Is chronic pain caused by central sensitization? A review and critical point of view

• Published in: Neuroscience and biobehavioral reviews Vol. 167; p. 105886
• Main Authors: Velasco, Enrique, Flores-Cortés, Mar, Guerra-Armas, Javier, Flix-Díez, Laura, Gurdiel-Álvarez, Francisco, Donado-Bermejo, Aser, van den Broeke, Emanuel N., Pérez-Cervera, Laura, Delicado-Miralles, Miguel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.12.2024
• Subjects: Central sensitization; Chronic pain; Neurophysiology; Pain behaviour; Central sensitization; Pain behaviour; Chronic pain; Neurophysiology
• ISSN: 0149-7634; 1873-7528; 1873-7528
• DOI: 10.1016/j.neubiorev.2024.105886

Chronic pain causes disability and loss of health worldwide. Yet, a mechanistic explanation for it is still missing. Frequently, neural phenomena, and among them, Central Sensitization (CS), is presented as causing chronic pain. This narrative review explores the evidence substantiating the relationship between CS and chronic pain: four expert researchers were divided in two independent teams that reviewed the available evidence. Three criteria were established for a study to demonstrate a causal relationship: (1) confirm presence of CS, (2) study chronic pain, and (3) test sufficiency or necessity of CS over chronic pain symptoms. No study met those criteria, failing to demonstrate that CS can cause chronic pain. Also, no evidence reporting the occurrence of CS in humans was found. Worryingly, pain assessments are often confounded with CS measures in the literature, omitting that the latter is a neurophysiological and not a perceptual phenomenon. Future research should avoid this misconception to directly interrogate what is the causal contribution of CS to chronic pain to better comprehend this problematic condition. [Display omitted] •It is not demonstrated that Central Sensitization causes Chronic Pain.•The occurrence of Central Sensitization in humans is yet to be investigated.•A part of the bibliography misunderstands what Central Sensitization is.•Questionnaires and evoked-pain responses measure pain, not Central Sensitization.•To measure Central Sensitization is necessary to record neural activity.