Chronic pain and central sensitization

What is central sensitization? "Pain itself often modifies the way the central nervous system works, so that a patient actually becomes more sensitive and gets more pain with less provocation. That sensitization is called “central sensitization” because it involves changes in the central nervous system (CNS) in particular — the brain and the spinal cord. Victims are not only more sensitive to things that should hurt, but also to ordinary touch and pressure as well. Their pain also “echoes,” fading more slowly than in other people."  Pain changes how pain works


It really is in the title of the article. Pain changes how pain works. One neurologist told me migraines beget more migraines. Until you become more sensitive to triggers and more wired for migraines... and then chronic  migraines. Not the case for every case of chronic migraines, but certainly many. And it is a familiar term when it comes to Fibromyalgia as well... it is what fibromyalgia pain is about after all... more pain with less provocation, felt for longer time periods. It is something that can occur from an injury though .. but unknown why some people the the brain becomes wired for pain long after the injury is gone.

"Indeed, this neurological meltdown is such a consistent feature of other painful problems that some researchers now believe central sensitization is actually a major common denominator in most difficult pain problems — the nearly universal factor that puts the “chronic” in chronic pain, giving them all shared characteristics regardless of how it got started."
"Another unfortunate gap in our scientific knowledge is that there are no clear criteria for diagnosing central sensitization. There is no easy lab test or checklist that can confirm it.2 It could be present in nearly any difficult case of chronic pain, but it’s not a sure thing — the pain could still be coming from a continuing problem in the tissue, with or without central sensitization muddying the waters."

"Central sensitization is bad news, but worse still is how few health care professionals are aware of the neurology and make things worse with careless or even deliberately rough, no-pain-no-gain treatment. It’s bad enough that ignorance of central sensitization leads to wild goose chases and patients riding a merry-go-round of expensive and ineffective therapies, but many kinds of therapy are also quite painful — and can make the problem worse. With tragic irony, the most likely victims are also the most vulnerable and desperate patients, patients going through the therapy grinder, their hopes leading them right into the hands of the most intense therapists." - I think most of us are familiar with this one. So familiar.  "When physical therapists, massage therapists and chiropractors treat a chronic pain patient too intensely, they are going to trigger that alarm system, and quite possibly make the situation worse instead of better." I can honestly say massage therapy is horrible... no matter how many times they say they are being gentle due to your FM it is horrible pain that just lingers and lingers. Chiropractors I had actually been warned about because they are known for not being gentle and could cause more damage than good... I did try one for migraines, so work on the neck and it did hurt but it was the spasms it caused that worried me. Anyway you expect the pain, you think you must endure it for the greater good, like exercise... surely in the end it does something good right? No pain no gain?
"It’s actually quite astonishing how little pain is caused by some seemingly dramatic issues in your tissues! “The evidence that tissue pathology does not explain chronic pain is overwhelming (e.g., in back pain, neck pain, and knee osteoarthritis).” (Moseley)
It all starts to make a lot more sense when you understand how the your pain system works — that pain is strongly regulated by the brain.
Professionals may pay some lip service to the importance of integrating neurological considerations into treatment, but their respect is often more poetic and politically correct than practical.4 Care for chronic pain of all kinds needs to soothe and normalizethe nervous system — not challenge it with vigorous manipulations."
Naturally calming down the nervous system makes sense. I assume medications like Lyrica are aimed at dulling the edge of it. "Medications that work on the central nervous system are probably the most promising treatment for serious pain system dysfunction. Only a physician trained in the care of chronic pain can prescribe those medications. The best place to look for such a doctor is in a pain clinic — if you have serious chronic pain, you should start looking for one today."

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