The aim of this Review is to give a short presentation of the manifestations, assessment methods, and mechanisms underlying localized and widespread musculoskeletal pain, deep somatic tissue hyperalgesia and chronification. Hyperalgesia can be explained by increased pain sensitivity of nociceptors located in deep tissue (peripheral sensitization) or by increased responses from dorsal horn neurons (central sensitization). The spreading of pain and sensitization is related to increased synaptic activity in central neurons and to changes in descending control from supraspinal centers. Manifestations related to the different aspects of sensitization can be assessed quantitatively using sensory tests, such as pressure algometry (quantitative palpation) and cuff-algometry. Repeated pressure stimulation can evaluate the degree of temporal summation, which is a proxy for the level of central sensitization, as is expanded referred muscle pain area. The transition of acute localized musculoskeletal pain into chronic widespread pain is related to the progression of peripheral and central sensitization. This sensitization for the chronification of pain should be assessed by adequate pain biomarkers. Furthermore, pain prevention should target early intervention strategies and new anti-hyperalgesic compounds should be developed.
The different manifestations of localized, regional and widespread musculoskeletal pain involve different peripheral and central mechanisms
Methodologies are available for quantitative assessment of musculoskeletal pain targeting specific mechanisms such as hyperalgesia, spreading sensitization, temporal summation and pain referral
Peripheral and central sensitization are key neurophysiologic mechanisms in musculoskeletal pain
Central sensitization is a likely reason for the chronification of widespread pain conditions
The transition of acute localized musculoskeletal pain into chronic widespread pain is probably related to the progression of peripheral and central sensitization
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The authors declare no competing financial interests.
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Graven-Nielsen, T., Arendt-Nielsen, L. Assessment of mechanisms in localized and widespread musculoskeletal pain. Nat Rev Rheumatol 6, 599–606 (2010). https://doi.org/10.1038/nrrheum.2010.107
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