Central Sensitization: Explanation or Phenomenon?

[Dolphin]

http://journals.sagepub.com/doi/abs/10.1177/2167702618781804

Central Sensitization: Explanation or Phenomenon?



Emanuel N. van den Broeke Diana M. Torta, Omer Van den Bergh, , ...
First Published July 2, 2018 Article Commentary
Article information

Abstract
Central sensitization (CS) is a popular concept that is frequently used to explain pain hypersensitivity in a large number of pain conditions. However, the concept of CS is now also increasingly used to explain nonpain symptoms. In the present commentary, we argue that CS, as defined by the International Association for the Study of Pain, refers to changes in nociceptive neurons only and therefore cannot be applied to enhanced responses to stimuli other than nociceptive and/or pain. Moreover, the evidence for CS in widespread pain (other than secondary hyperalgesia) and many other conditions is scarce to absent. As a consequence, CS is a descriptive label for the explanandum rather than an explanation and, as such, suffers the risk of being a circular explanation. Finally, cognitive and emotional factors should also be considered as potential mechanisms for the wide range of phenomena that are currently interpreted as evidence for CS.

Keywords central sensitization, pain, functional syndromes

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[duncan]

Finally, cognitive and emotional factors should also be considered as potential mechanisms for the wide range of phenomena that are currently interpreted as evidence for CS.

From the frying pan into the fire.

 

[Hoopoe]

Sounds like they are worried that central sensitization is acquiring a bad reputation because it's applied to psychosomatic conditions.

 

[Jonathan Edwards]

From the frying pan into the fire.

Well maybe if its circular it is swings and roundabouts.

 

[alktipping]

c s has never been more than an hypothesis unfortunately the psych lot prefer assumptions rather than something that can be proven in a logical and scientific manner.

 

[James Morris-Lent]

c s has never been more than an hypothesis unfortunately the psych lot prefer assumptions rather than something that can be proven in a logical and scientific manner.

It seems to be a ubiquitous phenomenon for ideologically-based humanities branches to proliferate a burgeoning yet circular, self-referential body of literature to provide a facade of legitimacy and authority for their claims.

Instead of stopping to produce convincing evidence for the foundational premises, intellectual exercises and practical actions are undertaken which build upon them, uncritically assuming their correctness.

The unsubstantiated nature of the premises becomes obscured by the sophisticated, sometimes dazzlingly inscrutable superstructure of ideas built on top of them. They become dogma. I observed this a lot as a politics major.

The premises may be incorrect, or they can be so far removed from reality and meaning that they transcend the spectrum of right-wrong. Central sensitization appears to be of this second type at the moment.

The process described can happen in a more organic or more concerted, strategic manner. It appears that BPS, PACE, MUS, LP central sensitization, bodily distress, etc. proponents seem to be attempting to make the process happen as fast as possible, sensing that the jig is up and people are actually looking critically at their nonsense.

 

[Milo]

It seems to be a ubiquitous phenomenon for ideologically-based humanities branches to proliferate a burgeoning yet circular, self-referential body of literature to provide a facade of legitimacy and authority for their claims.

Instead of stopping to produce convincing evidence for the foundational premises, intellectual exercises and practical actions are undertaken which build upon them, uncritically assuming their correctness.

The unsubstantiated nature of the premises becomes obscured by the sophisticated, sometimes dazzlingly inscrutable superstructure of ideas built on top of them. They become dogma. I observed this a lot as a politics major.

The premises may be incorrect, or they can be so far removed from reality and meaning that they transcend the spectrum of right-wrong. Central sensitization appears to be of this second type at the moment.

The process described can happen in a more organic or more concerted, strategic manner. It appears that BPS, PACE, MUS, LP central sensitization, bodily distress, etc. proponents seem to be attempting to make the process happen as fast as possible, sensing that the jig is up and people are actually looking critically at their nonsense.

I agree James, and I would add that it is starting to get branded as sustainable health care, as a way to prevent the expenses of diagnostics and medical treatments. Instead what is being offered is less expensive group therapy, CBT and soft medicine (acupuncture, alternative therapies, etc)

 

[Sean]

It appears that BPS, PACE, MUS, LP central sensitization, bodily distress, etc. proponents seem to be attempting to make the process happen as fast as possible, sensing that the jig is up and people are actually looking critically at their nonsense.

I think this is correct.

 

[Woolie]

The article is short and quite good.

full text here.

We believe that the evidence for CS in conditions other than secondary hyperalgesia is scarce, if not absent, and that the use of CS to explain an expanding and widely varying set of phenomena relies on a hypothetical, almost metaphoric, use of the concept.

... CS as an explanation in (functional somatic syndromes) runs the risk of being circular: CS is defined as enhanced responding in several response systems, and the explanation for this enhanced responding is CS. In other words, the described evidence for the conclusion is not different from the conclusion itself. In this way, CS is a label for the explanandum rather than an explanation.

The above quote takes quite a while to unpack. But what I think they're saying is that CS is the name for an observable phenomenon (to do with a heightened responsiveness to pain stimuli in areas surrounding an area where a painful stimulus has recently been applied) not an explanation. The explanation for the phenomenon is unclear (there are some good theories, but none that are universally accepted yet). But people use the term CS as if it were some sort of explanation, in and of itself.

But then at the end, they just say instead of attributing functional somatic syndromes to CS, they should instead be attributed to traditional psychological factors, such fear avoidance and negative thinking blah, blah, bah.

 

[Milo]

But then at the end, they just say instead of attributing functional somatic syndromes to CS, they should instead be attributed to traditional psychological factors, such fear avoidance and negative thinking blah, blah, bah.

Boooo... hiss... booo... hiss....
The easy way out, take the money and run. This is not medicine.

P.S. @Woolie this is not directed at you.

 

[Marco]

Nominal fallacy innit :

The Name Game

Too often in science we operate under the principle that "to name it is to tame it", or so we think. One of the easiest mistakes, even among working scientists, is to believe that labeling something has somehow or another added to an explanation or understanding of it. Worse than that we use it all the time when we are teaching, leading students to believe that a phenomenon that is named is a phenomenon that is known, and that to know the name is to know the phenomenon. It's what I, and others, have called the nominal fallacy. In biology especially, we have labels for everything — from molecules to anatomical parts, to physiological functions, to organisms, to ideas or hypotheses. The nominal fallacy is the error of believing that the label carries explanatory information.

https://www.edge.org/response-detail/11730

 

[Woolie]

Boooo... hiss... booo... hiss....
The easy way out, take the money and run. This is not medicine.

P.S. @Woolie this is not directed at you.

I think even despite the obvious cop out at the end, the piece makes some useful arguments. I think the "central sensitization" idea is potentially more dangerous that the traditional psychobabble because it sounds scientific while at the same time being entirely unfalsifiable.

You also need to remember that most people take psychological "evidence" at face value, they think it must be true, otherwise it wouldn't be believed by so many respectable researchers. In an ideal world, everyone would question every psyc "phenomenon" ever claimed as fact, because the evidence base is so shaky. But this isn't an ideal world, so I'll take what I can get.