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Chronic Pain & Your Brain

This topic is a big one _ please get in touch if this raises any questions or you would like to know how these concepts apply to you.


Understanding Central Sensitisation


Central sensitisation is a condition of the nervous system that is closely associated with the development and persistence of chronic pain. It involves a phenomenon known as wind-up, where the nervous system remains in a state of heightened reactivity. This persistent state lowers the threshold for pain, causing pain to be felt more intensely and for longer periods, even after the initial injury has healed.


In central sensitisation, pain no longer serves its usual protective function. It is similar to a smoke alarm that becomes overly sensitive and starts to trigger even in response to non-threatening factors such as changes in room temperature, light, or noise. The alarm loses its effectiveness as a protective mechanism against danger or harm.


This condition can manifest in various clinical syndromes. In these situations, pain may arise spontaneously, be elicited by normally harmless stimuli (allodynia), be exaggerated and prolonged in response to painful stimuli (hyperalgesia), and spread beyond the original site of injury (secondary hyperalgesia).




Allodynia and Hyperalgesia: Heightened Sensitivity


Central sensitisation is characterized by two main features: allodynia and hyperalgesia. Allodynia refers to the perception of pain in response to stimuli that are typically non-painful. For example, individuals with chronic pain may experience touch or massage as painful, even though these stimuli are normally safe and harmless. The heightened reactivity of the nervous system causes the brain to interpret such stimuli as painful, amplifying the sensations beyond their actual nature.

Hyperalgesia, on the other hand, occurs when a painful stimulus is perceived as more painful than it should be. For instance, a minor bump that would typically cause mild discomfort can trigger an intense and exaggerated pain response in individuals with central sensitisation. Once again, the persistent state of heightened reactivity amplifies the pain experience.


The Complex Impact of Central Sensitisation

Central sensitisation is not only associated with chronic pain but also with cognitive deficits such as poor concentration and short-term memory issues. Emotional distress, particularly anxiety, is often intertwined with central sensitisation, as the nervous system is responsible for both pain perception and emotional experiences.

Younger proffesional experiencing lower back pain at a desk
Back Pain


Understanding the Causes

Central sensitisation is rooted in specific changes that occur within the nervous system, particularly in the dorsal horn of the spinal cord and various areas of the brain. It can occur after experiencing persistent pain for an extended period or when the pain has had significant impacts on one's life trajectory. Generally, central sensitisation occurs after three months of pain, when the pain is classified as chronic. It is essential to work collaboratively with your healthcare provider and GP to rule out other potential causes At Move in collaboration with your GP our role is to to rule out any serious underlying conditions. Once we have been cleared of a serious condition, we can begin addressing your pain.


Central Sensitisation in Chronic Pain Disorders


Central sensitisation has been observed in various chronic pain disorders, expanding our understanding of its prevalence. It can occur in conditions such as chronic low back pain, chronic neck pain, whiplash injuries, chronic tension headaches, migraines, rheumatoid arthritis, osteoarthritis, endometriosis, motor vehicle accident injuries, and post-surgical pain. Fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome also share central sensitisation as common underlying factors.


Recognizing an Overprotective Pain System


It's important to remember that an overprotective pain system does not reflect a weak personality or mind, nor does it mean your injury is worsening or your body is falling apart. It simply means that your body is being overly vigilant in protecting itself.


Signs of an overprotective pain system include heightened sensitivity, where your body becomes more sensitive than before. Activities that previously caused mild discomfort now cause significant pain, and even non-painful activities may start to become painful. Pain may also spread to new areas or alternate sides of the body. Additionally, you may experience stiffness, muscle spasms, and increased sensitivity to external factors such as noise or smells. These signs indicate that your pain system is on high alert, and pain can be influenced by thoughts, emotions, and other factors unrelated to the injured area.


Example Noi group of the protectomer,  when pain increases due to credible evidence
Protectometer

How do I know if my pain system is being overprotective?


