{"id":8095,"date":"2026-02-05T20:02:31","date_gmt":"2026-02-05T19:02:31","guid":{"rendered":"https:\/\/blueportance.com\/wandering-central-sensitization\/"},"modified":"2026-10-25T22:43:35","modified_gmt":"2026-10-25T21:43:35","slug":"wandering-central-sensitization","status":"publish","type":"page","link":"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/wandering-central-sensitization\/","title":{"rendered":"KB_Pudendal Neuralgia_06 : The Diagnostic Odyssey and Central Sensitization in Pudendal Neuralgia"},"content":{"rendered":"\n\n<!-- BDC \u2014 Pudendal Neuralgia \u2014 Chapter 6: The Diagnostic Odyssey and Central Sensitization in Pudendal Neuralgia \u2014 Blue Portance -->\n\n<style>\n  .bp-bdc-wrap {\n    max-width: 980px;\n    margin: 0 auto;\n    padding: 0 16px 48px;\n    color: #222;\n    line-height: 1.65;\n  }\n\n  .bp-bdc-breadcrumb {\n    max-width: 900px;\n    margin: 0 auto;\n    padding: 20px 16px 0;\n    font-size: .85rem;\n    color: #6b7280;\n  }\n\n  .bp-bdc-breadcrumb a {\n    color: #2a7fba;\n    text-decoration: none;\n  }\n\n  .bp-bdc-breadcrumb a:hover {\n    text-decoration: underline;\n  }\n\n  .bp-bdc-hero {\n    max-width: 900px;\n    margin: 30px auto 0;\n  }\n\n  .bp-bdc-hero h1 {\n    margin-bottom: 18px;\n    line-height: 1.2;\n  }\n\n  .bp-bdc-meta {\n    margin-top: 22px;\n    padding: 12px 16px;\n    background: #f4f8fb;\n    border-left: 4px solid #2a7fba;\n    color: #52606d;\n    font-size: .9rem;\n  }\n\n  .bp-bdc-toc {\n    max-width: 900px;\n    margin: 34px auto;\n    padding: 22px 26px;\n    background: #f7fafc;\n    border: 1px solid #e1e8ee;\n    border-radius: 10px;\n  }\n\n  .bp-bdc-toc h2 {\n    margin-top: 0;\n  }\n\n  .bp-bdc-toc a {\n    color: #1e73be;\n  }\n\n  .bp-bdc-content {\n    max-width: 900px;\n    margin: 0 auto;\n  }\n\n  .bp-bdc-content h2 {\n    margin-top: 48px;\n    padding-bottom: 8px;\n    border-bottom: 2px solid #d9e8f5;\n    line-height: 1.3;\n  }\n\n  .bp-bdc-content h3 {\n    margin-top: 32px;\n    line-height: 1.35;\n  }\n\n  .bp-bdc-content p {\n    margin: 0 0 18px;\n  }\n\n  .bp-bdc-content ul,\n  .bp-bdc-content ol {\n    margin-bottom: 22px;\n  }\n\n  .bp-bdc-content li {\n    margin-bottom: 10px;\n  }\n\n  .bp-bdc-box {\n    margin: 26px 0;\n    padding: 20px 24px;\n    border-radius: 10px;\n  }\n\n  .bp-bdc-box--soft {\n    background: #f4f8fb;\n    border: 1px solid #d9e8f5;\n  }\n\n  .bp-bdc-box--warning {\n    background: #fff8ed;\n    border-left: 4px solid #f39c12;\n  }\n\n  .bp-bdc-navigation {\n    margin-top: 44px;\n    padding: 22px 24px;\n    background: #f7fafc;\n    border: 1px solid #e1e8ee;\n    border-radius: 10px;\n  }\n\n  .bp-bdc-navigation a {\n    color: #1e73be;\n  }\n\n  .bp-bdc-footer {\n    margin-top: 28px;\n    padding: 18px 20px;\n    background: #fff8ed;\n    border-left: 4px solid #f39c12;\n    font-size: .92rem;\n  }\n\n  .bp-bdc-copyright {\n    font-size: .85em;\n    color: #6b7280;\n    margin-top: 22px;\n  }\n\n  .bp-reference-note {\n    color: #59636e;\n    font-size: .9rem;\n  }\n\n  .bp-bdc-level {\n    display: inline-block;\n    margin: 0 6px 6px 0;\n    padding: 3px 8px;\n    border-radius: 999px;\n    background: #eaf3f9;\n    color: #245f85;\n    font-size: .78rem;\n    font-weight: 700;\n    letter-spacing: .02em;\n  }\n\n  @media (max-width: 700px) {\n    .bp-bdc-wrap {\n      padding-left: 12px;\n      padding-right: 12px;\n    }\n\n    .bp-bdc-box {\n      padding: 18px;\n    }\n  }\n<\/style>\n\n<nav class=\"bp-bdc-breadcrumb\" aria-label=\"Breadcrumb\">\n<a href=\"\/en\/\">Blue Portance<\/a> \u2192 <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/\">Knowledge Base<\/a> \u2192 <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/\">Sitting-Related Pain<\/a> \u2192 <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/\">Pudendal Neuralgia<\/a> \u2192 Diagnostic Odyssey and Central Sensitization\n<\/nav>\n\n<section class=\"bp-bdc-wrap\">\n\n  <header class=\"bp-bdc-hero\">\n\n    <h1>\n      The Diagnostic Odyssey and Central Sensitization\n      in Pudendal Neuralgia\n    <\/h1>\n\n    <p>\n      Pudendal neuralgia can be difficult to identify because its diagnosis\n      rests mainly on clinical findings and because its symptoms can overlap\n      with those of several urological, gynecological, anorectal,\n      dermatological, muscular, or neurological conditions.