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Jo Nijs
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=== Treating central sensitization === Together with long-time collaborator [[Mira Meeus]], Nijs wrote two reviews<ref name="Options2011" /><ref name="NijsCS2014" /> on the treatment of CS. Special attention goes to medications that target central pathways of the pain response. One example is acetaminophen (paracetamol) that reinforces the inhibitory serotonergic pathway. Meeus & Nijs tested this in ME/CFS patients with comorbid fibromyalgia. Though pain thresholds rose, there was no influence on temporal summation or conditioned pain modulation.<ref name="MeeusAce2013" /> [[Selective serotonin reuptake inhibitor]]s (SSRIs) also activate the serotonergic descending pathways. In a 2011 study, Meeus & Nijs gave their test subjects intravenous SSRI ([[citalopram]]) but the trial had to be stopped prematurely, since the medication caused too many side-effects.<ref name="MeeusSero2011" /> [[Opioid]]s form another option, although these drugs are now restricted and rather controversial because they can lead to [[substance use disorder|addiction]]<ref name="OpioidRisk">{{Cite web | url = http://www.medscape.com/viewarticle/547066 | title = Prescribing Opioids for Chronic Pain| website = Medscape |language=en|access-date=2022-04-03}}</ref> and cause selective pain sensitization. In 2017 Meeus & Nijs tested [[morphine]] and [[naloxone]] (an opioid antagonist) against a placebo, but the results were rather bleak: <blockquote>"[...] neither morphine nor naloxone influenced deep tissue pain, temporal summation or CPM. Therefore, these results suggest that the opioid system is not dominant in (enhanced) bottom-up sensitization (temporal summation) or (impaired) endogenous pain inhibition (CPM) in patients with CFS/FM or RA."<ref name="Hermans, 2017" /></blockquote>There are other therapeutic options to treat central sensitization like N-methyl-D-aspartate –receptor antagonists (e.g. ketamine), GABA-antagonists (e.g. pregabalin) or a ketogenic diet. Nijs & Meeus also propose exercise therapy and emphasize that a time-contingent approach is preferable in treating CS:<blockquote>"A symptom-contingent approach may facilitate the brain in its production of nonspecific warning signs like pain, whereas a time-contingent approach may deactivate brain-orchestrated top-down pain facilitatory pathways."<ref name="NijsCS2014" /></blockquote>The authors do however caution that this approach might not work in every CS-patient group: <blockquote>"[...] some patients with CS pain, including those with chronic whiplash associated disorders , chronic fatigue syndrome and fibromyalgia, are unable to activate endogenous analgesia following exercise. It remains to be established whether long-term exercise therapy accounting for the dysfunctional endogenous analgesia is able to 'treat' CS in these patients."<ref name="NijsCS2014" /></blockquote>
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