If you’re dealing with persistent pain, or work with pain patients, central sensitization is a big deal.
PainScience.com publisher, Paul Ingram writes: "There is great variety in acute pain, but chronic pain is often defined by pain sensitization, regardless of how it all started."
And world-leading pain scientist, Professor Lorimer Moseley adds: "...fear of movement, pain catastrophizing, anxiety, and nervous system sensitization appear to be the main contributors to pain and disability."
So, let’s figure out what it’s all about...
- Central Sensitization in Chronic Pain (Plus Treatments)
- Central Sensitization Explained
- Sensitization Is Like a Faulty Alarm
- Why does Central Sensitization occur?
- Can We Diagnose Central Sensitization?
- My Personal Experience with Sensitization
- Dangers Of Not Understanding Sensitization
- Feeling Betrayed by Your Body? Try Not To
- How To Calm a Sensitized Nervous System?
- Have Hope!
Central Sensitization Explained
Central sensitization means that our central nervous system has become highly sensitive to potential threats to the body. That results in more pain, more often.
The ‘threat’ is anything that triggers your pain. That could be certain movements, changes in your routine, physical exertion, and so on - the list is endless.
It’s like the volume on your pain system has been turned up, and is stuck in high alert - sounding the alarm (pain!) at any signs of danger. Your body is doing too good of a job at protecting itself with the pain response.
Modern pain science shows that persistent pain leads to real changes in your brain and central nervous system and how it processes messages about pain.
Most people don’t know it’s the brain and nervous system that creates all pain – both short-term acute pain – like when you stub your toe – and chronic pain.
Once acute pain lasts more than a few months, your brain and nervous system get better and better at creating the sensation of pain. Just like we learn any new skill or habit, the more our brain and body practice creating pain, the easier it gets for it to create the pain again.
In other words, repeated acute pain changes how your nervous system works.
Over time, our brain and nervous system become sensitized and overprotective. The pain becomes self-sustaining and whether or not you’re going to feel pain, depends less and less on the condition of your body, and more on your beliefs, thoughts, expectations, and how you’re moving your body.
In a recent pain science course with Professor Lorimer Moseley, he commented: “…the sensitization process begins as soon as you start feeling pain.” He added: “…but it’s at the three months that we can start defining pain as chronic.”
Sensitization Is Like A Faulty Alarm
You can think of pain like your personal alarm system. In the context of acute pain, the danger alarm is useful. It makes us want to avoid pain, and look after the injured part of our body till it heals.
However, just as a house alarm can be activated in the absence of a burglary, your body’s alarm system can create pain in the absence of any tissue damage.
When this happens, our protective behavior when in pain – like fear of movement and guarding the injured area – loses its protective benefit, and works to sustain pain.
Fear, stress, endorphins, adrenaline, anxiety, depression, lack of sleep, overactivity, lack of activity, poor nutrition, sickness, and many more factors can influence your alarm system’s perception of danger, increase sensitivity, and lead to a greater protective experience of pain.
A compelling example of pain sensitization can be seen in the condition of Allodynia. Patients can feel excruciating pain at the gentlest touch. The patient is not being damaged by the touch. The problem is the overexcited pain system.
Why does Central Sensitization occur?
There’s no doubt that central sensitization exists. What isn’t so clear is why central sensitization occurs in some people and not others.
The leading theories on how acute pain transitions to chronic pain, include when:
- An acute injury isn’t adequately treated and over time, the brain and nervous system get better at creating the pain experience.
- Fear, pain catastrophizing, and pain anxiety continue to trigger the fight-or-flight mechanism, sustaining the pain experience.
- Hypervigilance on painful sensations wires the pain response deeper and deeper.
Can We Diagnose Central Sensitization?
Although we can’t objectively test how much pain someone is experiencing, some advanced research techniques help prove the existence of sensitization.
Central sensitization has been identified in the following conditions:
- Chronic Fatigue Syndrome
- Chronic Tension Headaches
- Endometriosis
- Fibromyalgia
- Irritable Bowel Syndrome
- Low Back Pain
- Migraines
- Neck Pain
- Osteoarthritis in the Knee
- Rheumatoid Arthritis
- Shoulder Pain
- Whiplash
Important caveat: although sensitization is extremely common in pain patients, it’s not always the cause of persistent pain. You must visit more than one health professional, to get a thorough checkup to rule out anything dangerous.
