{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T17:10:12Z","timestamp":1786381812835,"version":"build-2736575974"},"reference-count":45,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Persistent pain following orthopaedic trauma is common, often disproportionate to structural healing, and increasingly interpreted as reflecting centrally mediated pain mechanisms. However, the mechanisms, clinical features, diagnostic approaches, prognostic indicators, and management strategies relevant to trauma-related central sensitisation (CS) remain poorly understood. Objective: To map and synthesise existing evidence on CS following orthopaedic trauma, addressing mechanistic pathways, clinical manifestations, epidemiology, assessment methods, management approaches, and health system implications. Methods: A scoping review was conducted in accordance with PRISMA-ScR. Twenty-one studies met the eligibility criteria, comprising nine primary trauma cohorts and 12 contextual mechanistic or review studies relevant to trauma-associated CS. Data were charted across six prespecified domains of mechanistic processes, clinical presentation and diagnostic features, epidemiology and prognosis, assessment tools and outcome measures, interventions, and health system and care delivery considerations. Results: Mechanistic studies demonstrated trauma-induced neuroimmune activation, altered cortical and spinal excitability, and molecular pathways consistent with sensitisation. Clinical studies have identified neuropathic features, widespread pain, and heightened sensory responsiveness following fractures and other injuries. Neurophysiological evidence has indicated early cortical disinhibition following upper limb trauma, whereas epidemiological cohorts have reported persistent pain and disability years after major trauma. Measurement studies have highlighted the limited reliability and specificity of current tools in trauma populations, including quantitative sensory testing and self-report instruments. Early predictors of adverse trajectories include severe acute pain, neuropathic descriptors, psychological distress, and opioid-dominant analgesia. Evidence regarding early intervention, rehabilitation strategies, and system-level screening pathways remains limited. Conclusions: Central sensitisation (CS)\u2013consistent mechanisms after orthopaedic trauma are suggested by convergent mechanistic, neurophysiological, and clinical findings. However, trauma-specific diagnostic criteria, prognostic models, and management frameworks remain underdeveloped. High-quality longitudinal research is needed to clarify early trajectories, refine assessment methods, and establish targeted interventions to reduce long-term pain and disability.<\/jats:p>","DOI":"10.3390\/jcm15031035","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T15:04:46Z","timestamp":1769612686000},"page":"1035","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Central Sensitisation After Orthopaedic Trauma: An Overlooked Contributor to Chronic Pain and Functional Disability\u2014A Scoping Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6016-0171","authenticated-orcid":false,"given":"Arfaz","family":"Shaik","sequence":"first","affiliation":[{"name":"Department of Trauma and Orthopaedics, Croydon Health Services NHS Trust, London CR7 7YE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Chakrapani","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Torbay and South Devon NHS Trust, Torquay TQ2 7AA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, University Hospital Llandough, Cardiff CF64 2XX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Al Jumaili","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Croydon Health Services NHS Trust, London CR7 7YE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umar","family":"Hayat","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Medway Maritime Hospital, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1111\/aas.13380","article-title":"Incidence of Chronic Pain 6 y after Major Trauma","volume":"63","author":"Kolstadbraaten","year":"2019","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1302\/0301-620X.103B.BJJ-2020-2204.R1","article-title":"Chronic Pain with Neuropathic Characteristics after Surgery for Major Trauma to the Lower Limb: Prevalence, Predictors, and Association with Pain Severity, Disability, and Quality of Life in the UK WHiST Trial","volume":"103-B","author":"Keene","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_3","unstructured":"IASP (2020). Task Force on Taxonomy. Terminology and Definitions of Pain, International Association for the Study of Pain (IASP)."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/j.pain.0000000000001384","article-title":"Chronic Pain as a Symptom or a Disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)","volume":"160","author":"Treede","year":"2019","journal-title":"Pain"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1016\/j.pain.2011.06.017","article-title":"A New Definition of Neuropathic Pain","volume":"152","author":"Jensen","year":"2011","journal-title":"Pain"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1097\/j.pain.0000000000000507","article-title":"Do We Need a Third Mechanistic Descriptor for Chronic Pain States?","volume":"157","author":"Kosek","year":"2016","journal-title":"Pain"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e491","DOI":"10.1097\/j.pain.0000000000003646","article-title":"A Bad Break: Mechanisms and Assessment of Acute and Chronic Pain after Bone Fracture","volume":"166","author":"Nishimura","year":"2025","journal-title":"Pain"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Zhang, H., Li, N., Li, J., and Zhang, L. (2022). Chronic Pain after Bone Fracture: Current Insights into Molecular Mechanisms and Therapeutic Strategies. Brain Sci., 12.","DOI":"10.3390\/brainsci12081056"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e12137","DOI":"10.1111\/jabr.12137","article-title":"The Neurobiology of Central Sensitization","volume":"23","author":"Harte","year":"2018","journal-title":"J. Appl. Biobehav. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1097\/01.anes.0000264769.87038.55","article-title":"Central Sensitization: Uncovering the Relation between Pain and Plasticity","volume":"106","author":"Woolf","year":"2007","journal-title":"Anesthesiology"},{"key":"ref_11","first-page":"e352","article-title":"New Paradigms in Pain Management after Skeletal Trauma: Orthopaedic Trauma Association\u2019s 2023 Basic Science Focus Forum Symposium","volume":"8","author":"Higgins","year":"2025","journal-title":"OTA Int."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Jodoin, M., Rouleau, D.M., Bellemare, A., Provost, C., Larson-Dupuis, C., Sandman, \u00c9., Laflamme, G.-Y., Benoit, B., Leduc, S., and Levesque, M. (2020). Moderate to Severe Acute Pain Disturbs Motor Cortex Intracortical Inhibition and Facilitation in Orthopedic Trauma Patients: A TMS Study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0226452"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.bja.2019.05.030","article-title":"Severe Acute Pain and Persistent Post-Surgical Pain in Orthopaedic Trauma Patients: A Cohort Study","volume":"123","author":"Edgley","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/PSY.0000000000001181","article-title":"Traumatic Events, Posttraumatic Stress Disorder, and Central Sensitization in Chronic Pain Patients of a German University Outpatient Pain Clinic","volume":"85","author":"Manuel","year":"2023","journal-title":"Psychosom. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"526","DOI":"10.47360\/1995-4484-2022-526-537","article-title":"Chronic Post-Traumatic Pain: Rheumatological and Orthopedic Aspects","volume":"60","author":"Karateev","year":"2022","journal-title":"Rheumatol. Sci. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1002\/ejp.1670","article-title":"Measures of Central Sensitization and Their Measurement Properties in Musculoskeletal Trauma: A Systematic Review","volume":"25","author":"Middlebrook","year":"2020","journal-title":"Eur. J. Pain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1097\/j.pain.0000000000001590","article-title":"Quantitative Sensory Testing and Predicting Outcomes for Musculoskeletal Pain, Disability, and Negative Affect: A Systematic Review and Meta-Analysis","volume":"160","author":"Georgopoulos","year":"2019","journal-title":"Pain"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1136\/ard.2005.037531","article-title":"Does Physical Trauma Lead to an Increase in the Risk of New Onset Widespread Pain?","volume":"65","author":"Macfarlane","year":"2006","journal-title":"Ann. Rheum. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Chunduri, A., and Aggarwal, A.K. (2022). Multimodal Pain Management in Orthopedic Surgery. J. Clin. Med., 11.","DOI":"10.3390\/jcm11216386"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.2519\/jospt.2016.0612","article-title":"Recognition and Treatment of Central Sensitization in Chronic Pain Patients: Not Limited to Specialized Care","volume":"46","author":"Nijs","year":"2016","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1213\/ANE.0000000000005807","article-title":"Chronic Pain Following Fracture-Related Surgery: Posttraumatic Rather Than Postsurgical Origin Promotes Chronification\u2014A Prospective Observational Study With 1-Year Follow-Up","volume":"134","author":"Aulenkamp","year":"2022","journal-title":"Anesth. Analg."},{"key":"ref_22","first-page":"128","article-title":"Chronic Pain and Disability After Pelvic and Acetabular Fractures\u2014Assessment with the Mainz Pain Staging System","volume":"69","author":"Gerbershagen","year":"2010","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1177\/1071100717712432","article-title":"High Prevalence of Chronic Pain with Neuropathic Characteristics After Open Reduction and Internal Fixation of Ankle Fractures","volume":"38","author":"Rbia","year":"2017","journal-title":"Foot Ankle Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S71","DOI":"10.1097\/BOT.0000000000000793","article-title":"Improving Pain Management and Long-Term Outcomes Following High-Energy Orthopaedic Trauma (Pain Study)","volume":"31","author":"Castillo","year":"2017","journal-title":"J. Orthop. Trauma"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Alkassabi, O., Voogt, L., Andrews, P., Alhowimel, A., Nijs, J., and Alsobayel, H. (2022). Risk Factors to Persistent Pain Following Musculoskeletal Injuries: A Systematic Literature Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19159318"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"39","DOI":"10.2147\/JPR.S38878","article-title":"Systematic Review of Persistent Pain and Psychological Outcomes Following Traumatic Musculoskeletal Injury","volume":"2013","author":"Rosenbloom","year":"2013","journal-title":"JPR"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1179\/106698111X13129729551903","article-title":"Basic Aspects of Musculoskeletal Pain: From Acute to Chronic Pain","volume":"19","year":"2011","journal-title":"J. Man. Manip. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"419e","DOI":"10.1097\/PRS.0000000000011568","article-title":"Neuropathic Pain after Major Limb Amputation: A Cross-Sectional Study","volume":"155","author":"Langeveld","year":"2025","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.pain.2009.09.030","article-title":"Peripheral and Central Sensitization in Remote Spinal Cord Regions Contribute to Central Neuropathic Pain after Spinal Cord Injury","volume":"147","author":"Carlton","year":"2009","journal-title":"Pain"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.jelekin.2003.09.017","article-title":"Mechanisms of Central Sensitization, Neuroimmunology & Injury Biomechanics in Persistent Pain: Implications for Musculoskeletal Disorders","volume":"14","author":"Winkelstein","year":"2004","journal-title":"J. Electromyogr. Kinesiol. Off. J. Int. Soc. Electrophysiol. Kinesiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1007\/s13311-020-00905-7","article-title":"Central Nervous System Targets: Glial Cell Mechanisms in Chronic Pain","volume":"17","author":"Donnelly","year":"2020","journal-title":"Neurotherapeutics"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/ALN.0000000000002130","article-title":"Neuroinflammation and Central Sensitization in Chronic and Widespread Pain","volume":"129","author":"Ji","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1002\/ejp.1443","article-title":"The Central Sensitization Inventory Predicts Painrelated Disability for Musculoskeletal Disorders in the Primary Care Setting","volume":"23","author":"Tanaka","year":"2019","journal-title":"Eur. J. Pain"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4725303","DOI":"10.1155\/2020\/4725303","article-title":"Emerging Basic and Clinical Studies on Musculoskeletal Pain and Management","volume":"2020","author":"Wang","year":"2020","journal-title":"Pain Res. Manag."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/ALN.0000000000002238","article-title":"Persistent Postsurgical Pain: Pathophysiology and Preventative Pharmacologic Considerations","volume":"129","author":"Capdevila","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1136\/postgradmedj-2013-132215","article-title":"Chronic Pain after Surgery: Pathophysiology, Risk Factors and Prevention","volume":"90","author":"Reddi","year":"2014","journal-title":"Postgrad. Med. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2958","DOI":"10.1093\/pm\/pnaa069","article-title":"Central Sensitization in Chronic Musculoskeletal Pain Disorders in Different Populations: A Cross-Sectional Study","volume":"21","author":"Neblett","year":"2020","journal-title":"Pain Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"592","DOI":"10.2519\/jospt.2020.0610","article-title":"Central Sensitization in Musculoskeletal Pain: Lost in Translation?","volume":"50","author":"Schmid","year":"2020","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1080\/09593985.2016.1194646","article-title":"The Efficacy of Pain Neuroscience Education on Musculoskeletal Pain: A Systematic Review of the Literature","volume":"32","author":"Louw","year":"2016","journal-title":"Physiother. Theory Pract."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"103147","DOI":"10.1016\/j.msksp.2024.103147","article-title":"Central Sensitization-Related Symptoms and Their Relationship to Disability in Prevalent Chronic Musculoskeletal Pain: A Cross-Sectional Study","volume":"73","year":"2024","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.math.2009.12.001","article-title":"Recognition of Central Sensitization in Patients with Musculoskeletal Pain: Application of Pain Neurophysiology in Manual Therapy Practice","volume":"15","author":"Nijs","year":"2010","journal-title":"Man. Ther."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e383","DOI":"10.1016\/S2665-9913(21)00032-1","article-title":"Central Sensitisation in Chronic Pain Conditions: Latest Discoveries and Their Potential for Precision Medicine","volume":"3","author":"Nijs","year":"2021","journal-title":"Lancet Rheumatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1140.e1","DOI":"10.1016\/j.jpain.2019.02.011","article-title":"Pain Neuroscience Education for Adults with Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis","volume":"20","author":"Watson","year":"2019","journal-title":"J. Pain"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1097\/PHM.0000000000002239","article-title":"Effects of Orthopedic Manual Therapy on Pain Sensitization in Patients with Chronic Musculoskeletal Pain: An Umbrella Review with Meta-Meta-Analysis","volume":"102","year":"2023","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/AJP.0000000000000689","article-title":"Posttraumatic Stress Symptoms Mediate the Effects of Trauma Exposure on Clinical Indicators of Central Sensitization in Patients with Chronic Pain","volume":"35","author":"McKernan","year":"2019","journal-title":"Clin. J. Pain"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1035\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T15:29:35Z","timestamp":1769614175000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":45,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15031035"],"URL":"https:\/\/doi.org\/10.3390\/jcm15031035","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,28]]}}}