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Novel Therapies for Centralized Pain: a Brief Review

  • Alternative Treatments for Pain Medicine (M Jones, Section Editor)
  • Published:
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Abstract

Purpose of Review

Centralized pain presents a complex pathology that many classic pharmacological agents for pain have not been able to sufficiently treat. To date, there are no clear guidelines for preferred treatment methods or comprehensive protocol that addresses confounding factors in this population. We sought to summarize the current field of knowledge around centrally mediated pain and to understand promising novel therapies.

Recent Findings

Many treatments currently used address not only the centralized pain phenotypem but the impact of central sensitization and the common comorbidities that reside within this population. Some novel therapies with promising evidence include the following: low-dose naltrexone, IV ketamine, acupuncture, aerobic activity, and laser therapy. Non-interventional treatment options include aerobic exercise, cognitive-behavioral therapy, mind–body therapies, virtual reality, and patient education on disease expectations. Much of the literature further emphasizes the importance of patient-level predictors, including factors like pain catastrophizing and social history, on treatment compliance and reported pain relief.

Summary

We found that there are many potential treatment options for patients with centralized pain, particularly those that can be used as adjunct or combination therapies. The introduction of new approaches should occur in a carefully controlled, titrated manner to avoid exacerbation of pain symptoms. This is successfully conducted through patient-physician communication as this is a highly complex and personalized pain category. Our examination shows that while physicians have many options with proven success, there is a need for studies with longitudinal and larger patient populations to better articulate treatment guidelines.

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  1. Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue, HRK 199, New York, NY, USA

    Paul Ryan Haffey

  2. Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA

    Jade I. Basem

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Basem, J.I., Haffey, P.R. Novel Therapies for Centralized Pain: a Brief Review. Curr Pain Headache Rep 26, 805–811 (2022). https://doi.org/10.1007/s11916-022-01085-z

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