Unless you've been under a rock as a clinician, the term 'central sensitization' should be in your vocabulary. It has gained popularity through the cycle of pain science, especially over the past 5-10 years. Even though it appears central sensitization is new and sexy, it is not a modern term, and to my knowledge, the seminal paper on it by Dr. Woolfe goes all of the way back to 1983. Much change and marketing has happened in this 33 year span, but even still, the thought process of this term has been around for centuries.
You can find 6 ways to Sunday to explain this phenomenon to your patients, which I do using my "Pain Cartesian Scale (here too). I encourage you to find the best way to translate this to your patients in the context they need to understand. My colleague and friend, Dr. Matt Dancigers, explains this better than anyone else I know. I highly recommend reading his blog.
Nevertheless, I find the explanation of central sensitization to be somewhat limiting to achieving better outcomes for my patients. Don't get me wrong, it does help, but not an extraordinary game changer. What I find works better in clinical practice is the term, "Re-sensitization". This is an ad-on to central sensitization and of course has to go alongside it in your education, but seems to be more of a heavy hitter in regards to applicability for the individual---especially after he/she has felt results and gained your trust.
In a nutshell, the way I assimilate Re-sensitization to patients is one they understand---it is an exacerbation of symptoms. We all know this happens for any condition, but especially chronic pain. I translate the importance of a healthy diet, stress reduction and general exercise, of ways to reduce re-sensitization----this is a multi system issue (endocrine, metabolic, cardiovascular, etc) and not just musculoskeletal. But for the main purpose of my point in this post, I recommend focusing on a specific HEP based off of what worked for the patient under a course of care.
In some individuals, a general exercise program at a gym may just do it. But what I find, and I'm sure many of you, is that you need something specific for the area/region that seems to be the one that is picked at the most. It could be a neural glide, self-mobilization, myofascial ischaemic compression, etc etc----but your job, and what I get most out of the umbrella term of sensitization, is to find and prescribe what works with the upmost confidence and highest power to desensitize the system to prevent re-sensitization.
It works like this: Peripheral sensitization leads to Central sensitization----we can ramp down this entire system (and local region) through our interventions----but then Re-sensitization occurs over a course of Time---this is where intervention is needed again---by either specific HEP and or Therapist Treatment.
It is challenging to put more concepts into words and make it applicable to your setting, approach, and patient type. But, I do hope you are learning more about central sensitization and now the phrase re-sensitization---which has been successful for me in the science of pain. It also helps me establish a wellness program and principle of coming back to me vs medication/physician/surgeon if exacerbation occur as an overall successful business plan.
As an added bonus for reading my blog,, I am offering a FREE, 30 min, E-mentorship session for anyone who feels they would like more information on re-sensitization, but also mentorship and guidance on complicated cases. Just email me at harrisonvaughanpt@gmail.com with "re-sensitization" in subject line. You may just find it to be beneficial and would like to go through a mentoring process. Feel free to contact me for more information and read about the Program more on my E-mentorship page.
As always, looking forward to your input.
You can see original post and all prior posts at http://intouchpt.wordpress.com
Harrison Vaughan, PT, DPT, OCS, Dip. Osteopractic, FAAOMPT
Dr. Harrison N. Vaughan, PT, FAAOMPT is author of a In Touch PT blog, provides in-home and office physical therapy treatments, consultation and e-mentorship opportunities for clinicians atwww.painandspinespecialist.com. He is also CEO of Integrative Clinical Concepts (ICC) at www.iccseminars.com. You can best reach him at harrisonvaughanpt@gmail.com
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