Central pain mechanisms in chronic pain states--maybe it is all in their head

Best Pract Res Clin Rheumatol. 2011 Apr;25(2):141-54. doi: 10.1016/j.berh.2011.02.005.

Abstract

Mechanisms underlying chronic pain differ from those underlying acute pain. In chronic pain states, central nervous system (CNS) factors appear to play particularly prominent roles. In the absence of anatomical causes of persistent pain, medical sub-specialities have historically applied wide-ranging labels (e.g., fibromyalgia (FM), irritable bowel syndrome, interstitial cystitis and somatisation) for what now is emerging as a single common set of CNS processes. The hallmark of these 'centrally driven' pain conditions is a diffuse hyperalgesic state identifiable using experimental sensory testing, and corroborated by functional neuroimaging. The characteristic symptoms of these central pain conditions include multifocal pain, fatigue, insomnia, memory difficulties and a higher rate of co-morbid mood disorders. In contrast to acute and peripheral pain states that are responsive to non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, central pain conditions respond best to CNS neuromodulating agents, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and anticonvulsants.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenergic Uptake Inhibitors / therapeutic use
  • Analgesics, Opioid / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Anticonvulsants / therapeutic use
  • Central Nervous System Diseases / diagnosis*
  • Central Nervous System Diseases / drug therapy
  • Central Nervous System Diseases / physiopathology
  • Chronic Pain / diagnosis*
  • Chronic Pain / drug therapy
  • Chronic Pain / physiopathology
  • Fibromyalgia / complications
  • Fibromyalgia / diagnosis*
  • Fibromyalgia / drug therapy
  • Fibromyalgia / physiopathology
  • Functional Neuroimaging
  • Humans
  • Hyperalgesia / pathology
  • Hyperalgesia / physiopathology
  • Osteoarthritis / complications
  • Osteoarthritis / diagnosis
  • Osteoarthritis / physiopathology
  • Pain / diagnosis
  • Pain / etiology
  • Pain / physiopathology
  • Peripheral Nervous System Diseases / diagnosis*
  • Peripheral Nervous System Diseases / drug therapy
  • Peripheral Nervous System Diseases / physiopathology
  • Serotonin Uptake Inhibitors / therapeutic use
  • Syndrome

Substances

  • Adrenergic Uptake Inhibitors
  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticonvulsants
  • Serotonin Uptake Inhibitors