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chronic pain: the clinical criteria for central sensitization


I’ve written about CHRONIC PAIN’S PERFECT STORM several times over the years, and according to my “unofficial” definition, it always refers to three distinct concepts.

  • Not only is FASCIA the most abundant connective tissue in the body, it is arguably the single most pain-sensitive as well.
  • FIBROSIS / MICROSCOPIC SCAR TISSUE can be over 1,000 times more pain-sensitive than normal tissue (HERE).
  • Fascia cannot be properly imaged with standard advanced imaging techniques such as high frequency x-rays, CAT SCANS, or even MRI

The authors of the latest issue of Practical Pain Management (The Perfect Storm: Chronic Pain, Inflammation, and Dysfunctional Sleep) give a bit different version of the “perfect storm,” saying that, “Disordered sleep, inflammation, and chronic pain — known in pain circles as the perfect storm — has gained recognition as a triad disorder.  Fragmented sleep, inflammation, and chronic pain are all disorders that are disruptive to wide ranges of the ability to process pain.”  

In fact, the authors go as far as saying that, “When all three occur together, this trifecta of pain conditions becomes a distinct core disease, which experts call central sensitization syndrome (CSS).”  Frankly, this is rather scary because as you will soon see, Central Sensitization is serious, ugly, and potentially permanent stuff!

When I’ve spoken of AUTOIMMUNE DISEASES in the past (click the link for a list of them), I’ve talked about the way they tend to travel in packs, like wolves.  The thing to remember here is that autoimmunity is not so much a problem with the organ, tissue, or enzymes being attacked by your body’s own immune system, but a problem with the immune system itself that’s gone rogue and doing the attacking. 

Thus, once you have one, you are just as likely to end up with a half dozen.  Or more.  And when it comes to CENTRAL SENSITIZATION, the authors similarly talk about a number of related problems that, “travel in herds” along with.  Naturally, this begs the question; what do these herds look like? 

  • ALTERED ENDOCRINE & IMMUNE ACTIVITY:  These two cannot really be separated as you can see from my post called ENDOGUT.  The Gut contains about 80% of your body’s immune system (HERE), while the endocrine system controls things like your THYROID and BLOOD SUGAR REGULATION among others.
  • ALTERED AUTONOMIC NERVOUS SYSTEM ACTIVITY:  Even though the Parasympathetic Nervous System has the potential to go haywire, for the most part we are talking here about SYMPATHETIC DOMINANCE, meaning that the body remains in some degree of “fight or flight” mode all the time.  It’s tough to sleep when your body is being adrenalized to exhaustion.
  • TMJ / TMD:  These are the disorders / pain associated with the jaw (TMJ).
  • IRRITABLE BOWEL SYNDROME:  IBS is an autoimmune disease characterized by alternate bouts of diarrhea and constipation, often in the same day.  Not only is it intimately related to FODMAPS, but you must be aware that virtually all Autoimmune Diseases are related to gluten on some level (HERE).
  • FIBROMYALGIA:  I have lots of information on both ADRENAL FATIGUE (which could just as easily been filed under the first bullet) as well as FIBROMYALGIA itself. 

And this is where it all gets very interesting.  I would argue that Sympathetic Dominance (SD) is the number one cause of sleep disorders — particularly insomnia.  SD’s chief biomarker (maybe its only real biomarker) is HEART RATE VARIABILITY, which is itself known to be a byproduct of inflammation. 

What is inflammation?  It would behoove you to become intimate with inflammation (HERE), considering it is the ROOT CAUSE OF ALMOST EVERY MAJOR DISEASE PROCESS, including all the heavy hitters (CANCER, HEART DISEASE, ARTHRITIS, DIABETES, AUTOIMMUNE DISEASES, etc, etc).  Be aware this is true despite the fact that your doctor is still coddling you by telling you that your problems are all genetic (HERE).

I am more convinced than ever that the best way to address inflammation is by a combination of DIET and GUT HEALTH.  I have seen many cases of these very problems either fixed or dramatically improved, simply by making the proper lifestyle changes.  But what about those problems that are purely (or at least mostly) mechanical — PIRIFORMIS SYNDROME for instance?   The FASCIAL SYSTEM will need to be addressed. 

And the beautiful thing is, even if doing so does not solve your problem, unlike the vast majority of medical interventions, it won’t make you worse (HERE).  Just remember that because inflammation always leads to Fibrosis / Scar Tissue, a failure to address root causes of inflammation can lead to continued build up of soft tissue adhesions (HERE).

The article on the opposite page in PPM (Multimodal Approach to Physical Therapy for Chronic Pain) provides a glimpse into the sort of treatment that the medical community is using for those with CSS and other similar chronic pain syndromes.  Besides mentioning things like LASER THERAPY, soft tissue mobilization, and EXERCISES THAT INVOLVE BOTH STRENGTH AND RANGE OF MOTION, (yoga would fit in here as well) the author says that, “those of us who deal with chronic pain have realized that with straight physical therapy, there’s something missing“. 

Although the author believes that this “missing link” is something called CBT (Cognitive Behavioral Therapy), I’m at a loss to see how any of this, if one is not making significant changes to one’s diet, will prove truly effective over the long haul when it comes to addressing the root of the problem — inflammation.

Bottom line, if you believe what these authors are saying, their “triad” (sleeplessness, pain, and inflammation) means you are essentially finished.  The only real hope you have is to do palliative treatments (treatments to try and make you feel better for a while), which, while they might diminish the pain temporarily, don’t really address the underlying cause of said pain.  I would argue that while this “trifecta” is not in any ways a good sign, if you click on the next link below, you’ll begin to see a ray of hope —- that there are actually some empowering steps that you can take help you get your life back, and that this triad does not necessarily mean you have central sensitization.

Be sure to like, share or follow on FACEBOOK if you know people with chronic pain that might be due to central sensitization.


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