\n    <\/p>\n\n    <p>\n      The absence of any visible abnormality on imaging does not mean that the\n      pain is imaginary or lacks a mechanism. It means that no structural lesion\n      sufficient to explain it has been identified by the examination performed.\n      The persistence of symptoms may then involve peripheral, neuromuscular,\n      psychological, and neurophysiological factors, including central\n      sensitization in some patients.\n    <\/p>\n\n    <p>\n      It has not been established, however, that the diagnostic odyssey on its own\n      causes central sensitization. It is more prudent to consider that a delayed\n      diagnosis, persistent pain, stress, sleep disturbances, and the lack of a\n      coherent management strategy may contribute to maintaining or amplifying the pain\n      experience.\n    <\/p>\n\n    <p>\n      Three levels should therefore be distinguished: the initial mechanism of the\n      pain, the factors that maintain it, and those that amplify its expression.\n      The diagnostic odyssey is not necessarily the initial cause; it can, however,\n      prolong exposure to aggravating factors and foster a context in which\n      protective behaviors, reduced activity, and hypersensitivity take on a\n      growing role.\n    <\/p>\n\n    <div class=\"bp-bdc-meta\">\n      Blue Portance Knowledge Base \u00b7 Non-commercial reproduction permitted with\n      citation of the source\n    <\/div>\n\n  <\/header>\n\n  <nav class=\"bp-bdc-toc\" aria-label=\"Table of contents\">\n\n    <h2>Table of Contents<\/h2>\n\n    <ul>\n      <li>\n        <a href=\"#errance\">\n          1. The diagnostic odyssey and delays in recognition\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#projection\">\n          2. Distributed symptoms and differential diagnoses\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#invalidation\">\n          3. Lack of understanding, stress, and the pain experience\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#sensibilisation\">\n          4. Central sensitization and hypersensitivity\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#implications\">\n          5. Implications for comprehensive care\n        <\/a>\n      <\/li>\n\n      <li>\n        <a href=\"#references\">\n          Scientific References\n        <\/a>\n      <\/li>\n    <\/ul>\n\n  <\/nav>\n\n  <main class=\"bp-bdc-content\">\n\n    <section id=\"errance\">\n\n      <h2>\n        1. The diagnostic odyssey and delays in recognition\n      <\/h2>\n\n      <p>\n        <span class=\"bp-bdc-level\">CLINICAL FRAMEWORK<\/span>\n        <span class=\"bp-bdc-level\">MAINTAINING FACTORS<\/span>\n      <\/p>\n\n      <p>\n        Pudendal neuralgia is primarily a clinical diagnosis. The Nantes criteria\n        notably take into account pain located in the pudendal territory,\n        worsened by sitting, not usually waking the patient at night, without\n        objective sensory deficit, and relieved after a diagnostic pudendal\n        anesthetic block\n        (Labat et al., 2008).\n      <\/p>\n\n      <p>\n        None of these elements, taken in isolation, constitutes proof of\n        anatomical compression. Likewise, imaging and additional tests can be\n        useful for looking for certain causes or ruling out differential\n        diagnoses, but they cannot always objectively\n        demonstrate the mechanism responsible for the symptoms.\n      <\/p>\n\n      <p>\n        This situation can contribute to long diagnostic journeys: symptoms are\n        sometimes attributed successively to the bladder, the rectum, the\n        genitals, the muscles, or the spine before a neuropathic hypothesis is\n        considered. Chronic pelvic pain is known to require a broad and often\n        multidisciplinary differential evaluation\n        (Fu\u010d\u00edk &amp; Ma\u0161ata, 2021).\n      <\/p>\n\n      <p>\n        A diagnostic delay does not, however, on its own constitute proof of\n        neurophysiological worsening. It may nevertheless be accompanied by\n        prolonged exposure to pain, activity limitation, increased stress, and a\n        loss of confidence in the healthcare system. These factors may\n        contribute to maintaining disability and pain.