Webinar Prof. Jo Nijs: Centrale sensitisatie & aanhoudende pijn: Recente ontdekkingen op weg naar precisiegeneeskunde

Central Sensitization and Persistent Pain – Recent Discoveries Towards Precision Medicine

Chronic pain is recognized by the WHO as a disease of the central nervous system. In this webinar, Prof. Dr. Jo Nijs (Vrije Universiteit Brussel, UZ Brussel) presents the latest scientific insights into central sensitization and nociplastic pain — mechanisms that explain why pain can persist long after tissues have healed.

Using the new IASP clinical criteria for nociplastic pain, participants learn how to identify patients with central sensitization and understand its clinical implications for assessment and management.

The webinar explores three major themes:

1. What is nociplastic pain and central sensitization?
2. – Understanding altered nociception and the dynamic pain connectome.
3. – Differentiating nociplastic from nociceptive and neuropathic mechanisms.
4. The Myths of Central Sensitization
5. – Why bottom-up interventions (surgery, manual therapy, dry needling, electrotherapy) often fail in sensitized patients.
6. – The limited effectiveness and risks of centrally acting medications, including opioids.
7. The Sense of Central Sensitization
8. – The value of pain neuroscience education, lifestyle interventions, and a biopsychosocial approach.
9. – Evidence for combining education with exercise therapy to reduce pain vigilance and disability (Malfliet et al., JAMA Neurology, 2018).

After this session, clinicians will be able to:

• distinguish central sensitization from nociceptive and neuropathic pain,
• identify patients fitting nociplastic pain profiles,
• and implement evidence-based top-down approaches targeting the central nervous system.

Learning Goals

1. Critically evaluate the neurophysiological mechanisms underlying central sensitization and nociplastic pain, including their role within the dynamic pain connectome and their implications for persistent pain without ongoing tissue damage.
2. Integrate IASP diagnostic criteria for nociplastic pain into complex clinical reasoning to differentiate nociceptive, neuropathic, and nociplastic mechanisms across musculoskeletal conditions such as osteoarthritis, whiplash, tendinopathies, and chronic low back pain.
3. Analyse and appraise the limitations of bottom-up and pharmacological interventions (e.g., surgery, electrotherapy, opioids) by interpreting current evidence demonstrating their limited efficacy in sensitized patient populations.
4. Design and justify a top-down, evidence-based management plan for patients with central sensitization that combines pain neuroscience education, cognitive-behavioural strategies, lifestyle modification, and graded exercise to modulate central processing of pain.
5. Reflect on and reframe clinician–patient communication by applying metaphors such as the “spam filter” to explain central mechanisms, thereby enhancing patient understanding, reducing medical shopping, and promoting self-efficacy in pain management.

Bronnen:

1.        Nijs JG, SZ; Clauw, DJ; Fernández-de-las-Peñas, C; Kosek, E; Ickmans, K; Fernández Carnero, J; Polli, A; Kapreli, E; Huysmans, E; Cuesta-Vargas, AI; Mani, R; Lundberg, M; Leysen, L; Rice, D; Sterling, M; Curatolo, M. . Central sensitisation in chronic pain conditions: Latest discoveries and their potential for precision medicine. The Lancet Rheumatology 2021; 3: e383-92.

2.        Kosek E, Cohen M, Baron R, et al. Do we need a third mechanistic descriptor for chronic pain states? Pain 2016; 157(7): 1382-6.

3.        Kosek E, Clauw D, Nijs J, et al. Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain 2021; 162(11): 2629-34.

4.        Nijs J, Leysen L, Vanlauwe J, et al. Treatment of central sensitization in patients with chronic pain: time for change? Expert opinion on pharmacotherapy 2019; 20(16): 1961-70.