What are the Predictive Factors for Central Sensitisation in
Chronic Musculoskeletal Pain Populations? A Systematic Review
Jacqui Clark1,2,3, Jo Nijs2,3, Gillian Yeowell 1, Peter Goodwin1
University, Faculty of Health, Psychology and Social Care, UK
2Vrije Universiteit Brussel,
Faculty of Physical Education and Physiotherapy, Brussels, Belgium
3Pain in Motion International
Introduction: Central Sensitisation (CS) is
the predominant pain mechanism in a proportion of chronic musculoskeletal pain
disorders and is associated with poor outcomes. Although existing studies predict
poor outcomes such as persistent pain and disability, to date there is little
consensus on what factors specifically predict CS.
Aim: To review the existing literature on the
predictive factors for CS in musculoskeletal pain populations.
Methods: Using supplemented PRISMA
guidelines, a systematic
search was performed by two mutually blinded reviewers. Relevant articles were screened
by title and abstract from Medline, Embase, PubMed, CINAHL and Web of Science electronic
databases. Alternative sources were also sought to locate missed potential
articles. Eligibility included baseline measurements taken at the pre-morbid or
acute stage; > 3 month follow-up time after pain onset and CS-specific
primary outcome measures. Risk of Bias was assessed using the QUIPS tool. Study
design, demographics, musculoskeletal region, inclusion / exclusion criteria, measurement
timelines, predictor and primary outcome measures and results were extracted.
Data was synthesized qualitatively and strength of evidence was scored using
the GRADE scoring system.
Results: Nine eligible articles were
located, in various musculoskeletal populations (whiplash, n=2; widespread
pain, n=5; temporomandibular disorder, n=2). Moderate evidence was found for two
predictive factors of CS: 1) high sensory sensitivity (using genetic testing or
quantitative sensory tests), 2) psychological factors (somatisation and poor
self-expectation of recovery), at pre-morbid or acute stage baseline.
Conclusion: Premorbid and acute stage high
sensory sensitivity and/or somatization are the strongest predictors of CS in
chronic musculoskeletal pain to date. This is the first systematic review
specifically targeting CS as the primary outcome in musculoskeletal pain
populations. Early identification of people at risk of developing chronic pain
with CS may guide clinicians in appropriate management, diminishing the burden
of persistent pain on patients and heath care providers alike.