Centralization Phenomenon: Its Usefulness in Evaluating and Treating Referred PainDONELSON RONALD MD; SILVA, GREGORY PT; MURPHY, KENNETH MDSpine: March 1990 Article: PDF Only Abstract In patients with low-back and radiating leg pain, a clinical phenomenon has been described known as “centralization,” which occurs during a mechanical evaluation protocol described by McKenzie. Relocation of the most distal pain in a proximal or central direction characterizes the pain behavior when patients are assessed in this fashion. Centralization typically occurs rapidly and can be maintained. In a review of 87 such patients, centralization occurred in 76 (87%). Its occurrence during initial mechanical evaluation is a very accurate predictor of successful treatment outcome and reliably determines the appropriate direction of treatment exercise. Nonoccurrence of centralization accurately predicts poor treatment outcome and was a helpful early predictor of the need for surgical treatment. © Lippincott-Raven Publishers.