How to Measure and Treat Central Sensitization in the Clinic

Overview:

Dr. Sinead Dufour and Carolyn Vandyken are joined by three international clinicians and researchers for this online course that examines the question: 

How do we measure Central Sensitization in the clinic and what is its clinical relevance?

Research is clear that central pain mechanisms are a significant contributor to persistent pain, captured in the concept of nociplastic pain.  
 
Nociplastic pain helps us to understand conditions such as: 

• Fibromyalgia
• Idiopathic low back pain
• Complex regional pain syndrome
• Migraine and tension headaches
• Whiplash associated disorders
• Osteoarthritis
• MSK pain
• TMJ pain/dysfunction
• Most pelvic pain conditions

However, there is significant uncertainty about how to best assess nociplastic pain in the clinic.  
 
Is quantitative sensory testing a useful and practical construct for clinical practice?  What about the use of the Central Sensitivity Inventory (CSI)?  
 
Does the CSI have good reliability and validity, and does it measure what we think it measures?
 
Beyond measuring central sensitivity, how do we phenotype nociplastic pain to address sensitivity with precision in clinical practice? How can we effectively incorporate psychosocial distress questionnaires?
 
We seek to update you on both the most recent research in this arena, as well as how to translate this research into clinical practice.

Session 1: Setting the Stage 

Recorded on January 28, 2022
 
In this session, Sinead Dufour and Carolyn Vandyken will explore fundamental questions including:

• What is the definition of nociplastic pain?
• What do we currently know about central sensitization and why is nociplastic pain a better term?
• What is the difference between nociception, neuropathic pain and nociplastic pain?
• How do we measure nociplastic pain, including the Central Sensitivity Inventory (CSI), Pain DETECT questionnaire, Orebro questionnaire, Quantitative Sensory Testing (QST), Keith Smart's Odds Ratio predictors, and Central Sensitivity Syndromes?
• What are the limitations of these clinical tools? 

If you are a new clinician or new to the topic of central sensitization, this session will provide the foundation required to fully engage with sessions 2 and 3. 
 

Session 2:  Precision Rehabilitation for Central Pain Mechanisms  

Recorded on February 25, 2022
 
Dr. Judith Thompson from Australia and Jilly Bond from Wales will be our special guests on this segment. They will help us get curious and reflect on how therapists on three different continents  integrate questionnaires to phenotype central pain mechanisms.  

Phenotyping may allow for increased precision in rehabilitation.  Once nociplastic pain is recognized using the CSI and other measures as discussed in Segment 1, there seems to be a significant push back regarding how to use psychosocial distress questionnaires to further guide treatment.  “Is it in my scope of practice?” is a common question we hear.  We would like to set the stage for having an interactive conversation on this hotly debated topic.

Session 3:  Our “Current Tools” aren’t Perfect but they are a BIG Step Forward

Recorded on March 11, 2022
 
We are joined by Dr. Martin Rabey from New Zealand for this final session to translate knowledge of nociplastic pain into effective clinical practice. What is the role of quantitative sensory testing in correlation with self-report measures?  What does the research say? How do we apply this to our clinical practice?  
 
Dr. Rabey will lead an informative discussion on why we need multiple measures to effectively profile and phenotype nociplastic pain in different people.

How do we use the International Association for the Study of Pain's (IASP) guidelines of different pain mechanisms to assess whether a peripheral approach is going to work, or whether we need a whole-person central approach that addresses psychological, immunological, cognitive and endocrine drivers?  

This last session will put it all together, providing advice and guidelines that can be implemented to enhance clinical practice.

Session 4: Final Wrap Up (Bonus!)