\n      <\/p>\n\n      <p>\n        From a functional standpoint, the time that elapses may also matter\n        because the person sometimes continues to endure the situation that\n        triggers their symptoms without having a coherent strategy for\n        modulating the load. The problem is therefore not the administrative\n        delay itself, but what persists during that delay: exposure, lack of\n        understanding of the mechanism, contradictory trials, avoidance, or the\n        maintenance of protective postures.\n      <\/p>\n\n      <div class=\"bp-bdc-box bp-bdc-box--soft\">\n        <strong>Key point<\/strong>\n        <p>\n          The diagnostic odyssey should be understood as a possible context of\n          amplification, and not as a stand-alone cause of central sensitization.\n          Its influence depends on the duration of the pain, the sustained\n          mechanical loads, sleep, stress, and the adaptive capacities still\n          available.\n        <\/p>\n      <\/div>\n\n    <\/section>\n\n    <section id=\"projection\">\n\n      <h2>\n        2. Distributed symptoms and differential diagnoses\n      <\/h2>\n\n      <p>\n        The symptoms of pudendal neuralgia can be felt in different regions of\n        the perineum, the anal margin, the urethra, the vulva, the clitoris, the\n        penis, or the scrotum. This distribution reflects the territories of the\n        pudendal nerve and its branches, but it does not allow clinicians to\n        conclude automatically that the nerve is the cause of the symptom.\n      <\/p>\n\n      <p>\n        The logic of distribution among the branches is detailed in\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/referred-pain-trident\/\">\n          Referred Pain and the Pudendal Trident: Understanding Symptom Territories\n        <\/a>.\n      <\/p>\n\n      <p>\n        Urethral or bladder pain must be distinguished from an infection, an\n        inflammation, bladder pain, mucosal irritation, or another urological\n        condition. Rectal pain must be distinguished from a fissure, hemorrhoidal\n        disease, an inflammation, functional anorectal pain, or a muscular\n        disorder.\n      <\/p>\n\n      <p>\n        Similarly, genital pain may stem from a dermatological, infectious,\n        inflammatory, vulvar, or muscular condition, or from another neuropathy.\n        When local examinations are normal, this justifies a broader analysis,\n        but it does not allow the conclusion that the pain is necessarily\n        pudendal.\n      <\/p>\n\n      <p>\n        The review by Fu\u010d\u00edk and Ma\u0161ata highlights the importance of differential\n        diagnosis in pelvic neuropathic pain. The aim is to avoid both the\n        multiplication of tests without a guiding hypothesis and the premature\n        attribution of all symptoms to a single nerve structure\n        (Fu\u010d\u00edk &amp; Ma\u0161ata, 2021).\n      <\/p>\n\n    <\/section>\n\n    <section id=\"invalidation\">\n\n      <h2>\n        3. Lack of understanding, stress, and the pain experience\n      <\/h2>\n\n      <p>\n        <span class=\"bp-bdc-level\">BIOPSYCHOSOCIAL EXPERIENCE<\/span>\n      <\/p>\n\n      <p>\n        When tests show no lesion, some people may feel that their pain is being\n        minimized or disputed. This experience of not being understood can affect\n        the therapeutic relationship, confidence in care, and the ability to take\n        an active part in the care pathway.\n      <\/p>\n\n      <p>\n        Stress, uncertainty, lack of sleep, and the anticipation of worsening can\n        influence perceived intensity and protective behaviors. These factors do\n        not mean that the pain is psychological. They illustrate the\n        biopsychosocial nature of the pain experience, in which biological,\n        psychological, and social dimensions interact\n        (Linton &amp; Shaw, 2011; Darnall et al., 2017).\n      <\/p>\n\n      <p>\n        A person who anticipates pain may limit their movements, change their\n        posture, or contract certain muscles. These responses may be\n        understandable in the short term, but they can also contribute to\n        maintaining a functional limitation when they become permanent. This\n        relationship remains individual and does not allow the pain to be\n        attributed to a single mechanism.