Neurosensitization: A model for persistent disability in chronic pain, depression, and posttraumatic stress disorder following injury.

A neurosensitization syndrome (NSS) is defined as: a syndrome of subjective discomfort and objective functional disability; that often appears excessive in duration and severity with respect to the identified initiating injury or event; that may be resistant to conventional medical and psychological treatment modalities; and that is hypothesized to develop as the result of progressively enhanced sensitivity or reactivity of central nervous system (CNS) mechanisms at the neurophysiological, biochemical, and intracellular levels. This paper applies the neurosensitization model to the three syndromes which are frequently comorbid and treatment-refractory in clinical practice: (1) chronic pain; (2) depression; and (3) posttraumatic stress disorder. The understanding of how pathological behavioral syndromes spiral out of control may lead to productive, integrative medical, behavioral, and psychotherapeutic treatment strategies.