What is Central Sensitization?


July 28, 2020

Central sensitization, in short, is a hypersensitivity to stimuli from things that are not typically painful. The first evidence of this type of hypersensitivity dates back to 1933. Living with any type of pain, acute or chronic, can interfere with many normal aspects of everyday life. A handshake, a hug, anything regarding sense of touch can be greatly affected by chronic pain, particularly in those suffering from central sensitization disorders. Patients who find themselves suffering from forms of central sensitization experience pain from stimuli that should not induce pain. Things as gentle as brushing the back of a hand with a cotton ball can cause extreme, intense pain. 

Nociceptors are sensory receptors that respond to painful stimuli. With central sensitization dysfunction, there is a nociceptor-induced sensitization of the somatosensory system; a portion of the sensory nervous system that is concerned with the conscious perception of temperature, movement, position, touch, pressure, pain, and vibration. The somatosensory system is adaptive meaning that it becomes hyper alert in conditions where there is a risk of further damage or immediately after exposure to a damaging or intense stimulus. This creates synaptic plasticity in the central nervous system. There are multiple forms of chemical, structural, and functional plasticity that can sensitize the central nervous system to produce pain hypersensitivity. 

Central Sensitization and Other Forms of Chronic Pain

Also referred to as allodynia, central sensitization can be associated with other types of chronic pain including: 

  • Fibromyalgia
  • Temporomandibular joint dysfunction (TMJ)
  • Migraines 
  • Skin damage from ultraviolet radiation
  • Surgical scars

Pain problems such as these can cause chronic pain on their own, but with a hypersensitive central nervous system, allodynia can develop. Some migraine sufferers have reported pain with shaving, wearing contact lenses, and brushing their hair. 

Central Sensitization Treatments

Because this can affect every individual differently, there is not a one-size-fits-all approach to treatment. At least there shouldn’t be. A multi-faceted approach to treatment is typically considered for patients with allodynia. Tricyclic compound medications also known as TCA’s are often used in cases such as these. A process known as desensitization is also a topical form of treatment. This can be a painful process in the beginning but has proven to be successful over time. Having patients place their hand or foot into a bowl of uncooked rice, the use of paraffin wax, and clay are all ways of reducing hypersensitivity of the skin and tissues.  

Pain neuroscience education is recommended in treatment as well. Commonly referred to as PNE, the goal is to re-conceptualize pain by helping the patient understand that all pain is in the brain and their situation is caused by a hypersensitivity of the central nervous system rather than local tissue damage. The goal is for the therapist and patient to reach a therapeutic alliance and for the patient to understand the controversy and cause surrounding their pain. 

As with any effective medical treatment, diet, sleep, and stress management may also be addressed. Ensuring that the patient is getting adequate sleep and rest is crucial to their overall health both physically and mentally. Stress can heighten pain even more, so various forms of stress management may be recommended to patients. This may include practices such as yoga, mindfulness, or meditation. Dietary intervention may also be necessary. Eliminating inflammatory foods and consuming nutrient-dense whole foods can be an important and effective part of treatment. 

As central sensitization can affect patients differently, clinicians should seek to design individually tailored treatment plans. It may take effort from both the patient and physician, but treatment is available for those who are seeking it.