\n      <\/p>\n\n      <p>\n        From an SBNFA\u2122 perspective, this protection may progressively narrow the\n        functional repertoire: fewer positions used, fewer variations in support,\n        and more co-contractions intended to avoid the feared movement. This\n        narrowing may limit stress redistribution and recovery. It does not mean\n        that the pain is produced by fear; it describes a possible interaction\n        between real pain and the bodily responses set in place to protect\n        against it.\n      <\/p>\n\n      <p>\n        Clear clinical communication must therefore acknowledge two things at\n        once: the absence of a visible lesion does not negate the reality of the\n        pain, and the presence of pain does not allow a pudendal lesion to be\n        inferred automatically.\n      <\/p>\n\n    <\/section>\n\n    <section id=\"sensibilisation\">\n\n      <h2>\n        4. Central sensitization and hypersensitivity\n      <\/h2>\n\n      <p>\n        <span class=\"bp-bdc-level\">NEUROPHYSIOLOGY<\/span>\n        <span class=\"bp-bdc-level\">POSSIBLE MECHANISM<\/span>\n      <\/p>\n\n      <p>\n        Central sensitization refers to an increase in the responsiveness of\n        nociceptive neurons in the central nervous system to signals that are\n        normally painful or to stimuli that are usually only mildly so. It may\n        contribute to pain hypersensitivity, but its presence should not be\n        inferred solely from the duration of symptoms\n        (Woolf, 2011).\n      <\/p>\n\n      <p>\n        In other words, it concerns the <strong>gain of nociceptive processing<\/strong>\n        rather than whether the signal is real or unreal. A peripheral input\n        may continue to exist, while the response it produces becomes more intense,\n        longer-lasting, or more widespread. Recognizing this amplification therefore\n        amounts neither to denying a local cause nor to psychologizing the pain.\n      <\/p>\n\n      <p>\n        Possible manifestations include dynamic allodynia, pressure\n        hyperalgesia, increased temporal summation, and a spread of pain\n        sensitivity. These signs can guide clinical reasoning, but they do not\n        on their own constitute specific proof of central sensitization.\n      <\/p>\n\n      <p>\n        Allodynia is pain provoked by a stimulus that is not normally painful,\n        such as light touch or rubbing. In the pelvic region, hypersensitivity\n        to touch may also have a local, peripheral, dermatological, or\n        neuropathic cause. Interpretation must therefore remain clinical and\n        differential\n        (Woolf, 2011; Clauw, 2015).\n      <\/p>\n\n      <p>\n        Chronic pain may combine nociceptive, neuropathic, and nociplastic\n        mechanisms to varying degrees. Central sensitization therefore does not\n        replace the search for a peripheral cause and does not necessarily mean\n        that no local structure is involved in the\n        symptoms\n        (Clauw, 2015; Nijs et al., 2014).\n      <\/p>\n\n      <p>\n        In the specific case of pudendal neuralgia, it is preferable to speak of\n        possible central sensitization or associated hypersensitivity when the\n        clinical findings suggest it, rather than to assert that the condition\n        is systematically \u201ccentralized.\u201d\n      <\/p>\n\n      <p>\n        The most coherent model is often bidirectional: persistent peripheral\n        inputs may keep the alarm system active, while heightened sensitivity may\n        lower the threshold at which posture, contact, or sitting duration become\n        painful. The relative contribution of these two components cannot be\n        determined from a single symptom.\n      <\/p>\n\n    <\/section>\n\n    <section id=\"implications\">\n\n      <h2>\n        5. Implications for comprehensive care\n      <\/h2>\n\n      <p>\n        <span class=\"bp-bdc-level\">INTEGRATED APPROACH<\/span>\n        <span class=\"bp-bdc-level\">SBNFA\u2122 HYPOTHESIS<\/span>\n      <\/p>\n\n      <p>\n        Recognizing possible central sensitization changes the way pain is\n        interpreted, but it does not lead to abandoning the search for\n        peripheral factors. A comprehensive approach can simultaneously take\n        into account mechanical loads, neuromuscular factors, sleep, activity,\n        stress, pain-related beliefs, and coping strategies.