Breaking the Pain Cycle: Amplifier Loops, Central Sensitization, and a CSI-Guided Clinical Decision Framework — A Scoping Review and Clinical Framework Proposal

Scoping review (PRISMA-ScR) mapping four amplifier loops sustaining central sensitization in chronic pain and proposing a CSI-stratified clinical decision framework. 63 verified references in AMA format, ~5,000 words body text. Includes charting table (Supplementary Table 1), PRISMA-ScR checklist (Supplementary Table 2), and excluded studies summary (Supplementary Table 3). Submitted to Pain Medicine (Oxford). OSF protocol: https://osf.io/jrxaq/