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
1Manchester Metropolitan University, Faculty of Health, Psychology and Social Care, UK
2Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Brussels, Belgium
3Pain in Motion International Research Collaboration

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.

ResultsNine 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.