Applying modern pain neuroscience in clinical practice: Criteria for the classification of central sensitization pain

J. Nijs*, Rafael Torres-Cueco, C. Paul Van Wilgen, Enrique Lluch Girbés, Filip Struyf, Nathalie Roussel, Jessica Van Oosterwijck, Liesbeth Daenen, Kevin Kuppens, Luc Vanderweeën, Linda Hermans, David Beckwée, Lennard Voogt, Jacqui Clark, Niamh Moloney, Mira Meeus

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

210 Citations (Scopus)


Background: The awareness is growing that central sensitization is of prime importance for the assessment and management of chronic pain, but its classification is challenging clinically since no gold standard method of assessment exists.

Objectives: Designing the first set of classification criteria for the classification of central sensitization pain.

Methods: A body of evidence from original research papers was used by 18 pain experts from 7 different countries to design the first classification criteria for central sensitization pain.

Results: It is proposed that the classification of central sensitization pain entails 2 major steps: the exclusion of neuropathic pain and the differential classification of nociceptive versus central sensitization pain. For the former, the International Association for the Study of Pain diagnostic criteria are available for diagnosing or excluding neuropathic pain. For the latter, clinicians are advised to screen their patients for 3 major classification criteria, and use them to complete the classification algorithm for each individual patient with chronic pain. The first and obligatory criterion entails disproportionate pain, implying that the severity of pain and related reported or perceived disability are disproportionate to the nature and extent of injury or pathology (i.e., tissue damage or structural impairments). The 2 remaining criteria are 1) the presence of diffuse pain distribution, allodynia, and hyperalgesia; and 2) hypersensitivity of senses unrelated to the musculoskeletal system (defined as a score of at least 40 on the Central Sensitization Inventory).

Limitations: Although based on direct and indirect research findings, the classification algorithm requires experimental testing in future studies.

Conclusion: Clinicians can use the proposed classification algorithm for differentiating neuropathic, nociceptive, and central sensitization pain.

Original languageEnglish
Pages (from-to)447-457
Number of pages11
JournalPain Physician
Issue number5
Publication statusPublished - 24 Sep 2014
Externally publishedYes


Dive into the research topics of 'Applying modern pain neuroscience in clinical practice: Criteria for the classification of central sensitization pain'. Together they form a unique fingerprint.

Cite this