Central Sensitization Syndrome (CSS)

What is Central Sensitization Syndrome

How the human brain perceives sensory input is a fascinating phenomenon. Petting a fluffy puppy, listening to a favorite song, or cuddling up with a soft pillow can evoke feelings of comfort and warmth. 

But what if the millions of neurons in our brain that process sensory input start to misfire? What if cuddling with that soft pillow makes you feel unimaginable pain? 

Unfortunately, this is a reality for many people. And there’s a name for it—central sensitization.

What Is Central Sensitization Syndrome?

Central Sensitization Syndrome (CSS) is a medical condition that affects the nervous system. It is a group of multiple illnesses, such as chronic fatigue, myofascial pain syndrome and fibromyalgia, all resulting from the same nervous system disorder—central sensitization. 

“Central” refers to the central nervous system, and “sensitization” refers to a heightened response to stimuli.

Central sensitization causes an individual to become hypersensitive to stimuli that are not typically painful, such as the feeling of clothes against the skin. Even something that causes a small amount of pain like a pin prick will be interpreted as intense stabbing.

This condition puts your nervous system in a state of high reactivity. Even after the painful stimuli are removed, you will still feel pain. It also confuses the brain into perceiving harmless stimuli as painful. The phenomenon of neuroplasticity in the brain allows for lifelong learning and establishment of new pathways.  While this is a positive adaptation for establishing positive emotional mindsets or for learning new tasks, it is also the underlying reason central sensitization occurs. As the pain sensation pathways are reinforced, the pain response becomes stronger and stronger and almost goes on autopilot resulting in constant pain and heightened pain to any stimulus.

Central sensitization can be categorized into two forms—allodynia and hyperalgesia.

Allodynia is when you feel pain from things that are not supposed to be painful. For example, touching a water bottle causes pain. 

A water bottle is a harmless object that should not cause pain, but because your nerve transmits the touch signals to the brain, your brain, impacted by CSS, interprets this signal as a pain message.

Hyperalgesia, on the other hand, amplifies the pain you already feel because the nerves are overstimulated. Think of it as extreme sensitivity to pain. 

It may also lead to other medical conditions, such as worsening depression, anxiety, stress, and in some cases, memory loss.

Symptoms Of Central Sensitization Syndrome

CSS is a chronic condition that can have a range of symptoms. These symptoms, in turn, may vary from mild to severe enough to negatively impact your life. 

CSS symptoms often overlap one another, so a person with CSS can exhibit one or several of the following signs at the same time in varying intensities:

  • Abdominal and or pelvic pain
  • Emotional and mental struggles like depression
  • Fatigue
  • Headache
  • Pain that is widespread/all over the body
  • Poor concentration
  • Poor sleep quality
  • Sensitivity to lights, odors, and sounds
  • Short term memory

As you can tell, CSS can manifest itself in any health condition. In addition to being a symptom, it might also be a sign of an actual medical condition.  So it is crucial to note any changes in your mental, emotional, and physical health to help detect CSS early.

What Is Central Sensitization Syndrome?

Causes Of Central Sensitization Syndrome

Central sensitization syndrome causes physical changes in the nervous system that alter the sensory processing in the brain. However, what causes these physical changes can be tricky to determine. 

CSS is frequently associated with emotional trauma, injury, infection, or a pre-existing or healed medical illness.

Other possible causes of central sensitization syndrome are:

  • A genetic tendency for low pain threshold
  • History of depression
  • History of physical trauma
  • History of psychological trauma
  • Pre-existing apprehension about pain
  • Stressful and unhealthy lifestyle

Treatments For Central Sensitization Syndrome

Although CSS is challenging to detect and establish, the good news is that it can be managed and down regulated. That phenomenon of neuroplasticity in the brain discussed above can be down regulated if the pain sensation pathways and the interpretation of pain is not constantly reinforced by things like anticipation of the pain sensation and emotional reaction or attachment to the pain sensation. This is why the mind-body approach is so important and successful. 

Developing the right custom pain management plan and consistently implementing it is crucial to progress. 

Here are some of the ways to manage Central Sensitization Syndrome.

1. Exercise Therapy

Chronic pain can make any movement painful. Consistent exercise therapy can help alleviate your pain and minimize the possible adverse effects of medications if it is done in a mindful way. Oftentimes overexertion and intense aerobic activity can make the symptoms worse (remember the pain response can be to any stimulus) . 

Not only does gentle, mindful exercise therapy improve your quality of life, but exposing your muscles to regular movement is also good for your overall mobility. Gentle aerobic exercises, including stationary cycling, walking, and swimming, can effectively manage CSS. Engaging in these physical activities and using resistance machines and free weights will strengthen your body. It will also build your strength to tolerate and manage the pain better.

