Is the Central Sensitization in Chronic Nonspecific Low Back Pain Structural Phenomenon or Psychological Reaction? A Narrative Review

Lower back pain (LBP) is a common condition affecting primarily populations in developed countries, placing a significant burden on public health systems around the world. A high rate of pain recurrence increases the risk of developing a chronic syndrome and the occurrence of complex psychosocial and professional problems. Symptoms lasting longer than 12 weeks are associated with the risk of sleep problems, depression, and anxiety. In the 21st century, the development of knowledge about central sensitization (CS) to pain allowed for a better understanding of the pathomechanism of pain and the transformation of LBP into a chronic form. Patients with chronic severe pain often experience accompanying symptoms such as fatigue, depression, anxiety, sleep disorders, appetite disorders, flatulence, dyspepsia, and dizziness-these are part of the picture of CS. The article presents a narrative, chronological review of reports covering the current state of knowledge on the possibility of assessing central sensitization and its impact on low back pain. The authors also attempt to answer the question posed in the title. CS can be seen as an excessive reactivity of nociceptive neurons in the central nervous system to normal or subthreshold afferent chronic stimuli in people with certain mental predispositions.