First things first: get yourself thoroughly checked out by a qualified health professional, At Move we will work with you and your healthcare team to ensure we ask the right questions, and tests to do to make sure you have not got a serious condition. Having a serious condition doesn’t mean that this stuff doesn’t apply, it just means you have to do other things as well to treat the condition.

Once you have been cleared of a serious condition, you are set to go!

Practice makes perfect! If you have had pain for more than a few months, then your pain system will be more efficient at producing pain. This is what happens over time – your system becomes more sensitive. It learns pain. Nerve cells in your spinal cord and brain change their properties to be more responsive. Exactly the same thing happens when you learn a new skill, such as playing the piano – nerve cells change their properties to be more responsive. The process is the same. The nerve cells involved are different.

You will know your pain system is becoming overprotective when:

Your body starts to feel more sensitive than it did.

  • Activities that used to cause a little pain now cause a lot of pain.

  • Activities that were usually not painful, start to become painful.

  • These things also happen straight after an injury – you might be able to see how excellent they are at protecting your tissues. They often resolve when the tissues heal. However, when the pain remains and the sensitivity sets in, it can feel like your injury is getting worse, but that is actually very unlikely.

Other signs your pain system is becoming overprotective include:

  • Your pain might spread, or it might move from one side of your body to the other, or from one location to another, or new spots become sore.

  • Your movement system starts to get in on the act. Remember that movement is another great way to protect. You might find some movements become more difficult. You might feel stiff.

  • You might have muscle spasms. They can be really frightening, particularly if you don’t understand them or know what caused them. They are another way your body protects a painful area. They are almost never a sign that you have damaged something.

  • You might even find you become more sensitive to things that don’t seem related to your body – loud noises, unusual smells - slightly annoying people can become very annoying people.

All these things show that your system is ‘on alert’. Pain can actually be turned up and down by your thoughts, feelings and other things going on in your life – things that actually have nothing to do with the painful body part!

Pain scientists understand how this works and it actually makes terrific sense. However, many people don’t understand it – even some health professionals. One thing that we know absolutely for certain, 100%, is that an over protective pain system is NOT a sign you have a weak personality or a weak mind; it does NOT mean you are going crazy and it does NOT mean your injury is getting worse or your body is falling apart.


It means your body is doing too good a job of protecting itself.


When our pain system becomes over protective, it stops us doing the movements, activities and other things and that are actually necessary for recovery.


But we know you can’t ‘just beat pain’ because this sensitive system that is producing pain is also the system that helps to make you you! Everyone can learn new ways of retraining their pain system to be less protective. So, now is as good a time as any to get started.


Brain
We can change your nervous system

So can we change it ?? YES!


Empowering Strategies for Recovery

While central sensitisation poses its challenges, you can change it; see below evidence-based approaches to recovery to help you regain control over your pain and enhance your quality of life.



  1. Education: Seek knowledge about pain science, central sensitisation, and its mechanisms. Understanding the science behind pain can empower you to participate in your recovery actively.

  2. Movement and Exercise: Engage in appropriate movement and exercise tailored to your capabilities. Gradually exposing your body to movement can recalibrate your nervous system and enhance its resilience.

  3. Stress Reduction: Explore stress reduction techniques such as mindfulness, deep breathing exercises, and relaxation strategies. Managing stress levels can alleviate the impact of central sensitisation.

  4. Graded Exposure: Collaborate with your healthcare team (at Move & your GP/ Specialist) to gradually expose yourself to activities or movements that you may have been avoiding due to fear of pain. This gradual approach can help retrain your brain's threat detection system.

  5. Social Support: Seek support from understanding family, friends, or support groups, healthcare professionals or counseling/psychologists can often help reframe how your brain and nervous system detects.

  6. Know your DIMS & SIMS (more on this later)


Move Sports Physio examples of Danger in movement and safetfy in movement comparison table

Remember, central sensitisation is a complex process, but by understanding its mechanisms and implementing empowering strategies, you can take steps towards reclaiming your well-being and living a fulfilling life.


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