It is best to work with a practitioner with experience treating patients with CSS, so they can help draft a suitable care plan. They can help determine your exercise’s ideal duration, frequency, and limitations.

2. Acupuncture/Acupressure

Acupuncture and acupressure are effective treatments for CSS. This branch of traditional Chinese medicine has long been used to remedy chronic pain, headache, irritable bowel syndrome, low back pain, and neuropathic pain.

It is a gentle procedure that provides short-term pain relief, and when done frequently, it can also help your body manage the pain better. The healing touch from the acupressure also helps to reset your nervous system and desensitize the pain sensations.

Acupuncture involves puncturing your skin with extremely thin needles at strategic spots on your body called acupoints. This causes your body to release endorphins, your natural painkillers, while also influencing the part of your brain that handles serotonin, which is responsible for your mood. The same acupoints are targeted during acupressure with the added benefit of healing touch.

3. Movement Therapies

Movement therapy is another treatment care plan that doctors often recommend. Qi Gong, Tai Chi ( a form of Qi Gong),  and yoga are examples of slow methodical movements that are ideal for many CSS patients because of the low-level intensity of these activities and the positive effect it has on the fascia overlying the muscles (see the blog on Myofascial pain)

Besides being a more feasible workout for people who experience chronic pain most of the time, movement therapies not only improve joint flexibility and mobility but regulate the autonomic nervous system which is out of balance in CSS.

4. Meditation

Mindful meditation is also a powerful and effective way to manage pain and your response to it better. This practice helps you focus on the present and makes you more centered and stable, which can help you better handle pain and feelings of discomfort. 

In the long term, meditation accompanied by breathing techniques can also alter your brain’s pain response and make you less sensitive to stimuli.


5. Infrared (IR) Laser Therapy

You can also opt for an infrared laser therapy which is effective at resetting the action potential of the peripheral nerves with zero downtime. The most effective therapies are with a Class IV laser that can be applied without actually touching the skin by changing the beam focus with a special tip. This is particularly helpful for people with allodynia.

This laser therapy uses different wavelengths targeted to induce different chemical reactions at the cellular level to increase blood flow, increase the efficiency of oxygen delivery and activate the mitochondria to help promote soft tissue healing.

This therapy is often used to relieve pain, reduce inflammation, and promote tissue repair.

6. Cognitive Behavioral Therapy (CBT)

One of the most commonly used and recommended treatments to handle CSS is Cognitive Behavioral Therapy (CBT). This form of therapy focuses on your thought patterns and emotions concerning pain. 

CBT involves working with a trained therapist to help you identify the thought patterns linked to your fears and pain. They will help you deconstruct these patterns and develop newer and healthier responses to pain, hence downregulating those pathologic pain pathways. 

The therapy also often incorporates role-playing to help you prepare yourself to calm your mind and body. Unemotionally witnessing or noticing the pain and knowing how to not reinforce the pathway can make you feel more physically and mentally confident to deal with it.

7. Medication

Pharmacological treatment for pain management is recommended as a temporary solution. This is not a long-term option and is often paired with other intervention treatments, such as lifestyle changes, therapy, and exercises.

The most common drugs prescribed are NSAIDs, acetaminophen, and serotonin inhibitors. Opioids or other dependent medications are not used for CSS as they make symptoms worse and can lead to drug dependency, leading to other problems.

8. Sleep Management

Insomnia is prevalent in people with CSS. And when the body cannot get proper rest and good quality sleep at night, it can make the pain more intolerable. 

Lack of sleep also impacts your mood and overall perception, making you irritable and fatigued and even impacting your immune system.

Sleep management, facilitated by knowledgeable practitioner, can help you feel more empowered regarding sleep education, stimulus control instructions, sleep restriction measures, and sleep hygiene. 

All of these are meant to help you sleep better so that your body and mind can get the necessary rest.

Work With Advanced Musculoskeletal Medicine Consultants, Inc. (AMMC) To Manage CSS!

Central Sensitization Syndrome doesn’t have to stop you from doing the things you enjoy. Don’t let the pain control you and limit you from living your life to the fullest.

Today, numerous treatment options are available that can help holistically address CSS. By heading to our website, you can learn more about the different options to treat central sensitization syndrome. 

We offer various mind-body treatment packages that include acupressure, one-on-one coaching for breathing techniques and meditation, and no-touch IR laser therapy to help with allodynia symptoms. 

Get in touch with our team who have vast experience treating patients with chronic pain. By onboarding the right team to provide you with the help you need, you won’t have to face your pain alone. You will soon be able to manage this condition and live the life you want!