Central sensitivity syndromes are a wide range of debilitating and distressing symptoms often associated with vague or undetermined pathological cause.
There is usually symptom overlap, like pain and fatigue, and affect different systems; generally neurological, gastrointestinal, and musculoskeletal. central sensitivity syndromes tend to demonstrate what is called central sensitization, a hypersensitivity to pain.
As indicated in a 2019 Evidence Based Complementary and Alternative Medicine, this central sensitization is defined as “an amplification of neural signaling within the central nervous system (CNS) that elicits pain hypersensitivity.”
These conditions are usually related to visceral or somatic problems, and associated with chronic or long term conditions. Common central sensitivity syndromes are chronic lower back pain, chronic neck pain, chronic whiplash, myofascial pain syndrome, temporomandibular joint disorders, fibromyalgia, chronic fatigue syndrome, tension headaches, migraines, irritable bowel syndrome, restless legs syndrome, chronic prostatitis, chronic pelvic pain, interstitial cystitis and vulvodynia.
This hypersensitivity to pain is a reduction in inhibition and increased excitability of nerves when exposed to injury, activity or inflammation. This can result in situation where there is pain which may not be associated with an acute or apparent cause.
This does not mean there is no pathological cause; it could mean one has not been found, like the case of chronic back pain from Modic changes. Long thought to be a normal, sometimes innocuous arthritis or degeneration; we now know it is a serious cause of pain and disability, which would be overlooked due to lack of current knowledge or recognition. It is a treatable condition and I discuss this in relation to the lumbar spine and chronic disabling pain; however, the cervical spine applies as well.
This would usually lead to years of searching for causes and treatments, to no avail, thus fostering chronicity and central sensitization. Often resulting in a diagnosis of it’s all in your head or we can’t find anything; but a new focus on central sensitivity is perhaps a more workable diagnosis.
This centralization of pain; where it actually becomes ingrained into the neural network in the brain after many years, is now the focus of new medications like Lyrica or Cymbalta which are often prescribed for this, but can have effects on pain and even conditions like dropped head syndrome. We know there are many factors in chronic pain, understanding the consequences of centralization that perpetuates pain and the psycho-social factors that place limitations on quality of life that can be devastating, life altering, and cause much anxiety about the future. This also affects others we care about as well, especially when they seem to not understand because there is nothing specific at which to point regarding a firm diagnostic entity.
This leads to the importance of a rapid diagnosis and response to treatments, in order to avoid promoting a chronic condition and the risks of central sensitization. It should not be an excuse to stop seeking solutions, have a diagnosis and some medications. If there is a specific pathological generator, it should be found.
Many health care providers are over diagnosing this as a cause. Often these conditions have a complex cause between biological and psychological factors. For instance; chronic back pain is highly prevalent in the general population, which affects approximately 11% of men and 16% of women. There are over 100 possible risk factors found in the literature, indicating the ambiguous nature in understanding the causes of this condition.
However, not every case of chronic back pain is due to central sensitivity. There may be some involvement, none, or most, but only a small percentage of these will be amenable to attempts at treating as one of the central sensitivity syndromes.
Other examples of central sensitivity syndromes are chronic fatigue syndrome and fibromyalgia. Fibromyalgia presents with widespread pain and is present in approximately 8% of the population, quite more often diagnosed in women between 30 and 55 years old. Chronic fatigue syndrome is similar to fibromyalgia, but diagnosed as separate regarding physiological problems in endocrine response and autonomic function. The gender difference is less pronounced than fibromyalgia, however, is seen more in middle-aged women than men, by about 2:1.
While no clear causes have been found predisposing one to develop central sensitivity syndromes, explanations are being explored, like genetic predispositions, immune dysfunctions, viral triggers, and childhood trauma/abuse; indicating the difficult psychological and physical burdens, but clearly demonstrating the difficulty in understanding causes and predisposing factors.
Regarding chronic back pain, we often find hypercentralization due to the chronic nature; so that even when there is a specific pain generator, like hard pressure on a nerve seen in some cases of spinal stenosis, calcification of the ligamentum flavum, or osteophytes, for which conservative therapies are largely futile, hypersensitivity to pain occurs and may persist even beyond successful surgery. This can be some of the reason for “failed back surgery syndrome” in those who develop psycho-social repercussions of continual pain without remediation for a prolonged period.
A 2020 review the journal RMD Open indicates that part of pain indicated as nerve related or neuropathic in rheumatic disease might be rather nociplastic, which is pain from altered perceptions with no clear evidence of actual damage, secondary to a central sensitisation mechanism. This emphasizes the complex nature of pain and pain syndromes.
Sometimes new therapies are available, but not generally well known or accepted by insurance companies. I discuss this and about some of the advances in regenerative medicine at the bottom of the page and have a link to an office I have corresponded with. Visit the link on the page and you can learn about some of these options that you may have never heard.
As a note: In my opinion, all injections should be guided. It may be that surgery is the only solution to your problem and central hypersensitivity will not be a problem. Nothing is guaranteed, but if you fit the criteria as good as possible, this maximizes results, so I would always have a second or third opinion.