\n      <\/p>\n\n      <p>\n        Interventions should be individualized and determined with qualified\n        professionals. Depending on the clinical picture, they may include clear\n        information about pain, a reduction in aggravating factors, a gradual\n        return to activity, attention to the pelvic floor, and an appropriate\n        approach to sensitization.\n      <\/p>\n\n      <p>\n        The literature on central sensitization generally recommends combining\n        education, attention to peripheral factors, and strategies aimed at\n        modulating the nervous system, rather than seeking an exclusively local\n        solution\n        (Nijs et al., 2011; Nijs et al., 2014).\n      <\/p>\n\n      <p>\n        Therapeutic communication is also an important element. Explaining that\n        pain can be real without a visible lesion helps avoid invalidation. Care\n        should be taken, however, not to replace diagnostic uncertainty with a\n        single, definitive explanation.\n      <\/p>\n\n      <p>\n        The SBNFA\u2122 framework can use this reading to describe an interaction between\n        mechanical loads, pain, muscle guarding, stress, and nerve sensitivity.\n        This framework remains an internal conceptual model and does not\n        constitute a validated medical classification.\n      <\/p>\n\n      <p>\n        The distinction between structural contribution, functional mechanisms,\n        and adaptive reserve is developed in\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/structural-functional-triage\/\">\n          SBNFA\u2122 Triage: Distinguishing Structural Factors from Functional Mechanisms\n        <\/a>.\n      <\/p>\n\n      <p>\n        This interaction can be organized into a functional loop: pain or\n        perceived threat \u2192 muscle guarding and reduced movement \u2192 narrower\n        postural repertoire \u2192 less variable loading and more difficult recovery\n        \u2192 lowered tolerance threshold \u2192 earlier onset of pain. Stress, lack of\n        sleep, and uncertainty may reinforce the loop, without necessarily being\n        its origin.\n      <\/p>\n\n      <p>\n        The conceptual aim is therefore neither to \u201ctreat only the nerve\u201d nor to\n        \u201cdesensitize only the brain.\u201d It consists in identifying the\n        contributions that are still active: peripheral factors, sitting loads,\n        protective hypertonia, reduced variability, recovery, and\n        neurophysiological amplification.\n      <\/p>\n\n      <div class=\"bp-bdc-box bp-bdc-box--soft\">\n        <strong>Indicators of functional change<\/strong>\n        <p>\n          The time before symptoms appear, their intensity for a comparable load,\n          the extent of the sensitive areas, the number of positions still\n          tolerated, and the recovery time help track functional\n          change. Taken in isolation, they are not validated measures of central\n          sensitization.\n        <\/p>\n      <\/div>\n\n    <\/section>\n\n    <section id=\"references\">\n\n      <h2>\n        Scientific References\n      <\/h2>\n\n      <div class=\"bp-bdc-box bp-bdc-box--soft\">\n\n        <ol>\n\n          <li>\n            <strong>\n              Labat JJ, Riant T, Robert R, Amarenco G, Lefaucheur JP, Rigaud J.\n            <\/strong>\n            Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment\n            (Nantes criteria).\n            <em>Neurourology and Urodynamics<\/em>.\n            2008;27(4):306\u2013310.\n            DOI:\n            <a\n              href=\"https:\/\/doi.org\/10.1002\/nau.20505\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              10.1002\/nau.20505\n            <\/a>.\n            <br>\n            <a\n              href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17828787\/\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              View the PubMed record\n            <\/a>\n          <\/li>\n\n          <li>\n            <strong>Woolf CJ.<\/strong>\n            Central sensitization: implications for the diagnosis and treatment\n            of pain.\n            <em>Pain<\/em>.\n            2011;152(3 Suppl):S2\u2013S15.