Understanding Central Sensitization Syndrome : Symptoms, Diagnosis, and Treatment

Central sensitization syndrome is a phenomenon that occurs in the brain and increases the sensitivity to pain. In this, the brain and the spinal cord gets sensitive to pain signal and leading to long-lasting pain.⁽¹⁾

It is important to have an understanding of central sensitization syndrome as it affects the central nervous system and can lead to a significant change in a person’s behavior and emotional state. It is observed that people who have experienced chronic stress, trauma, or exposure to traumatic events develop this syndrome. 

Central sensitization syndrome can be a barrier to recovery in people who have experienced trauma and may interfere with the ability to engage in therapeutic intervention. A correct diagnosis of Central sensitization syndrome can help the providers in giving an appropriate treatment plan that can address the underlying cause and help the individual regain their self and improve the quality of life.

Central sensitization syndrome occurs when the central nervous system misfires and amplifies sensory input leading to pain, fatigue, brain fog, and sleep problems. The condition causing central sensitization syndrome are fibromyalgia, arthritis, injury, and neuropathic pain.

In central sensitization syndrome, there is an alteration in the way the brain and spinal cord process the sensory stimuli which results in structural, functional, and neurochemical changes in the central nervous system exacerbating the pain response.⁽⁵⁾ There is a change in the way pain signals are processed and transmitted within the nervous system. Normally, the nervous system filters irrelevant responses to pain signals in a controlled and appropriate manner. In centralized sensitization syndrome, the nervous system gets overly sensitive to pain signals. This leads to pain even in the absence of any external stimuli or as a response to a stimulus that may not otherwise cause pain. It can also cause the development of chronic widespread pain.

Central sensitization syndrome is different from other pain conditions in various ways:

Chronic pain associated with central sensitization syndrome has a widespread distribution and can be triggered by a stimulus that would not otherwise elicit a pain response and pain from other conditions is typically localized to the joint affected. Neuropathic pain is characterized by a burning, tingling, or shooting sensation while sensitization may lead to aching or throbbing pain.

Central sensitization occurs due to changes in the central nervous system and is associated with conditions that may be causing pain including fibromyalgia, chronic lower back pain, and chronic regional pain syndrome. Other chronic pain conditions are due to joint damage and inflammation. There are certain neuropathic conditions that occur as a result of nerve damage.

The treatment of central sensitization and other pain conditions varies largely. Central sensitization syndrome can be treated with the help of physical therapy, cognitive behavior therapy and mindfulness-based therapy other pain conditions may not find these treatments effective. Also, the medications including anticonvulsants, antidepressants, and topical agents used for treating central sensitization syndrome may be ineffective for other pain conditions.

Chronic pain is the main symptom of central sensitization syndrome and has may have no clear physical cause.⁽²⁾ There is widespread pain in the muscles and joints that may or may not have an obvious injury or disease.

The pain in central sensitization syndrome also arises from a couple of abnormal types of pain, which are hyperalgesia and allodynia.

Hyperalgesia means experiencing increased pain making any type of injury, surgery, or chronic sources more debilitating. Allodynia means feeling pain from things that otherwise do not cause any pain.

There are several conditions that describe central sensitization syndrome including chronic pain, fibromyalgia, chronic fatigue syndrome, and complex pain syndrome.

The physical symptoms of central sensitization syndrome include:

• Pain in the muscles
• Fatigue
• Headaches
• Joint pain
• Sleep disturbances
• Numbness or tingling sensation
• Weakness and muscle wasting
• Sensitivity to light and sound

The psychological symptoms associated with central sensitization syndrome include:

• Anxiety
• Depression
• Mood swings
• Irritability
• Stress
• Sleep disturbance

Difficulty in remembering things and difficulty in concentration

The psychological symptoms may also result due to physical symptoms associated with central sensitization syndrome.

Proper diagnosis of central sensitization syndrome is important to identify the underlying cause of the patient’s chronic pain and other symptoms. This can be helpful in guiding toward the appropriate treatment and management strategies. The diagnosis can be helpful in preventing unnecessary and potentially harmful medical procedures and interventions. Also, early and accurate diagnosis can be helpful in preventing delays in the treatment and improves the overall patient outcome.

