You have pain in various parts of your body, constant pain for years.
It seems that nobody knows what the cause of this chronic pain is, you get different
diagnoses every time you see a different doctor. In addition to pain, you wake in the morning,
and you feel like a truck run over your body the whole night, your mood is very depressed
and you have anxiety attacks. It is hard for you to concentrate, and your
memory is poor. Your doctor suggested that these symptoms
could be caused by central sensitization. Central what? You asked!
If this is your case, then this video is for you.
Today, I’ll explain to you What are the symptoms of central sensitization?
How does a person develop central sensitization? Is there any test that can be ordered to confirm
the diagnosis? And most importantly, how to get rid of central
sensitization.
So, let’s talk about Central Sensitization today
The main symptom of central sensitization is pain in many areas of your body, it is
pain that is hard to define, hard to localize, difficult to explain.
It is a constant pain, it seems that your pain never goes away, there is always a background
pain, like you are always conscious of the pain, even when you try to distract yourself,
it is always there. There might also be some numbness, tingling
and tremors. The pain is spreading to many parts of your
body. It may have started with a lower back pain, but now, it is affecting the upper back,
the shoulders, the thighs, the knees and so on.
You don’t know why the pain is spreading to your body. Even your head hurts, your eyes,
and even chest. Sometimes it hurts just to breath.
This already seems severe, doesn’t it? Well, but this is not all. You also have other vague
symptoms like dizziness, difficulty to concentrate, poor memory, and fatigue. Well, you feel tired
all the time, but then, when you go to bed, you can’t sleep. And when you wake up in
the morning, you feel like a truck run over your body all night.
In some cases, the person has restless legs when they are trying to sleep at night.
Their mood is also affected, they have symptoms of depression and anxiety attacks.
That is not all, there are people who also have skin problems, like dryness, itchiness,
or rashes.
There is more.
Certain perfumes and smells, make them dizzy and nauseated.
And more… they have to urinate frequently and have pelvic pains, and pain for urination
or during sexual activity.
You may be thinking, Am I crazy? Am I making up all these symptoms? Are these all psychological?
No, you are not inventing these symptoms. These are classical symptoms of central sensitization.
Fortunately, not all patients with chronic pain have central sensitization, but the bad
news is that many do, and many patients that I see were never diagnosed with central sensitization
when it started 5, 10, 20 years ago.
So, I hope that if you are watching this video and your symptoms of Central sensitization
are just starting, you will be able to revert this condition before it spreads to your whole
body. The treatment is quite easy but requires your participation and perseverance. The improvements
will not be noticed right away. I tell people that they need at least 2 years of treatment
to see the reversal of central sensitization.
I know a lot of doctors who don’t know how to diagnose central sensitization, and they
tell patients with these symptoms that they are imagining this pain, that there is nothing
they can do, and they don’t know how to offer the treatments that are very effective
to revert central sensitization.
Unfortunately, these doctors did not get this type of education in their medical training.
We need to do a better job at training the next generation of medical students. Well,
that is another topic!
Let’s come back to your pain.
What is happening in your body to cause all these symptoms?
Before I continue, let me remind you that this video is not intended to replace medical
advice. It is for educational purposes only. You should contact your doctor for a proper
diagnosis and treatment plan for you. In case of emergency, go to the nearest emergency
department or call an ambulance. Our neurological system contains amazing structures
that are always changing and learning. Your brain today is different from you brain yesterday.
Today you have some synapses that you didn’t have yesterday. You heard a song today? Then
new synapses were created. You read a social media post today? Then you made new synapses.
You visited a place that you’ve never been before? New synapses were made. This is what
we call neuroplasticity.
A synapse is a connection between two neurons. The more we use this connection, the stronger
it gets.
For example, remember when you were learning to drive, on the first day you needed to pay
full attention to the steering wheel, the break, the traffic lights, the other cars,
the pedestrians, etc. At the end of the practice lesson, your brain had made thousands of new
synapses. But if you didn’t use these synapses again, they would become weak and probably
had dissolved.
