I was told my pain was because I have central sensitisation...now what?

What is central sensitisation?

Have you every heard this phrase and wondered what it really means? Within the medical system, we know that for some people neurons (nerve cells) in the spinal cord and brain fire sensitising chemicals more easily. This means that our central nervous system can end up in state of increased reactivity (called central sensitisation).  Practitioners with a bit more knowledge may also know that within neurons of the brain and spinal cord of people with chronic pain there is an increase in the quantity and activity of a type of a neuropeptide (think messenger chemical) called Substance P.  Neuropeptides have an effect upon how the brain will respond to sensory information from the body, and thus whether the brain will elicit a pain response.

Why treatment feels limited?

The question that remains unanswered is why is your nervous system responding and what contributing factors lead to you having 'central sensitisation'.  The message you have likely received is 'you have central sensitisation and we don’t know why your body has reacted this way'.  The hope is that with regular exercise and perhaps a pain management course you might at least be able to manage the symptoms for now. 

Of course that can often leave you feeling either like something must be being missed, or with the underlying feeling that your body has betrayed you - cue frustration and overwhelm.

A rehash on 'central sensitisation'

How I like to think about ‘central sensitisation; which is hopefully a bit less depressing, is that it is simply a phrase coined to describe a temporary increase in danger signalling.  Because this is essentially what is happening.  But why does this happen in some individuals and not others?  It comes down to how your subconscious brain and autonomic nervous system (fight/flight response) have been conditioned to react to stressors throughout your life. 

The underlying factors

Chemical activity within the CENTRAL nervous system or CNS (where the pain associated neuropeptide called substance P is found) is largely influenced by how much threat our primitive and emotional subconscious brain senses.  Your central nervous system includes all regions of the brain and spinal cord that interpret sensory data as well as store subconscious memories, meanings, beliefs and emotional associations.

This threat detection system is influenced by and has output to another part of the nervous system called the autonomic nervous system (ANS).  The ANS is made up of nerves that innervate our muscles and organs and respond to the primitive brain’s commands, activating a fight, flight, freeze, flop or relaxation response.

How this all works in a nutshell

Every time your subconscious survival brain detects any sort of threat (emotions of shame, rage, helplessness, terror, as well as the possibility of social rejection or self criticism/feeling not good enough), we get a release of neurochemicals in preparation to fight, flee, freeze or collapse, as a human survival response. 

Your limbic and survival brain regions create and release chemicals that can both alter the sensitivity of the 'central system' (central sensitisation) and alter the unconscious interpretation of sensory data from the body.

The final result

The more frequently this occurs and the more we flood our brain and central nervous system with neurochemicals, the more excitatory our central nervous system becomes.  Thus it is 'centrally sensitised'. So now we have all of this incoming sensory data from the body that is not only being delivered to the brain in a heightened way, also interpreted in a heightened way.  We start to experience pain, but not because the body is actually damaged.

What drives this protective mechanism to persist?

a.    The underlying emotional and psychological factors that are driving the increase in chemical 'danger' signalling stay the same.

b.     The brain can get efficient at generating the same neural circuits as it has done previously. Your brain just wants to do the same thing it did the day before because it uses less energy. Our brain learns to anticipate how to respond to sensory data based on prediction.  This is actually good news because changing how we respond to sensations (emotionally, cognitively and behaviourally) can actually change the neural circuit being created for pain.

Just as the brain and nervous system has become more sensitised, they can also become less sensitised.  And the key to this can be cultivating safety with mind-body modalities.