Central Sensitization and Chronic Overlapping Pain Conditions: Neuroplasticity Gone Wrong

Central Sensitization & Chronic Overlapping Pain Conditions: Neuroplasticity Gone Wrong

Outcomes

Learners completing this activity routinely report improved abilities in:

• Assessing 2 types central sensitization
• Identifying the cumulative effect of multiple pain generators
• Adopting a multifactorial approach to the patient with respect to integration of various causes for their pain
• Recognize failing pain treatments
• Conducting a comprehensive assessment
• Treating pain
• Communicating with patients

Learning Objectives

As a result of participating in this activity, learners will be better able to:

• Assess persons with chronic pain for multiple pain conditions and treat the patient as a whole
• Use the constellation of symptoms to address and treat the underlying mechanisms

Activity Outline

• Neuroplasticity and Central Sensitization
• Central Sensitization (CS)
• Chronic Overlapping Pain Conditions (COPCs)
• Evidence for CS in COPCs
• Clinical Implications of CS

Desirable Physician Attributes

• Medical Knowledge [ACGME/ABMS] about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
  
• Employ Evidenced-based Practice [IOM] Integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible
• Patient Care [ACGME/ABMS] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health

Pain management domains and core competencies

• 1. Multidimensional nature of pain: What is pain?
  • Demonstrates knowledge of the theories and science for understanding the physiology of pain and pain transmission

Accreditation & Designation

Release date: This activity was released 8/15/2020.

Termination date: The content of this activity remains eligible for CME Credit until 8/14/2023, unless reviewed or amended prior to this date.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this other activity (blended learning) for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships

Neither the speaker, peer reviewers nor any other person with control of, or responsibility for, the development, management, presentation or evaluation of the CME activity has, or has had within the past 12 months, any relevant financial relationships to disclose. This includes any relationships of an involved person's spouse/partner.

Additional Reading

1. Maixner, W., Fillingim, R. B., Williams, D. A., Smith, S. B., & Slade, G. D. (2016). Overlapping chronic pain conditions: implications for diagnosis and classification. The Journal of Pain, 17(9), T93-T107.
2. Levitt, A. E., Galor, A., Chowdhury, A. R., Felix, E. R., Sarantopoulos, C. D., Zhuang, G. Y., ... & Levitt, R. C. (2017). Evidence that dry eye represents a chronic overlapping pain condition. Molecular pain, 13, 1744806917729306.
3. Pelletier, R., Higgins, J., & Bourbonnais, D. (2015). Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders?. BMC Musculoskeletal Disorders, 16(1), 25.
4. Latremoliere, A., & Woolf, C. J. (2009). Central sensitization: a generator of pain hypersensitivity by central neural plasticity. The Journal of Pain, 10(9), 895-926.
5. Woolf, C. J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152(3), S2-S15.
6. Ohrbach, R., Fillingim, R. B., Mulkey, F., Gonzalez, Y., Gordon, S., Gremillion, H., ... & Maixner, W. (2011). Clinical findings and pain symptoms as potential risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study. The Journal of Pain, 12(11), T27-T45.
7. Ohrbach, R., & Dworkin, S. F. (2019). AAPT diagnostic criteria for chronic painful Temporomandibular disorders. The Journal of Pain, 20(11), 1276-1292.
   
8. Fillingim, R. B., Loeser, J. D., Baron, R., & Edwards, R. R. (2016). Assessment of chronic pain: Domains, methods, and mechanisms. The Journal of Pain, 17(9), T10-T20.
9. Slade, G. D., Rosen, J. D., Ohrbach, R., Greenspan, J. D., Fillingim, R. B., Parisien, M., ... & Bair, E. (2019). Anatomical selectivity in overlap of chronic facial and bodily pain. Pain Reports, 4(3).
10. King, C. D., Sibille, K. T., Goodin, B. R., Cruz-Almeida, Y., Glover, T. L., Bartley, E., ... & Fessler, B. J. (2013). Experimental pain sensitivity differs as a function of clinical pain severity in symptomatic knee osteoarthritis. Osteoarthritis and Cartilage, 21(9), 1243-1252.
11. Greenspan, J. D., Slade, G. D., Bair, E., Dubner, R., Fillingim, R. B., Ohrbach, R., ... & Maixner, W. (2013). Pain sensitivity and autonomic factors associated with development of TMD: the OPPERA prospective cohort study. The Journal of Pain, 14(12), T63-T74.
12. Slade, G. D., Sanders, A. E., Ohrbach, R., Fillingim, R. B., Dubner, R., Gracely, R. H., ... & Greenspan, J. D. (2014). Pressure pain thresholds fluctuate with, but do not usefully predict, the clinical course of painful temporomandibular disorder. Pain, 155(10), 2134-2143.
13. Carlesso, L. C., Segal, N. A., Frey‐Law, L., Zhang, Y., Na, L., Nevitt, M., ... & Neogi, T. (2019). Pain susceptibility phenotypes in those free of knee pain with or at risk of knee osteoarthritis: the multicenter osteoarthritis study. Arthritis & Rheumatology, 71(4), 542-549.
14. Alshuft, H. M., Condon, L. A., Dineen, R. A., & Auer, D. P. (2016). Cerebral cortical thickness in chronic pain due to knee osteoarthritis: the effect of pain duration and pain sensitization. PLoS One, 11(9), e0161687.
15. McCloy, K., & Peck, C. (2020). Common Factors in the Presentation and Management of Chronic Temporomandibular Disorders and Chronic Overlapping Pain Disorders. Journal of Oral Pathology & Medicine.
16. Lewis, G. N., Parker, R. S., Sharma, S., Rice, D. A., & McNair, P. J. (2018). Structural brain alterations before and after total knee arthroplasty: A longitudinal assessment. Pain Medicine, 19(11), 2166-2176.
17. Ahn, H., Woods, A. J., Kunik, M. E., Bhattacharjee, A., Chen, Z., Choi, E., & Fillingim, R. B. (2017). Efficacy of transcranial direct current stimulation over primary motor cortex (anode) and contralateral supraorbital area (cathode) on clinical pain severity and mobility performance in persons with knee osteoarthritis: An experimenter-and participant-blinded, randomized, sham-controlled pilot clinical study. Brain Stimulation, 10(5), 902-909.
18. Nascimento, S. S., Oliveira, L. R., & DeSantana, J. M. (2018). Correlations between brain changes and pain management after cognitive and meditative therapies: a systematic review of neuroimaging studies. Complementary Therapies in Medicine, 39, 137-145.
19. Seminowicz, D. A., Shpaner, M., Keaser, M. L., Krauthamer, G. M., Mantegna, J., Dumas, J. A., ... & Naylor, M. R. (2013). Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain. The Journal of Pain, 14(12), 1573-1584.
20. Cunningham, N. R., Kashikar-Zuck, S., & Coghill, R. C. (2019). Brain mechanisms impacted by psychological therapies for pain: identifying targets for optimization of treatment effects. Pain Reports, 4(4).