Year : 2018 | Volume
: 30 | Issue : 3 | Page : 199--200
The enigma of central sensitivity syndrome in dentistry
Clinical Associate Professor, Perth Oral Medicine and Dental Sleep Centre, Dental School, University of Western Australia, Perth, Australia
Dr. Ramesh Balasubramaniam
Dental School, University of Western Australia, Perth
|How to cite this article:|
Balasubramaniam R. The enigma of central sensitivity syndrome in dentistry.J Indian Acad Oral Med Radiol 2018;30:199-200
|How to cite this URL:|
Balasubramaniam R. The enigma of central sensitivity syndrome in dentistry. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2019 Mar 24 ];30:199-200
Available from: http://www.jiaomr.in/text.asp?2018/30/3/199/243653
Central sensitivity syndrome was coined to replace the previously commonly used term of functional somatic syndromes to describe medically unexplained symptoms and conditions that are typically associated with psychological distress. A lack of understanding of pain biology has led to many individuals being inappropriately labeled as having a “psychosomatic” or “functional” condition, implying a psychogenic origin for their complaint. With advances in our understanding of the science of “suffering,” it is now apparent that a distressing experience such as pain is not merely a sensation that is proportional to the level of nociceptive input, but rather an unpleasant experience influenced by emotional, cognitive, and social components.
Dentists, and in particular oral medicine specialists, will face the enigma of central sensitivity syndrome, whereby a distressed and desperate patient may present for diagnosis and treatment for his or her complex orofacial complaint. Orofacial diseases and disorders commonly associated with central sensitivity syndrome include chronic myofascial pain, persistent idiopathic facial pain (atypical facial pain), persistent dentoalveolar pain (atypical odontalgia), burning mouth syndrome (oral dysesthesia), occlusal dysesthesia, and halitophobia. An understanding of central sensitivity syndrome will better prepare dentists to be able to manage these complex cases.
Central sensitivity syndrome is best explained within a biopsychosocial context and with concepts of peripheral and central sensitization. In addition, studies have found detectable neurobiological, immune system and neuroendocrine axis changes that explain central sensitivity syndrome. A number of factors are believed to predispose an individual to central sensitivity syndrome, and these include endocrine and neuroendocrine dysfunction, altered autonomic nervous system function, persistent inflammatory or degenerative disorders (nociception), viral illnesses, sleep disturbances, psychosocial distress and stressors including childhood trauma, small-fiber neuropathies, environmental factors such as weather, noise, and chemicals, and medications such as opioids.
To use a classic clinical example to illustrate central sensitivity syndrome, a patient may present with the complaint of a hot, burning mouth, however complicated by generalized hypersensitivity to noxious and non-noxious stimuli, sleep disturbances, chronic fatigue, and psychosocial distress. A review of their medical history may highlight the typical conditions associated with central sensitivity syndrome such as fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, tension-type headache, chronic pelvis pain, interstitial cystitis, and vulvodynia. In such a case, a holistic approach beyond the primary complaint of burning mouth is necessary.
To manage patients who present with central sensitivity syndrome, the clinician must be trained to attain a thorough psychosocial history. This should include questions regarding the initiating, perpetuating, and predisposing factors for the complaint. For example, a patient diagnosed with burning mouth syndrome may report the onset of the burning sensation to coincide with the stress of a motor vehicle accident (initiating factor). However, with further questioning, it is deciphered that the patient has severe depression, history of panic attacks, and obsessive-compulsive tendencies that are likely perpetuating the condition (perpetuating factors). With good clinician–patient rapport, it becomes apparent that the patient has a long history of psychosocial distress that dates back to being sexually abused as a child (predisposing factor). Therefore, for a clinician to successfully treat a patient with central sensitivity syndrome, treatment must also be targeted toward psychosocial factors that may be contributing to the complaint. This must include questions on the behavioral aspects such as sleep disturbances and diet (caffeine, alcohol, drugs), the social aspects such as the effects of the pain on daily function, presence of support systems and dependencies, stigma and access to medical care, and the emotional aspects such as depression, anxiety, symptom reporting, catastrophizing, and fear avoidance.
Currently, dental students are trained to manage dental disease based on a cause-and-effect model with little discussion regarding psychosocial factors. Hence, the time has come for a shift in the paradigm in this education model, so patients with central sensitivity syndrome may be diagnosed and treated appropriately.
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