The Role of Central Sensitization in Chronic Pain of Rheumatic Diseases

Hye-Soon Lee

doi:10.7599/hmr.2014.34.2.81

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Lee: The Role of Central Sensitization in Chronic Pain of Rheumatic Diseases

Review Article

Hanyang Medical Reviews 2014; 34(2): 81-86.

Published online: 23 May 2014

DOI: https://doi.org/10.7599/hmr.2014.34.2.81

The Role of Central Sensitization in Chronic Pain of Rheumatic Diseases

Hye-Soon Lee

Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.

Correspondence to: Hye-Soon Lee. Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Korea. Tel: +82-31-560-2114, Fax: +82-31-553-7369, lhsberon@hanyang.ac.kr

Received 9 March 2014 Revised 15 April 2014 Accepted 19 April 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pain is the most common symptom of almost all rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, osteoarthritis, fibromyalgia, and others. In addition to commonly known peripheral or nociceptive pain mechanisms, central sensitization plays an essential and significant role as a cause of chronic pain in rheumatic diseases. Chronic pain is also associated with several psychiatric diseases such as depression and anxiety disorders and other various central pain maladies such as irritable bowel syndrome and temporomandibular joint disorder. Therefore, many researchers and clinicians have inferred that similar therapeutic strategies may be employed against this spectrum of disorders. Utilizing recently gained understanding of chronic pain mechanisms will allow a targeted therapeutic approach to individuals who have rheumatologic disease with different spectrum of symptomatic severity and disability.

Keywords: Rheumatic Diseases, Chronic Pain, Central Nervous System Sensitization, Mental Disorders

Figures and Tables

Fig. 1

Normal pain processing pathway. Modified from Ref. 6 with permission from Wolters Kluwer Health.

Table 1

Classification of pain in rheumatic diseases according to history taking and physical examination

Table 2

Classification of chronic pain according to mechanistic characteristics

NSAID, nonsteroidal anti-inflammatory drug; DMARDs, disease modifying antirheumatic drugs; TCA, tricyclic antidepressant.

Table 3

Neurotransmitters in the central nervous system that facilitate or inhibit pain transmission

GABA, gamma-aminobutyric acid.

Table 4

Pharmacologic treatments of fibromyalgia

SNRI, serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor.

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