Central sensitization is a phenomenon that complicates chronic pain. It represents a change in the nervous system that is associated with the development and maintenance of pain. The change results in a persistent state of high reactivity and a lowered threshold for feeling pain. For example, in one study, a person with central sensitization reported a pain level from a pinch of 8 out of 10 whereas the non-affected person reported 2 out of 10 for the same stimulus level.
Central sensitization syndromes develop in more than just chronic low back pain. Chronic abdominal or pelvic pain, bladder pain, headaches, and fibromyalgia can also be associated with sensitization. The management of sensitization requires a multi-faceted approach.
The three key pillars are:
1) Medical therapy to calm the nervous system
2) Understanding the mind-body connection
3) Learning active interventions to improve self-efficacy
Medical therapy includes treatment to calm the nervous system. It is like turning down the pain volume on a dial so the threshold pain level is higher. There are multiple classes of medications that calm the nervous system. Medications used to treat seizures are a common class. Just as they calm the nervous system and fewer seizures occur, so is the over-reactivity of reporting pain signals. Commonly used medications are gabapentin and pregabalin.
Equally important is mind-body awareness to connect how inner personal pain can associate and worsen physical pain. Unfortunately, emotional pain or severe stress can overflow into physical symptoms. With practice, one can identify the sources that worsen their physical pain. With achievement of the mind-body connection, one can then modify their environment to reduce triggers and thereby reduce pain episodes. Mind-body activities include the practice of mindfulness and body awareness. Another popular option is yoga which combines physical exercise with mindfulness.
Additionally, active interventions that improve self-care are helpful. These may include a functionally-based exercise program on the physical side or cognitive behavioral therapy to reduce negative thought patterns on the psychological side. Interestingly, with chronic pain, pain circuits become intertwined with emotional circuits. For this reason, negative thinking and negative thought patterns produce emotional upset which can then elevate pain levels.