But you kept driving, you kept using these synapses, then they became stronger and stronger,
they became so effective, that now they produce a lot of neurotransmitters and now you arebe
able to get the car keys, drive the whole town, back and forth, have a nice chat with
the passenger on your side, and you didn’t even pay attention to the brake pedal, the
gas pedal, you may not even remember all the details of the traffic in the city, because
you were driving the car almost as an auto-pilot, right?
Yes, your brain created those synapses and now it runs on auto-pilot.
Our brain can learn millions of new information, new skills, and become expert at that. Just
look at some people who play instruments, or play sports.
Practice makes perfect. Those synpases become very strong and efficient.
Well, that is basically what happens in central sensitization. The brain changes in response
to pain. We call this nociplastic pain. The brain is trying to eliminate pain, but
instead, it becomes expert in feeling pain. There are hundreds of new synapses that are
created and they are very effective in transmitting pain.
Remember practice makes perfect. And now, the brain feels pain so easily, almost like
an auto-pilot.
Well, this neuroplasticity occurs not only in the brain, the brain is only one organ
of the pain system. There are other organs like the spinal cord, the peripheral nerves,
the sensors in our skin, the immunological system and the endocrinological system. These
are all affected and changed in central sensitization.
The pain system is the alarm system of our body, so in normal circumstances, we need
to feel pain to alert us that something is abnormal and needs to be fixed. In central
sensitization, it is like the alarm system is malfunctioning. The volume of the siren
is too loud, there are some short-circuits and the alarm system is not doing what it
is supposed to do, to bring the firetruck, the ambulance or the police.
In normal situations, without central sensitization, the pain system would alert that something
is wrong, and then activate our own top-down pain suppressing capacity and that would take
care of the pain.
However, in central sensitization, the whole system is malfunctioning, this means that
there are a lot of bottom-up information arriving in the brain, and not enough top-down suppression
of pain
The functions that are affected by central sensitization are all the areas that are linked
to the pain system, to the pain matrix. So what are they?
Obviously, the sensation of pain itself. Both peripheral and central sensory systems are
sensitized. We feel pain mainly in the skin, but also in the bones, muscles, tendons, internal
organs, veins, arteries and membranes around the nerves.
A person without central sensitization feels a toothpick like a small sharp pain, but the
person with central sensitization feels a tooth pick like a knife piercing the skin.
In severe cases of central sensitization, their clothes bother them. Even a hug hurts.
The brain with central sensitization will use up all neurotransmitters that are normally
used to reduce pain in the top-down suppression response.
We have powerful neurotransmitters like serotonin and gaba that are used to abolish pain.
Our brain also produces our own opioids in response to pain, the endorphins, dynorphins
and enkephalins. But when the nerve system is sensitized, these responses are not working,
they are abnormal, they are malfunctioning.
The other function that is sensitized is the ability to respond to stressful situations.
In a person without central sensitization, the body releases adrenaline, noradrenaline
and cortisol when there is stress, and these hormones are very strong analgesics under
normal circumstances. You may have heard of people who were in a
life-threatening situation and they did not feel any pain when they suffered an injury,
that is how powerful these stress hormones are.
However, when there is central sensitization, a stressful situation will increase pain,
not decrease pain, this is because there is a malfunctioning of the stress response, because
of the central sensitization.
And last, another function that is affected by central sensitization is the response to
exercises. In a person without central sensitization,
exercises release endorphins and they have a sense of well being, happiness and no pain.
But in a person with central sensitization, the opposite happens. Exercise leads to more
pain and no noticeable pleasure.
Which types of chronic pain lead to central sensitization?
We know that central sensitization starts with acute pain. Then, in some people the
pain system will sensitize and initiate this cascade of symptoms.
There are some situations that predispose a person to have central sensitization. That
is the topic of another video that I made.
