"Centralization of pain is a pathologic state that results from microglial activation, neuroinflammation, metabolic disturbances, tissue destruction, and neuronal sensitization. In addition to constant pain, a number of physiologic abnormalities occur, including sleep interference, fatigue, and depression. There is hyper-stimulation of the hypothalamic-pituitary-adrenal axis and the autonomic-sympathetic nervous systems.
As a result of the many pathologic aberrations caused by pain centralization, the patient may be so physiologically and psychologically impaired that they become reclusive, antisocial, and unable to carry out activities of daily living. Due to the many facets of this process, it is clinically appropriate to refer to this state as central pain syndrome or chronic pain syndrome because these 2 labels are listed as such in the ICD. If other terms not listed in the ICD, such as neuropathic, sensitization, intractable, or persistent, are clinically used as labels, it is recommended that the term central or peripheral be attached to indicate if centralization has occurred.
The recognition and treatment of centralized pain probably is the biggest unmet need in pain management. At this time, the incidence and prevalence of centralized pain is not known precisely, but it undoubtedly ranks as one of the biggest public health problems in America. The aging population may increase the prevalence of centralization.
This consensus task force highly recommends that every chronic pain patient in every clinical setting be evaluated for the presence of pain centralization. The historical hallmarks of centralization are constant pain, sleep interference, and fatigue. The presence of pain centralization should be noted in a patient’s record and its clinical ramifications and prognosis communicated to all concerned parties."
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