Dear Colleagues,              

Chronic pain has been classified as a new disease. To improve the analgesic effect of treatment, an attempt has been made to define the pain mechanism leading to chronicity. Discrimination between nociceptive, neuropathic, and nociplastic pain has been suggested. However, the nociplastic pain mechanism is not yet fully understood, the leading role of central sensitization (CS) processes are indicated. Clinically, chronic pain patients present with amplified pain perception regarding its intensity, duration, and distribution, as well as maladaptive psychosocial factors, low vagal nerve activity, hyperalgesia, and/or allodynia.

Two main types of the CS mechanism have been hypothesized, namely “top-down” and “bottom-up”. Female predisposition is common to both CS mechanisms. Otherwise, the mechanisms differ. To illustrate the difference, patients manifesting the “top-down” subtype can have a family history of pain, high psychological co-morbidity, increased sensitivity to non-pain sensory stimuli, and a high number of chronic overlapping pain conditions, and the beginning of their symptoms is associated with puberty. 

Patients with the “bottom-up” subtype are generally less burdened. The most important difference between them is that “bottom-up” is thought to be a reversible process, contrary to irreversible “top-down”. Muscle-referred pain provoked by trigger points is considered to be secondary hyperalgesia that is a sign of central sensitization processes, probably of the “bottom-up” subtype. Fibromyalgia, irritable bowel syndrome or temporomandibular joint pain dysfunction syndrome represent the “top-down” subtype.

Different diagnostic and therapeutic approaches, evidence-based psychological therapies, as well as the economic cost of chronic pain seem particularly interesting. Research articles, reviews, as well as case study and short communications are preferred.

Prof. Dr. Elżbieta Skorupska
Dr. Pawel Piotr Dobrakowski
Guest Editors

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• chronic pain
• central sensitization
• nociplastic pain
• trigger points
• fibromyalgia
• irritable bowel syndrome
• temporomandibular joint pain dysfunction syndrome
• psychological treatment
• economic cost