Week 2: Features of Sensitisation

Question 1

What is the other name for central sensitisation?

Answer 1

Supraspinal sensitisation

Question 2

The longer pain is experienced the weaker the relationship….

Answer 2

Between tissue damage and pain

Question 3

From what direction is pain occurring in central sensitisation? What does this mean?

Answer 3

Top down (means the CNS is contributing to symptoms)

Question 4

Is there still nociceptive input in pain that is experienced beyond the normal healing timeline for an injury?

Answer 4

The pain is less likely to have nociception as the dominant driver. There may be still be nociceptive input but this is now being upregulated by a sensitive CNS

Question 5

Central sensitisation: Location

Answer 5

Shifting and spreading

Question 6

Central sensitisation: Quality

Answer 6

Often difficult to describe (patients may use analogies)

Question 7

Central sensitisation: Intensity

Answer 7

Severe/unpredictable ie movement may not necessarily make it worse

Question 8

Central sensitisation: Behaviour

Answer 8

Unpredictable (it can fluctuate)

Question 9

Central sensitisation: Duration

Answer 9

Does not ease quickly with rest

Question 10

Central sensitisation: Clinical signs

Answer 10

Pain is not associated with an obvious mechanical driver eg standing at a dinner party doesn’t cause pain vs standing at a bus stop causes pain

Question 11

From what direction is pain occurring in peripheral sensitisation?

Answer 11

Bottom up eg broken wrist (peripheral sensors are telling you that something is wrong)

Question 12

If someone has injured their ankle or broken their arm (acute situation) the dominant driver will be a ……?

Answer 12

Peripheral one

Question 13

Peripheral sensitisation: Location

Answer 13

Precise (closely associated with other signs of tissue damage)

Question 14

Peripheral sensitisation: Quality

Answer 14

Sharp, blunt, dull, aching

Question 15

Peripheral Sensitisation: Intensity

Answer 15

Worse with movement

Question 16

Peripheral Sensitisation: Behaviour

Answer 16

Doesn’t spread

Question 17

Peripheral Sensitisation: Duration

Answer 17

Eased quickly with rest

Question 18

Peripheral Sensitisation: Clinical signs

Answer 18

Associated with an injury (within 3mths of an injury eg ankle sprain)

Question 19

True of false: Pain will always be a combination of both peripheral and supraspinal (central) mechanisms - the key is to determine what the dominant driver is!

Answer 19

TRUE

Question 20

Peripheral (nociceptive) pain - Somatic
- Location
- Quality
- Intensity
- Behaviour
- Duration
- Clinical signs

Answer 20

• Location: very specific and well-localised and precise
• Quality: Sharp
• Intensity: Severe (upper end of VAS)
• Behaviour: Associated with withdrawal reflex
• Duration: very short (doesn’t last long)
• Clinical signs: The immediate pain that is experienced due to a rapid mechanical stimuli (blow to the body), extreme hot or cold stimulus (hand on a hot plate) or chemical irritation)