So our final trip into pain science for the time being will be to look at this article and learn how to spot central sensitization.
The article suggests looking first at the medical diagnosis and history the patient has. The following conditions have central sensitization as a characteristic of the disorder:
— chronic whiplash associated disorders
— chronic fatigue syndrome
— irritable bowel syndrome
Whereas these have central sensitization present in some cases:
— chronic low back pain
— (sub) acute whiplash associated disorders
— temporomandibular disorders
— myofascial pain syndrome
— rheumatoid arthritis
— chronic headache
So start there. Then look at the history and symptoms that patients is complaining of, looking specifically for hypersensitivity to the follow:
— mechanical pressure
Then the following complaints may also be related to central sensitization and worthwhile asking about:
— sleep disturbances
— unrefreshing sleep
— concentration difficulties
— swollen limbs
If the patient has a condition associated with central sensitization, reports of a few or more symptoms related to central sensitization, then you can jump to special tests for central sensitization. None of these directly indicates central sensitization, but if a couple of them turn up positive, you’ve probably found your culprit.
— pressure pain thresholds at sites remote to symptomatic area– below 4kg/cm2 on pressure algometer in area 3 or more spinal segments away from area which is painful.
— touch sensitivity at remote sites– increased sensitivity to palpation at site as above
— vibration sensitivity at remote sites– pain to vibration a few seconds in area as above
— heat sensitivity at remote sites– pain to hot pack a few seconds in area as above
— cold sensitivity at remote sites– pain to cold pack a few seconds in area as above
— pressure pain thresholds during and following exercise– Patient cycles on bike at constant speed. Resistance is gradually increased. While doing this, test pressure pain threshold at site distant to symptomatic area. Normal=pain decreases as activity increases.
— joint end feel (no detail provided)
— brachial plexus provocation test– bilateral positive of below
Besides diagnosis, these tests can also be used as outcomes measures to determine the severity and also to determine the treatment parameters of manual treatments used in subsequent sessions.