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Feature Article

Identifying central mechanisms in musculoskeletal pain

Geoffrey O Littlejohn, Emma Guymer

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Abstract

Central pain has an important role in the pathophysiology of numerous musculoskeletal pain disorders and should be considered in patients who present with persisting pain, stiffness and other key symptoms suggestive of central sensitisation.

Key Points

  • Central pain, which predominantly results from abnormal neurophysiological processes in the central nervous system, has an important role in the pathophysiology of numerous musculoskeletal pain disorders.
  • Referred pain underlies many musculoskeletal pain presentations and involves central mechanisms within the spinal cord.
  • Fibromyalgia is the prototypical example of central pain; many of the symptoms and signs of fibromyalgia are essentially those of referred pain.
  • Fibromyalgia should always be considered in patients with persisting pain, stiffness and other characteristic symptoms.
  • Identification of central pain mechanisms as a component of a patient’s presentation shifts management towards strategies that target central pain modulation.

    Picture credit: © kostudios.com

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