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923 - Central Pain Neurophysiology, Diagnosis, and Management: A Systematic Review

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Co-Author(s)

SS

Shiva Senthilkumar, BA

Medical Student
University of Toledo College of Medicine
Toledo, Ohio, United States
DL

Drew Lestersmith, DO

Resident Physician
Johns Hopkins Physical Medicine & Rehabilitation
Baltimore, Maryland, United States
HC

Harman Chopra, MD

Physician
Johns Hopkins
Baltimore, Maryland, United States

Presenting Author(s)

Stephanie Van, MD (she/her/hers)

Assistant Professor of Physical Medicine and Rehabilitation
Johns Hopkins University School of Medicine.
Bethesda, Maryland, United States

Objectives: Centralized (a.k.a. nociplastic) pain is a complex and demanding condition that physiatrists often encounter. When a part of the body sustains physical or psychological trauma, the nervous system can exhibit a heightened stress response. Subsequently, even minor irritations can inflict an elevated pain response, often presenting as allodynia and hyperalgesia. This phenomenon is seen in conditions such as Complex Regional Pain Syndrome, Ehlers Danlos Syndrome, Fibromyalgia, Dysautonomia, and Long COVID. Standardized treatment protocols for managing pain in these conditions remain limited. Limited diagnostics and stigma are additional barriers to treatment. This paper serves to be a review of the neurophysiology, common presentations, and practical management strategies of centralized pain to improve medical care and quality of life for these patients.

Design: A systematic review will be conducted to evaluate the etiology, diagnosis, prevalence, and treatment of centralized pain. Relevant studies will be identified through a comprehensive search of databases, including PubMed, Cochrane Library, and EMBASE. The search strategy will include terms related to “nociplastic pain,” “central pain,” and specific targeted therapies. Randomized controlled trials, cohort studies, and case series published in English will be included. Three independent reviewers will screen titles and abstracts for eligibility, with disagreements resolved by consensus.

Results: Data extraction will be performed on study characteristics, patient population, intervention details, and outcomes related to pain relief and quality of life. Risk of bias will be assessed using Cohen’s inter-rater reliability.

Conclusions: Physiatrists frequently treat patients with centralized pain in the context of a primary complaint or a symptom of an associated condition. Understanding the underlying neurophysiology and implementing a comprehensive treatment approach is essential to managing this condition. A successful approach to debilitating centralized pain conditions requires overcoming stigma, standardizing clinical diagnostic approaches, and offering multimodal management strategies.