Central Sensitization in Chronic Pain (Plus Treatments)

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 sensitisation appear to be the main contributors to pain and disability."

So let’s figure out what it’s all about...

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 and all signs of danger. Your body is doing too good of a job at protecting itself with the pain response.

Most people don’t know it’s the brain and nervous system that create 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 practices 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 about 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 month period that we can start defining pain as chronic.”

The pain is 100% real and is often debilitating. It’s not ‘all in the head’ or imaginary in any way.

This is just how long-term pain works, and pain specialists understand it well. But most patients and even some health professionals don’t. This is partly why chronic pain is at record levels.

When this happens, our protective behaviour when in pain – like fear of movement and guarding the injured area – loses it’s protective benefit, and actual 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. Clearly, the patient is not being damaged by the touch. The problem is the overexcited pain system.

Why Central Sensitization Occurs?

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.

Rates of central sensitisation vary from 10% in shoulder pain to 100% in fibromyalgia.

Remember, this list is not a complete list, 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 in relation to the injury or pathology
Pain persisting beyond expected tissue healing healing times
History of failed interventions (medical/surgical/therapeutic)
Pain-anxiety, fear-avoidance of pain, the belief of damage, and pain-related disability

My Personal Experience With Sensitization

For me, the sensitization fight is personal.

I suffered with years of chronic RSI pain that left me disabled. I went doctor shopping for years, had two invasive surgeries and it’s only once I learned about central sensitization, and all that comes along with it, was I able to train my brain away from pain.

This short video covers my journey and recovery from RSI. In addition, here’s my first-hand account on central sensitization FEELS:

My pain felt like lighting bolts shooting up and down my arms. But the sensations can take on any form - throbbing, sharp, achey, and so on.
The pain would come on suddenly, and take a little longer to settle down
The pain felt no different, or less real than any other pain I’ve experienced

In highsight, it’s clear that all of the pain I experienced was the result of sensitization. Looking back, that made sense because of the following:

The pain would move from place to place. Not something you’d expect if there was a mechanical or tissue issue
Despite ample rest and treatment, the pain didn’t improve. Considering the body’s remarkable healing abilities that doesn’t add up

I received different and sometimes even contradictory diagnosis 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 diagnosis 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

Feeling Betrayed By Your Body? Try Not To

Pain patients can start to feel like they’ve been betrayed by their body. 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 prioritised 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?

There’s no pill or potion that 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 over time 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 sensitisation is present should address the (lifestyle) factors that sustain the process of central sensitisation, 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,

Trying to turn down the volume on persistent pain, while dealing with pain and everything else pain brings, is a difficult task.

That’s why I created Pathways. Our program helps to train your brain away from pain. You can download for free on Apple or Android (update Aug 2023: Pathways is now a web app! Start our program here). If you’re a health professional interesting in recommending us to patients, please get in touch.

“I’ve had years of back and neck pain that stopped me working. 6 weeks into this program and I’m having my first pain free moments. Thank you!”

Sarah Snookstarstarstarstarstar

“A well made, beautiful web app. One of the few things that’s helped me with CRPS”

Robert Hicksstarstarstarstarstar

“Life changing web app. For over 10 years I have been tormented by RSI and after several sessions of using this my pain has reduced substantially and I am doing many of the things I once gave up”

Tom Meldrumstarstarstarstarstar

Central Sensitization in Chronic Pain (Plus Treatments)

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.

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.

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.

Important caveat: although sensitization is extremely common in pain patients, it’s not always the cause of persistent pain. It’s critical that you visit more than one health professional, to get a thorough checkup to rule out anything dangerous.

The pain I’d experience was completely disproportionate. Something simple like turning the page on a book would cause severe pain!

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.

Trying to turn down the volume on persistent pain, while dealing with pain and everything else pain brings, is a difficult task.

“I’ve had years of back and neck pain that stopped me working. 6 weeks into this program and I’m having my first pain free moments. Thank you!”

“A well made, beautiful web app. One of the few things that’s helped me with CRPS”

“Life changing web app. For over 10 years I have been tormented by RSI and after several sessions of using this my pain has reduced substantially and I am doing many of the things I once gave up”