Central Sensitization: When Pain Just Won’t Go Away

Bodily aches and pains are part of the human experience. They come and go, and vary in intensity, depending on the event or stimulus that triggered them, and the measures taken to treat and manage them. In most cases, pain has a specific and treatable underlying cause, but for some people, a chronic heightened hypersensitivity to even mild stimuli persists, a condition called central desensitization.

Pain scientists have only recently begun to unravel the mechanisms that contribute to a heightened pain response in certain individuals. Conditions like fibromyalgia, chronic neck pain, low back pain and other chronic pain syndromes often have no underlying mechanical causes. Even in patients with degenerative disc disease where there are mechanical changes, only a small minority report chronic pain, and many patients report no pain at all.

We are now beginning to understand that pain itself can alter the central nervous system in ways that heighten sensitivity to pain. In essence, for some people, pain begets pain, making even a mild touch or the slightest pressure a source of agony. Pain scientists suspect that chronic pain that will not go away for months on end is fueled by the CNS, and not by the original source or locus of pain.

Central Sensitization is broadly recognized among pain scientists as a very real medical condition, but what puzzles researchers is why some people experience it while others do not.

Some possible contributing factors include:

• genetics
• environmental factors
• stress
• psychological factors
• poor sleep quality

Whatever the cause, it is suspected that untreated or under-treated pain eventually rewires the central nervous system, causing the brain to misinterpret certain stimuli as a threat. In effect, pain become a sort of defense mechanism, warning you of danger in a way similar to the pain you feel when touching a hot surface. And the worst part is that every pain response feeds central nervous system dysfunction, causing an escalating spiral of pain and increased sensitivity.

Currently, pain science is a hot topic in research, but sadly, many medical practitioners are unaware of the central sensitization phenomenon, which is bad news for patients suffering from chronic pain. Patients may undergo expensive and ineffective therapies and surgeries in a quest to find a solution, and chronic pain syndromes are no doubt contributing to the opioid epidemic as patients become addicted to pain pills.

In some instances, doctors may dismiss patients complaining of chronic pain, telling the patient, “It’s all in your head,” which, ironically, it is. Pain is your brain’s interpretation of a stimulus. In many cases, the locus of pain can be distant from the source, making it futile to attempt to treat the painful region.

In an effort to help alleviate patients’ suffering, well-meaning massage therapists, chiropractors and physical therapists may treat CS patients too aggressively, triggering a CNS response that worsens the pain, rather than relieving it.