\n            DOI:\n            <a\n              href=\"https:\/\/doi.org\/10.1016\/j.pain.2010.09.030\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              10.1016\/j.pain.2010.09.030\n            <\/a>.\n            <br>\n            <a\n              href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20961685\/\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              View the PubMed record\n            <\/a>\n          <\/li>\n\n          <li>\n            <strong>Clauw DJ.<\/strong>\n            Diagnosing and treating chronic musculoskeletal pain based on the\n            underlying mechanism(s).\n            <em>Best Practice &amp; Research Clinical Rheumatology<\/em>.\n            2015;29(1):6\u201319.\n            DOI:\n            <a\n              href=\"https:\/\/doi.org\/10.1016\/j.berh.2015.04.024\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              10.1016\/j.berh.2015.04.024\n            <\/a>.\n          <\/li>\n\n          <li>\n            <strong>\n              Nijs J, Meeus M, Van Oosterwijck J, Roussel N, De Kooning M,\n              Ickmans K, Matic M.\n            <\/strong>\n            Treatment of central sensitization in patients with \u201cunexplained\u201d\n            chronic pain: what options do we have?\n            <em>Expert Opinion on Pharmacotherapy<\/em>.\n            2011;12(7):1087\u20131098.\n            DOI:\n            <a\n              href=\"https:\/\/doi.org\/10.1517\/14656566.2011.547475\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              10.1517\/14656566.2011.547475\n            <\/a>.\n            <br>\n            <a\n              href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/21254866\/\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              View the PubMed record\n            <\/a>\n          <\/li>\n\n          <li>\n            <strong>\n              Nijs J, Torres-Cueco R, van Wilgen CP, et al.\n            <\/strong>\n            Applying modern pain neuroscience in clinical practice:\n            criteria for the classification of central sensitization pain.\n            <em>Pain Physician<\/em>.\n            2014;17(5):447\u2013457.\n          <\/li>\n\n          <li>\n            <strong>Linton SJ, Shaw WS.<\/strong>\n            Impact of psychological factors in the experience of pain.\n            <em>Physical Therapy<\/em>.\n            2011;91(5):700\u2013711.\n            DOI:\n            <a\n              href=\"https:\/\/doi.org\/10.2522\/ptj.20100330\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              10.2522\/ptj.20100330\n            <\/a>.\n          <\/li>\n\n          <li>\n            <strong>Darnall BD, Carr DB, Schatman ME.<\/strong>\n            Pain psychology and the biopsychosocial model of pain treatment:\n            ethical imperatives and social responsibility.\n            <em>Pain Medicine<\/em>.\n            2017;18(8):1413\u20131415.\n            DOI:\n            <a\n              href=\"https:\/\/doi.org\/10.1093\/pm\/pnw166\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              10.1093\/pm\/pnw166\n            <\/a>.\n            <br>\n            <a\n              href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27425187\/\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              View the PubMed record\n            <\/a>\n          <\/li>\n\n          <li>\n            <strong>\n              Fu\u010d\u00edk T, Ma\u0161ata J.\n            <\/strong>\n            Pelvic neuropathic pain (differential diagnosis).\n            <em>\u010cesk\u00e1 gynekologie<\/em>.\n            2021;86(4):279\u2013283. DOI: 10.48095\/cccg2021279.\n            <br>\n            <a\n              href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34493054\/\"\n              target=\"_blank\"\n              rel=\"noopener\">\n              View the PubMed record\n            <\/a>\n          <\/li>\n\n        <\/ol>\n\n        <p class=\"bp-reference-note\">\n          These references support the concepts of chronic pelvic pain,\n          differential diagnosis, central sensitization, allodynia, pain\n          modulation, and the biopsychosocial approach. They do not demonstrate\n          that the diagnostic odyssey directly causes central sensitization in\n          every person with pudendal neuralgia.