Continuing on from my chronic pain and sensitisation posts of the last two weeks, Leah Adams and Dennis Turk in the Journal of Applied Biobehavioural Research published an article on 27th June 2018 on the neurobiology of central sensitization.
They describe how more recently, newer techniques in brain imaging, EEG and others have helped to further identify the underlying mechanisms of central sensitisation.
It is now thought to play a role in hundreds of painful conditions – many more than I described last week. So much so that a lot of these common ailments have had to be renamed.
Irritable Bowel Syndrome (originally called spastic colitis) has been found to not to show any spasticity in the gut that was thought to be the cause of the pain.
Jaw pain or TMD (Temporomandibular joint syndrome) has been found to be caused by problems largely outside the joint itself.
Interstitial Cystitis is now called bladder pain syndrome.
They have all been found to have no inflammatory cause or peripheral input – i.e. there is no identifiable problem in the joint or body area itself.
These issues have all been found to be driven in part by ongoing central sensitisation and they have now been labelled Chronic Overlapping Pain Conditions (COPC’s) as they find that the sensitisation from multiple pathways plays a big part in the ongoing nature of these conditions as opposed to one actual disease process in the area where the patient feels the pain.
This definition has come about because when scientists removed the input from the brain that was adding to the sensitisation as I described over the last two weeks, then the features of the central sensitisation partially or entirely disappeared. No treatment to the area of pain directly at all!
How do COPC’s Start?
Often people report having experienced fatigue, sleep disturbance and sensory sensitivity in early life.
Chronic low back pain is also included as a sensitisation problem as I said and what often appears to be a new episode of acute pain can in reality be just the newest region of the body to experience pain.
Therefore it is now suggested that COPC ‘s are actually a single lifelong disease that manifests in different body regions over time, depending on what is going on mentally or physically or both, in the patient’s life at the time.
Those suffering from COPC’s have also been found to have a strong family history of chronic pain or some type of sensitisation.
How do you know you have central sensitisation?
Chances are if you have had a whiplash injury, chronic low back pain, jaw (TMJ) pain, osteoarthritis, fibromyalgia, tennis elbow, shoulder pain, chronic fatigue syndrome, chronic headaches or irritable bowel syndrome then you will probably have central sensitisation according to Nijs et al.
Symptoms related to central sensitisation include, according to Nijs et al in the Journal of Orthopaedic and Sports Physical Therapy vol 46 issue 12 December 2016:-
Hypersensitivity to bright light, hypersensitivity to touch, noise, pesticides, mechanical pressure, medication, and high or low temperature; fatigue, sleep disturbances, unrefreshing sleep, concentration difficulties, swollen feeling in limbs, tingling or numbness in random areas.
How can you deal with it?
You would really benefit from face-to-face sessions of pain cause education so you can change how you perceive pain. For example – do you think that if you bend awkwardly you will create back pain? If you sit badly and for too long at your lap top do you think you will get headaches and neck pain? Do you think that if you get angry and clench your teeth you will aggravate your jaw pain?
The more you experience these fears the more likely it is that you have sensitisation going on. Avoiding certain movements ‘in case’ is called ‘Fear Avoidance Belief’. Imagining that a small twinge is the start of some much bigger problem is called ‘Catastrophising’.
You need to be taught how to cope and deal with these automatic feelings and thoughts. You may be fearful that there ‘must be something’ that is causing the pain – it is just that ‘nobody has found it yet and it’s bound to be terrible’, or you remember reading about someone who ‘has what I have’ and they died. Or ‘my Dad had it and he never recovered’. These are unreasoanable thoughts but you CAN be taught to think differently about the pain you have – you just need to replace these thoughts with others!
Chiropractic treatment is of course helpful for those with acute pain but not so effective for those with central sensitisation. But you can have the two together and reassurance and education that chiropractors provide does help you to think differently about your pain. Chiropractic is not just about the manipulation, don’t forget – we have a lot of tools in our toolbox to help you!
Medication should be used very sparingly. You must have read about the widespread misuse of opioids for chronic pain, and that although these medicines have been prescribed for years and are still being, they really do not solve the problem.
Other drugs that have proven to be effective for central sensitisation are
Paracetamol, Serotonin reuptake inhibitors, NMDA receptor antagonists, Gabapentin and Tramadol. Much better to find help for you condition without taking drugs like these, which all have the inevitable side effects.
General Healthy Lifestyle CAN Help!
Really it is quite boring!
Most of us would say, ‘I want a cure’ – ‘Can’t someone just give me a pill or treat me with manipulation and I can just get on with my life’. The reality is that if you have central sensitisation you WILL benefit from living the most healthy lifestyle you can – more than others who don’t have it!
So, you could start by sleeping well and getting ENOUGH sleep for YOU. Experiment and try different amounts of sleep and see how it works for you, particularly if you DO always seem to feel tired, even in the morning.
Try to think about how you could make your day less stressed. No, it won’t be easy – these things never are but you need to look at your needs not fret if you don’t seem to be able to work as hard as your colleague or friend. Life is not a competition. Yoga can help – try Heather at aerodynamic yoga in our basement see www.aerodynamicyoga.com.
Think about seeking help with cognitive behavioural therapy – a few pointers and exercises that you can do at home will help you think differently.
Eating good, nutritious foods and stop drinking too many caffeine laden drinks or processed foods.
Making sure you are moving and exercising correctly so you can confidently bend and twist and know you are not going to be doing harm. The better you can move the less likely you are to overload your tissues and add to the sensitisation.
Central sensitization is a multifactorial issue – we should address all of these things as if we don’t sleep well and if we are stressed, day in, day out and we don’t get any help and we drink too much coffee and tea to ‘keep us going’ every day and we grab too many processed foods because we leave work late and we are too tired to cook from scratch, we are really adding to the sensitisation day in, day out and so we are more likely to continue to suffer from these conditions.
We can definitely help you move better and can point you in the right direction to help with the other potential irritants.