As a physical therapist, one of the most complicated and frustrating disorders for me to treat was chronic pain. This was until I began to study the neural mechanisms behind pain and begin to understand the much more complex system at play in many of my patient’s conditions. A recent classification system has been developed to help other medical professionals determine what neural mechanisms are contributory to a patient’s pain. The old model of defining pain is time based and describes pain as either acute (<3 months) or chronic (>3 months). This system is obviously easily adminisered and labeled but due to the relatively unpredictable nature of pain, this classification has little validity in its actual relationship to a condition’s triggering of a pain output. The newly proposed alternative pain classification system has been validated and appears to be a better option when applying a label. The system has shown that clinicians are able to discriminate pain as either nociceptive, peripheral neuropathic or central sensitization. As physical therapists, we often do a rather good job at recognizing, understanding and treating conditions which are nociceptive or peripheral neuropathic but often label individuals in central sensitization as difficult, noncompliant, etc. This is likely because the pain is difficult to isolate, doesn’t make sense anatomically and is often associated with psychological variables. In this series of articles, I want to describe how central sensitization occurs, how we can recognize and more importantly, how we can intervene to treatment.
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