Central Sensitization in Chronic Pain Conditions: Mechanisms, Clinical Implications, and Treatment Strategies

Central sensitization is a key mechanism underlying chronic pain syndromes, including fibromyalgia, neuropathic pain, and migraine. This review aims to explore the physiological and pathological aspects of central sensitization, elucidate its role in chronic pain conditions, and assess current and emerging treatment strategies to manage its effects. A comprehensive literature review was conducted by analyzing recent clinical and preclinical studies on central sensitization. Databases such as PubMed, Scopus, and Google Scholar were searched for relevant articles focusing on neurophysiological mechanisms, diagnostic criteria, and treatment interventions. Studies on pharmacological, non-pharmacological, and neuromodulatory approaches were included to provide a holistic view of the clinical implications. Central sensitization is primarily driven by maladaptive neuroplasticity, including increased excitability of nociceptive neurons, impaired inhibitory control, and glial activation. It contributes to heightened pain perception, spontaneous pain, and widespread hyperalgesia in conditions like fibromyalgia and neuropathic pain. Current treatment approaches include pharmacological agents such as NMDA receptor antagonists, gabapentinoids, and antidepressants, alongside non-pharmacological interventions like cognitive-behavioral therapy, exercise, and neuromodulation techniques. Despite these advancements, treatment responses vary, highlighting the need for personalized, multimodal therapeutic strategies. Understanding central sensitization is crucial for improving chronic pain management. Although various treatments show promise, there is no universal solution due to individual variability in pain processing. Future research should focus on identifying biomarkers for central sensitization, optimizing combination therapies, and exploring novel neuroplasticity-modulating interventions. A multidisciplinary approach integrating pharmacological, psychological, and rehabilitative strategies is essential for effective pain management.