Why “Centralized” Is Unacceptable As A Descriptor For The Pain Of Fibromyalgia
The search is on for a third pain descriptor for chronic pain that is more appropriate for the large group of people whose pain is not associated with tissue damage (i.e. “nociceptive pain”) or with demonstrable nerve damage (i.e. “neuropathic pain”).
A recent article in the prestigious journal PAIN outlines the need for such a third descriptor and suggests the following candidates: “nociplastic”, “algopathic” and “nocipathic” [Kosek et al. 2016].
It is important to recognise that these descriptors are not diagnoses, just as “pain” itself is not a diagnosis. However they are intended to imply underlying neurophysiological mechanisms.
But another candidate has recently appeared upon the scene – “centralized pain” [Clauw 2014]. In this context, centralized refers to “central nervous system origins or amplification of pain”. Given that pain as an experience always originates from within the nervous system, and that pain is not a “thing” that can amplify itself, this proposition does not make sense.
The term “centralized” can refer only to an anatomical location within the central nervous system. Not only does the word itself not imply a mechanism but also it creates potential for confusion with conditions such as “central post-stroke pain” (which is technically “neuropathic”) and quite different from the phenomena that underlie Fibromyalgia.
Therefore “centralized” has no legitimate place as a descriptor for pain.
John Quintner & Milton Cohen
Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014; 311(15): 1547-1555,
Kosek E, Cohen M, Baron R, et al. Do we need a third mechanistic descriptor for chronic pain states? Pain 2016; 157(7): 132-186.