Central sensitization is the mechanism of nociplastic pain and leads to an overemphasized response to a painful stimulus (hyperalgesia) or pain to stimuli that do not otherwise cause pain (allodynia). Persistent nociceptive pain is a risk factor for nociplastic pain, which can often occur in isolation or combination with other types of pain, most often in patients with chronic musculoskeletal pain (osteoarthritis, lumbar and cervical syndrome, fibromyalgia, rheumatoid arthritis, complex regional pain syndrome, tendinopathy, etc.). Diagnosis of central sensitization is established through clinical examination, questionnaires and quantitative sensory testing (QST), which serves to assess and quantify sensory functions, i.e., determine the threshold for detection of sensory stimuli (heat-cold, pressure, vibration). Conditioned Pain Modulation (CPM) testing is important for clarifying pain modulation profiles, which can be pro-nociceptive (less effective CPM facilitation) and anti-nociceptive (effective, inhibitory CPM effect). In the pronociceptive modulation profile that is common in patients with musculoskeletal disorders, there is a higher risk of developing chronic pain, a higher prevalence of pain conditions and higher pain associated with injury. CPM testing is also important in the individualization of drug therapy for pain, based on predicting the effectiveness of drugs in the treatment.

Keywords: central sensitization; conditional pain modulation; musculoskeletal pain.

Sestre Milosrdnice University Hospital.

中枢敏化是感觉性疼痛的机制，会导致对疼痛刺激反应过度（痛觉过敏）或对通常不会引起疼痛的刺激产生疼痛感（触诱发痛）。持续性的伤害感受性疼痛会增加感觉性疼痛的风险，这种疼痛常常单独出现或者与其他类型的疼痛共同出现，尤其是在患有慢性肌肉骨骼疼痛（如骨关节炎、腰椎和颈椎综合症、纤维肌痛症、类风湿性关节炎、复杂区域疼痛综合症、腱病等）的患者中。中枢敏化的诊断是通过临床检查、问卷调查和定量感觉测试（QST）建立，这些测试用于评估和量化感官功能，即确定感知刺激的感觉阈值（热-冷、压力、振动）。条件性疼痛调节（CPM）测试对于阐明疼痛调节模式非常重要，这种模式可以是促痛的（CPM增强效果较差）或抗痛的（有效的抑制性CPM效应）。在患有肌肉骨骼疾病患者的常见促痛调节模式中，发生慢性疼痛的风险更高，疼痛症候群更普遍，并且与损伤相关的疼痛感更强。CPM测试还对根据预测药物治疗的有效性来个性化镇痛药疗法非常重要。

关键词：中枢敏化；条件性疼痛调节；肌肉骨骼疼痛。