Ep 6. Sensitization

Learn how central sensitization really presents. And yes, it’s a big deal that is currently essentially glossed over due to the lack of identification and treatments.

The symptom clusters this type of pain creates long term are diseases caused by the central nervous system. The issue is that we currently lack an effective way to investigate and treat the various ways nervous system dysfunction impacts patients beyond the accepted definition of nociplastic pain.

We share our model for categorizing central sensitization currently into various buckets including but not limited to:

• Sensory Hypersensitivity

• Sleep Disturbance

• Fatigue Disturbance

• Cognitive Dysfunction

• Mood Dysfunction

• Dysautonomias etc

All of these being largely undefined and not connected, lead patients down a rabbit hole of diagnoses. What we need instead, is a language to talk about symptoms providers are able to pull out of the patients' summary so we can efficiently investigate, and go through first to third line interventions with this presentations just like other types of pain.

We’ll go through an example of first and second line management strategies with sleep disturbance and orthostatic intolerance so you get a sense of how we prioritize interventions, and can attack these vague yet persistent symptoms much more effectively as a patient or provider.

Introduction

"It's Not in Your Head" is a podcast hosted by Dr. Dan Bates, a doctor, and Justine Feitelson, a pain coach and movement professional. This episode focuses on central sensitization, a key component of chronic pain alongside nociceptive and neuropathic pain. Central sensitization drives nociplastic pain, which is often challenging to treat without understanding its underlying mechanisms.

What is Central Sensitization?

Central sensitization is a neuro-inflammatory process affecting the central nervous system and parts of the peripheral nervous system. It amplifies sensations, leading to increased pain, brain fog, mood disturbances, and other buckets of dominant symptoms.

Key Components of Central Sensitization

Dr. Dan and Justine break down central sensitization into six main categories including:

1. Sensory Hypersensitivity

   • Widespread or focal pain

   • Sensitivity to light, sound, smell, touch, heat, and cold

   • Food intolerances

   • Balance issues

   2. Sleep Disturbance

   • Difficulty falling asleep

   • Inability to stay asleep

   • Waking up early and unrefreshed

   3. Fatigue

   4. Cognitive Dysfunction (Brain Fog)

   • Memory issues

   • Concentration problems

   • Difficulty thinking

   5. Mood Dysfunction

   • Anxiety

   • Depression

   • Irritability

   6. Dysautonomias

   • Orthostatic intolerance

   • Bladder dysfunction

   • Gastrointestinal symptoms

   • Hyperhidrosis (excessive sweating)

Conditions Associated with Central Sensitization

They further dive into and differentiate between several conditions that are depending on the context accepted as being caused by central sensitization, including:

• Fibromyalgia

• Chronic fatigue syndrome

• POTS (Postural Orthostatic Tachycardia Syndrome)

• Post-concussion syndrome

• Post-COVID syndrome

Diagnosis and Treatment Approach

The podcast emphasizes the importance of categorizing symptoms to better understand and treat central sensitization. This approach allows clinicians to:

1. Separate central sensitization symptoms from other underlying conditions

2. Identify appropriate intervention strategies for each symptom category

3. Avoid misdiagnosing patients with multiple unrelated conditions

Treatment Examples

The hosts provide examples of first-line and second-line management strategies for specific symptoms:

Sleep Disturbance example

• First-line: Establish a wind-down routine, anchor sleep and wake times, address circadian rhythm issues

• Second-line: Medications like Amitriptyline to address both pain and sleep disturbance in a more efficient manner, maximizing upside

Orthostatic Intolerance example

• First-line: Compression garments, increased water intake, salt intake up to 10 grams daily, position changes, gradual exercise progression

• Second-line: Referral to a cardiologist, tilt table testing, medications like midodrine, fludrocortisone, or beta-blockers

Conclusion

Understanding and categorizing central sensitization symptoms depending on which part of the nervous system is affected, allows for more effective connections and treatment strategies. By breaking down the complex presentation of central sensitization into manageable categories by dominant symptom bucket, clinicians can provide better care and patients can better understand their condition