical pain variation. Subjects with indication of low ‘central sensitization’ seem to exhibit larger variation in pain between “good” and “bad” days than subjects with indication of high ‘central sensitization’. The study indicates that ‘central sensitization’ does not explain intra-individual variations in clinical pain.ImplicationsThis study raises the question of the role of ‘central sensitization’ in clinical musculoskeletal pain disorders. Furthermore, a precise definition of the ‘central sensitization’ concept is called for.

► ‘Central sensitization’ does not explain intra-individual variations in clinical pain.
► ‘Central sensitization’ partly explains inter-individual variations in clinical pain.
► Subjects with indication of low ‘central sensitization’ seem to exhibit larger variation in pain between “good” and “bad” days than subjects with indication of high ‘central sensitization’.