This paradigm is very helpful in understanding some kinds of refractory low back or neck/shoulder pain. (You can order it from the canadian pain society website)
Central hyperexcitability in chronic musculoskeletal pain: A conceptual breakthrough with multiple clinical implications
J Lidbeck
Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes � including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others � may essentially be explained by abnormalities in central pain modulation.
The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.
Key Words: Central sensitization; Chronic musculoskeletal pain; Mechanism-based pain classification; Pain modulation
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