\n        <\/p>\n\n      <\/div>\n\n      <div class=\"bp-bdc-box bp-bdc-box--warning\">\n\n        <strong>Blue Portance internal reference<\/strong>\n\n        <p>\n          The notions of a fragmented diagnostic journey, adaptive reserve,\n          tolerance threshold, and chronicity loop can be integrated into\n          the SBNFA\u2122 framework. They constitute an internal conceptual framework and\n          must not be presented as validated medical criteria.\n        <\/p>\n\n        <p>\n          Proposed internal reference:\n        <\/p>\n\n        <ul>\n          <li>\n            Blue Portance. Mod\u00e8le SBNFA\u2122 \u2014\n            <em>\n              Neuro-anatomie, partie VI :\n              errance diagnostique, douleur persistante et sensibilisation\n            <\/em>\n            [SBNFA\u2122 Framework \u2014 Neuroanatomy, Part VI: Diagnostic Odyssey,\n            Persistent Pain, and Sensitization].\n            2026.\n          <\/li>\n        <\/ul>\n\n      <\/div>\n\n    <\/section>\n\n    <div class=\"bp-bdc-navigation\">\n      <strong>Pudendal Neuralgia Pathway<\/strong>\n      <p>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/pudendal-nerve-anatomy\/\">1. Functional Anatomy and Neuromechanics of the Pudendal Nerve<\/a><br>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/mechanical-locks\/\">2. Mechanical Vulnerability and Pudendal Nerve Entrapment Mechanisms<\/a><br>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/referred-pain-trident\/\">3. Referred Pain and the Pudendal Trident: Understanding Symptom Territories<\/a><br>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/structural-functional-triage\/\">4. SBNFA\u2122 Triage: Distinguishing Structural Factors from Functional Mechanisms<\/a><br>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/fascia-neural-gliding\/\">5. Fascia, Nerve Gliding, and Tissue Densification<\/a><br>\n        <strong>6. The Diagnostic Odyssey and Central Sensitization in Pudendal Neuralgia<\/strong>\n      <\/p>\n      <p>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/fascia-neural-gliding\/\">\u2190 Previous article<\/a> \u00b7\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/\">Back to the Pudendal Neuralgia Expert Guide \u2192<\/a>\n      <\/p>\n    <\/div>\n\n    <div class=\"bp-bdc-navigation\">\n\n      <strong>Navigation<\/strong>\n\n      <p>\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/pudendal-neuralgia\/\">\n          \u2190 Back to the Pudendal Neuralgia hub\n        <\/a>\n        <br>\n\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/sitting-related-pain\/\">\n          \u2190 See the topic: Sitting-Related Pain\n        <\/a>\n        <br>\n\n        <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/\">\n          \u2190 Explore the Knowledge Base\n        <\/a>\n      <\/p>\n\n    <\/div>\n\n    <footer class=\"bp-bdc-footer\">\n\n      <strong>Note:<\/strong>\n      this content aims to present possible mechanisms of persistent pain,\n      sensitization, and the diagnostic journey. It constitutes neither a\n      medical diagnosis, nor a therapeutic recommendation, nor proof that\n      central sensitization is present in any given person.\n\n    <\/footer>\n\n    <p class=\"bp-bdc-copyright\">\n      \u00a9 Gil Ayache. The concepts, diagrams, terminology, and principles presented on this page constitute a work protected by copyright. They are made available to Blue Portance under an intellectual property license agreement, without transfer of economic rights or of authorship.\n    <\/p>\n\n  <\/main>\n\n<\/section>\n\n\n\n","protected":false},"excerpt":{"rendered":"<p>Blue Portance \u2192 Knowledge Base \u2192 Sitting-Related Pain \u2192 Pudendal Neuralgia \u2192 Diagnostic Odyssey and Central Sensitization The Diagnostic Odyssey and Central Sensitization in Pudendal Neuralgia Pudendal neuralgia can be difficult to identify because its diagnosis rests mainly on clinical findings and because its symptoms can overlap with those of several urological, gynecological, anorectal, dermatological, [&#8230;]\n","protected":false},"author":6,"featured_media":0,"parent":8099,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_yoast_wpseo_title":"Central Sensitization in Pudendal Neuralgia | Blue Portance","_yoast_wpseo_metadesc":"The diagnostic odyssey and central 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