Rates of central sensitization vary from 10% in shoulder pain to 100% in fibromyalgia.
Remember, this list is not complete, only what’s been tested to date. For instance, my Repetitive Strain Injury (RSI) condition turned out to be 100% sensitization, but there’s little biological research on it.
Due to the complexity, it’s very unlikely that you’ll be able able to get any sort of sensitization test by your health professional.
But there are factors that we can look out for, which are pretty safe indicators that sensitization plays a role in your pain experience. These include:
- A disproportionate, non-mechanical, and unpredictable pattern of pain
- A disproportionate amount of pain about the injury or pathology
- Pain persisting beyond expected tissue healing times
- History of failed interventions (medical/surgical/therapeutic)
- Pain-anxiety, fear-avoidance of pain, the belief of damage, and pain-related disability
The pain I’d experienced was completely disproportionate. Something simple like turning the page on a book would cause severe pain!
- I received different and sometimes even contradictory diagnoses from doctors who all went hunting for ‘issues in the tissues’
- As with most pain patients, I had anxiety around the pain and the belief of damage in my body – which would have been enough to sustain the pain
Once I recovered from pain, I decided to dedicate my time to creating a product to help others in the same situation as me. Needlessly suffering from real, ongoing, and disabling pain, when all other treatments fail.
Dangers Of Not Understanding Sensitization
For a pain patient, not truly understanding what’s going on in chronic pain is tragic. Understanding sensitization is a way out of pain for many, myself included.
For medical professionals, a lack of understanding around central sensitization - a pillar of pain science - is negligent (to say the least!).
Ignorance of central sensitization leads to a wild goose chase of expensive, ineffective, and harmful therapies. Consider the many patients that still get pushed into surgery for back pain, believing it’s the only hope they have.
All the while industry experts continue to publish multiple studies to raise awareness on the “inappropriate tests” and “unnecessary, ineffective and harmful treatments” that are still being used for common conditions like low back pain, whilst failing to get to the root cause of the issue.
- I received different and sometimes even contradictory diagnoses from doctors who all went hunting for ‘issues in the tissues’
- As with most pain patients, I had anxiety around the pain and the belief of damage in my body – which would have been enough to sustain the pain
Once I recovered from pain, I decided to dedicate my time to creating a product to help others in the same situation as me. Needlessly suffering from real, ongoing, and disabling pain, when all other treatments fail.
Chronic pain patients are already the most vulnerable and desperate of patients. As they go from doctor to therapist and back again, each time they fail to find relief, their feelings of helplessness grow alongside the pain.
Feeling Betrayed By Your Body? Try Not To
Pain patients can start to feel like they’ve been betrayed by their bodies. Or that the pain is somehow their fault. This is not true.
Although central sensitization might sound like the enemy, know that ultimately your nervous system cares for your safety. And for safety, it’s better for the alarm to be more sensitive and have false alarms, rather than to not protect you in the case of a true threat.
Evolution has prioritized danger signals that hijack your whole being. Once the danger or threat has passed, perhaps you were asking too much from your body for too long, sometimes, we just need to give our bodies guidance back to safety.
How To Calm A Sensitized Nervous System?
No pill or potion can turn the sensitivity down on your nervous system.
But there are many things we can do with our mind and body, that do work overtime to reduce pain. In some cases (like mine), where sensitivity is responsible for all the pain, you could even become pain-free.
There’s no woo-woo or magic. Just science.
For example, this 2019 study goes on to conclude: “Treatment of patients in whom central sensitization is present should address the (lifestyle) factors that sustain the process of central sensitization, including illness beliefs, stress, sleep, physical activity, and diet.”
Countless other studies agree. This and this post from the Institute for Chronic Pain cover some of the key research nicely,
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens and New Hyde Park – Long Island. Call the Richmond Hill office at (718) 215-1888, or (516) 419-4480 for the Long Island office, to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.
