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Central sensitization
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== Criticism == === Central sensitization only involves pain === Several researchers have questioned the expansion of the concept of central sensitization. Per Hansson for example wrote that “a significant body of human experimental and clinical literature interprets a multitude of symptoms and signs as expressions of CS, to an extent that is not supported by current research evidence.”<ref name="Hansson2014" /> A Belgian research group made the same argument: <blockquote>“We argue that CS, as defined by the International Association for the Study of Pain, refers to changes in nociceptive neurons only and therefore cannot be applied to enhanced responses to stimuli other than nociceptive and/or pain. Moreover, the evidence for CS in widespread pain (other than secondary hyperalgesia) and many other conditions is scarce to absent.”<ref>{{Cite journal | last = van den Broeke | first = Emanuel N. | last2 = Torta | first2 = Diana M. | last3 = Van den Bergh | first3 = Omer | date = 2018-07-02 | title = Central Sensitization: Explanation or Phenomenon? | url = http://dx.doi.org/10.1177/2167702618781804 | journal = Clinical Psychological Science | pages = 216770261878180|doi=10.1177/2167702618781804|issn=2167-7026}}</ref> </blockquote> === Overly broad use of central sensitization === In its definition, the [[International Association for the Study of Pain]] warns against using a too broad use of the term (central) sensitization: <blockquote>“This is a neurophysiological term that can only be applied when both input and output of the neural system under study are known, e.g., by controlling the stimulus and measuring the neural event. Clinically, sensitization may only be inferred indirectly from phenomena such as [[hyperalgesia]] or [[allodynia]].”<ref name="terms" /> </blockquote>Phillips and Clauw suggest the use of other terms such as ‘central pain’ or ‘central augmentation’ instead of CS, given that the term CS was originally used in the context of a sustained peripheral noxious input in an experimental (not a clinical) setting.<ref>{{Cite journal | last = Phillips | first = Kristine | last2 = Clauw | first2 = Daniel J. | date = 2013-01-28 | title = Review: Central pain mechanisms in the rheumatic diseases: Future directions |url =http://dx.doi.org/10.1002/art.37739 | journal = Arthritis & Rheumatism | volume = 65 | issue = 2 | pages = 291–302|doi=10.1002/art.37739|issn=0004-3591|quote= | authorlink = | author-link2 = Daniel Clauw|via=}}</ref> Katsuhiro Toda questioned the need for CS-pain as a separate category next to neuropathic and nociceptive pain, as was suggested by the 2014 CS-criteria: <blockquote> “[…] differentiation between lesion/disease and dysfunction in the central nervous system makes no sense. Parkinson’s disease and multiple sclerosis were functional diseases in the sixth century. In all likelihood, dysfunction of the central nervous system in patients with CS pain such as fibromyalgia will be lesion in the twenty-fourth century. Differentiating CS pain from neuropathic pain confuses clinical practice. CS pain should be included in (central) neuropathic pain.”<ref>{{Cite journal | last = Toda | first = Katsuhiro | date = Nov 2014 | title = Central sensitization pain should be included in (central) neuropathic pain | url =https://www.ncbi.nlm.nih.gov/pubmed/25415794 | journal = Pain Physician | volume = 17 | issue = 6| pages = E783|issn=2150-1149|pmid=25415794}}</ref></blockquote> === A popular myth? === Cervero (2014) has questioned the popularity and widespread acceptance of central sensitization despite the limited evidence base.<ref name="Myth2014" />
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