Currently, no proper test can conclude that a person has central sensitization syndrome.⁽³⁾ Diagnosis involves clinical evaluation and assessment of the medical history, symptoms, and physical examination.

The common diagnostic criteria include:

• Presence of widespread pain, fatigue, and associated symptoms
• Quantitative sensory testing
• Pain provocation test
• Imaging studies
• Blood work can be ordered to look for causes of chronic pain such as rheumatoid arthritis
• Multidisciplinary approach involving different healthcare providers is necessary

Due to individual symptoms and mechanisms the central sensitization syndrome requires a customized treatment approach.

Mostly the central sensitization syndrome responds to a particular type of multidisciplinary approach including medications, physical therapy, cognitive behavior therapy, and other complementary therapies.⁽⁴⁾ The treatment plan depends on the symptoms of an individual and the needs.

Medical treatment includes antidepressants, muscle relaxants, and antiepileptic medications. They work by altering pain-mediating chemicals in the brain. Muscle relaxants may help prevent muscle spasms and tension. Non-steroidal anti-inflammatory drugs may be helpful in managing pain but might prove to be ineffective for chronic pain of central sensitization syndrome. Medication can be used along with other complementary therapies for more effectiveness.

Physical therapy, occupational therapy, and exercises can be helpful in dealing with central sensitization syndrome.

Physical therapy for central sensitization syndrome involves:

• Manual therapy includes massage, myofascial release, and point therapy to relieve tension and pain associated with central sensitization syndrome.
• TENS unit can be effective as it uses electrical impulses to ease the pain.
• Physical therapists can help teach an individual proper posture and body mechanics to reduce strain.

Exercises for central sensitization syndrome include:

• Aerobic exercises including low-impact exercises that can be helpful in increasing blood flow and improving flexibility.
• Stretching particularly neck, back, and shoulder muscles can relieve tension and improve flexibility.
• Strength training involves resistance exercises that use weight or resistance bands to improve muscle strength and stability.
• Cognitive behavior therapies for central sensitization syndrome can be helpful in dealing with emotional aspects due to pain

There are also a few lifestyle modifications that can be helpful in dealing with central sensitization syndrome. These include:

• Eating a healthy and balanced diet including fruits, vegetables, and omega-3 fatty acids is essential. These help with the symptoms of central sensitization syndrome.
• Activities can be broken down into smaller parts to avoid over-exertion.
• Stress can trigger as well as worsen the symptoms of central sensitization syndrome. Stress can be reduced with the help of meditation, deep breathing, and relaxational exercises.
• It is important to establish a proper sleeping habit which can be done by limiting screen time and creating a comfortable sleeping environment.

Coping with central sensitization syndrome can be challenging but there are several strategies that can be helpful in managing the symptoms.

• Supports Groups: Joining groups with people having similar conditions can provide social support and reduce feelings of isolation.
• Education: Getting educated about the problem and learning ways to manage a condition can make it easy to deal with it.
• Mind-Body Techniques: Mind and body techniques can be helpful in managing stress associated with any condition and promote relaxation and well-being.

Managing the condition with the help of complementary therapies can be helpful in reducing continuous discomfort. The treatment plan can be tailored with the help of a healthcare professional according to the need and symptom severity.

Central sensitization syndrome is a condition affecting the way the nervous system processes pain signals. This leads to pain and a range of symptoms. There are various conditions that can be the cause of central sensitization syndrome including fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. The symptoms can be complex and can be managed by various treatment options. There are various coping strategies that can help in managing life with central sensitization symptoms.

More research is needed to look ahead to the development of the treatment plan for central sensitization syndrome. If there is a better understanding of the physiological and biological aspects of this illness more targeted and effective treatment can be developed. New medication targeting the immune system function can be researched. Traditional medication can be combined with alternative therapies for symptom management.

Central sensitization syndrome can play a role in causing discomfort in the everyday life. A comprehensive treatment including medication, physical therapy, and lifestyle modification can be effective in managing its symptoms and improving the quality of life.