Central Sensitization Syndrome

Dr. Howard Cohen specializes in helping people suffering from central sensitization syndrome and other chronic pain conditions in the Dallas and Fort Worth, TX area. Many patients with CSS have become frustrated when the people around them (including doctors) don’t understand their condition, and when they are unable to find effective relief from pain and hypersensitivity. Through ketamine therapy and brain stimulation, Dr. Howard Cohen can help these patients live happier and more fulfilling lives.

Find relief from Central Sensitization Syndrome. 

What is Central Sensitization Syndrome?

Central sensitization syndrome, or CSS, is caused by changes in the nervous system that change the way a person processes pain and stimuli. In patients with CSS, the nervous system has undergone structural, functional, and chemical changes as a result of chronic pain. Because of this, the nervous system enters a process called wind-up, which puts the nerves in a persistent or constant state of high activity. This can make a person experience pain when others would not, a lower threshold for pain, or experience pain that endures longer than usual.

There are three main characteristics of CSS:

  • Allodynia happens when stimuli that are not normally painful elicit pain. For example, a person with CSS may find simple touch or the sensation of clothing on their skin painful. A person without CSS may not think twice about things like this.
  • Hyperalgesia occurs when a person experiences pain at a disproportionately higher level. For example, a person with CSS may find a small paper cut or bump on the knee to be extremely painful.
  • Global sensory hyperresponsiveness causes people to be highly affected by external stimuli such as sounds, smells, bright lights, and foods. This can also cause people to be highly affected by internal stimuli like their own heartbeat or digestion.1,2

Conditions Associated with Central Sensitization

Central sensitization syndrome is not a distinct condition; rather it’s a concept that underlies a group of conditions. CSS is the name for changes in the nervous system that bring about an increased response to stimulation, which leads to pain hypersensitivity. This is a common factor in various pain conditions, including:

  • Fibromyalgia: Characterized by widespread pain and tenderness, often linked with fatigue, sleep disturbances, and memory issues.
  • Chronic Fatigue Syndrome: This condition involves extreme fatigue that doesn't improve with rest and can be worsened by physical or mental activity.
  • Migraine and Tension-Type Headaches: Central sensitization can play a role in the increased sensitivity to pain in these conditions.
  • Irritable Bowel Syndrome (IBS): Patients with IBS often have heightened pain sensitivity in the gastrointestinal tract.
  • Chronic Pelvic Pain: Similar to IBS, this involves heightened sensitivity in the pelvic area.
  • Temporomandibular Disorders: Often referred to as TMJ by patients, disorders of the temporomandibular joint can involve heightened pain sensitivity in the jaw and facial muscles.3

Treatment Options for Central Sensitization Syndrome

Traditionally, treatment for central sensitization has included medications such as antidepressants and anticonvulsants. Non-pharmacologic treatment is often highly beneficial for CSS patients, and may include:

  • Cognitive Behavioral Therapy: This type of therapy is specifically geared toward helping patients understand thoughts, emotions, or behaviors that are damaging to them. Patients are then encouraged to restructure these into better strategies.

  • Patient Education: Patients with CSS often pursue diagnosis for years, and can become confused when a single, specific condition is not the cause of their pain. This can cause them to adopt unhealthy coping mechanisms, catastrophize, and turn to potentially addictive opioid painkillers. Educating patients about the nature of pain and how their body interprets pain can help them better understand their experiences. 

  • Lifestyle Changes: Stress management, sleep hygiene, and graded exercise (like aerobics) can all help patients with CSS.

Ketamine for CSS

Ketamine infusion therapy is increasingly recognized as a treatment option for patients with central sensitization and chronic pain conditions. Ketamine is a non-opioid anesthetic that blocks pain receptors and interrupts pain signals that are sent to the brain. By interfering with overactive pain pathways in the brain, ketamine therapy can reduce hypersensitivity and chronic pain associated with CSS.

Brain Stimulation for CSS

CSS is a result of changes in the nervous system as a response to chronic pain, or maladaptive plasticity. TMS, or transcranial magnetic stimulation, is a non-invasive treatment that uses magnetic fields to stimulate nerve cells in the brain. This can help “reset” some of the heightened activity seen in patients with CSS, and it may help reduce overactive pain signals.4

Frequently Asked Questions About Central Sensitization

Can central sensitization syndrome be cured?

There is no straightforward “cure” for central sensitization, but it is possible to manage it and significantly alleviate symptoms, including pain and hypersensitivity.

Is central sensitization a psychological condition?

No. CSS is caused by changes in the nervous system and the way the body perceives pain. However, CSS and chronic pain may be triggered by factors such as stress and emotional distress, and people with these conditions may be more likely to be diagnosed with depression, anxiety, and other psychological conditions.

How is central sensitization syndrome diagnosed?

Diagnosing CSS can be challenging, as there's no specific test for it. It's usually diagnosed based on medical history, a physical examination, and by ruling out other conditions. Doctors may look for characteristic symptoms like widespread pain and increased sensitivity to various stimuli.

Contact Us

If you suffer from central sensitization syndrome, we understand how difficult it can be to find effective treatment. Dr. Cohen specializes in treating chronic pain conditions, and has helped patients with central sensitization in the Dallas and Fort Worth, TX area find relief with novel therapies including ketamine therapy and brain stimulation. To learn more about your treatment options, contact us to schedule a consultation with Dr. Cohen.

1 Volcheck MM, Graham SM, Fleming KC, Mohabbat AB, Luedtke CA. Central sensitization, chronic pain, and other symptoms: Better understanding, better management. Cleve Clin J Med. 2023 Apr 3;90(4):245-254. doi: 10.3949/ccjm.90a.22019. PMID: 37011956. Available: https://pubmed.ncbi.nlm.nih.gov/37011956/. Accessed November 29, 2023.
2 Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011 Mar;152(3 Suppl):S2-S15. doi: 10.1016/j.pain.2010.09.030. Epub 2010 Oct 18. PMID: 20961685; PMCID: PMC3268359. Available: https://pubmed.ncbi.nlm.nih.gov/20961685/. Accessed November 29, 2023.
3 Adams LM, Turk DC. Psychosocial factors and central sensitivity syndromes. Curr Rheumatol Rev. 2015;11(2):96-108. doi: 10.2174/1573397111666150619095330. PMID: 26088211; PMCID: PMC4728142. Available: https://pubmed.ncbi.nlm.nih.gov/26088211/. Accessed November 29, 2023.
4 Naro A, Milardi D, Russo M, Terranova C, Rizzo V, Cacciola A, Marino S, Calabro RS, Quartarone A. Non-invasive Brain Stimulation, a Tool to Revert Maladaptive Plasticity in Neuropathic Pain. Front Hum Neurosci. 2016 Jul 27;10:376. doi: 10.3389/fnhum.2016.00376. PMID: 27512368; PMCID: PMC4961691. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961691/. Accessed November 28, 2023.