We know that any type of pain can lead to central sensitization, but the most common
are: Tension headaches
Migraine Whiplash
Myofascial Pain Temporomandibular Joint Disorder
Pelvic pain Low-back pain
Neuropathic pain Shoulder pain
And arthritis You may be asking. How about Fibromyalgia
and Complex Regional Pain Syndrome. These are two conditions that have a lot in common
with central sensitization. Fibromyalgia is central sensitization with pain in multiple
areas of the body. CRPS is central sensitization with pain in one or just a few regions of
the body. Is there any test that can be ordered to diagnose
central sensitization? At this point, there are functional MRIs of
the brain that can detect specific changes in the pain circuits and suggest central sensitization,
but these are not routinely used in clinical practice. They are available mostly for research.
There are also some tests that look at how a person responds to a painful stimulus, they
test how effective are the top-down pain suppressing paths. There is a test called conditioned
pain modulation or CPM, but again, it is only used in research studies.
In practice, we confirm if the person has central sensitization by asking the person
to complete some questionnaires about the symptoms of pain, sensitivities, depression,
anxiety and sleep. We also perform a physical examination, and we can detect some areas
that the skin is hyper sensitive, for example, we use a cotton ball to touch the skin and
the person feels pain. Or we use a sharp pin and the person feels like a knife.
Yes, I know, it sounds like a torture session, but I tell my patients that I need to examine
their sensors to see if there is sensitization or not.
Now, the better part of this story is that central sensitization is reversible.
The brain is an amazing structure, the brain is not static, it is dynamic, it is always
changing itself, creating new synapses, learning something new. Always open to new concepts.
It is truly amazing. So, if we train the brain to desensitize,
it will. It may take time, patience and perseverance. But it is worthwhile. I’ve seen many patients
who had severe central sensitization and now they are living a fulfilling and happy life.
In some cases, we may need to use medications to increase serotonin or gaba in the brain.
We use medications like SNRI antidepressants or gabapentinoids. If the person is using
opioids, we suggest the person to taper and stop because opioids aggravate opioid induced
hyperalgesia, which is one type of central sensitization. We suggest the person to increase
the diet intake of magnesium or take supplements. I have another video that I talk about magnesium.
And it is also important to improve sleep efficiency. Watch my other video to learn
some tips on how to improve the quality of your sleep.
But most of the time, what works best is brain retraining. And how do we do that?
Basically, using two techniques that you may be very familiar:
1) Mind-body therapies 2) And Movement
When used together, mind-body therapies and movement have amazing results. Especially
if they are used in the early stages of central sensitization. Even in people who have central
sensitization for many years, I’ve seen people completely revert it with these two
therapies. But nobody can do these therapies for you,
you need to do yourself. What kinds of mind-body therapies?
I have another video that I just talk about evidence-based mind-body therapies: cognitive
behavioural therapy or CBT, Biofeedback, Mindfulness, Meditation, mindfulness-based stress reduction,
Yoga, Hypnosis, guided imagery, Acceptance and Commitment therapy or ACT,
Basically, any type of mind-body therapy will work, you have to choose one that you like
because if you don’t like and you will not adhere to it.
So, you may try one of these mind-body therapies for a few sessions, maybe 10 sessions, and
if you don’t like it, then try a different one, and keep trying until you find one that
works for you. What kind of exercises?
Again, any type of exercise will do it, what is important is that you move your body, even
if it hurts. You need to find an exercise that you enjoy, something that will not be
hard for you, try different types of exercises until you find one that you really like.
You need to remember that although you are moving the muscles you are basically reprograming
the synapses in the brain, retraining the brain to disconnect the synapses of central
sensitization. Now remember, you need to practice these mind-body
therapies and movement every day, many times a week. The more you practice, the better
you will become at them. Before you realize, you will be doing them
almost like an autopilot, without even thinking of them.
They will become so natural and part of your daily life that it will not even seem like
therapy anymore, and then, when you are at that stage, you will realize, that pain is
not constant anymore and all of those symptoms and sensitivities are very diminished or completely
gone.
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Watch my next video here. Good bye!