Central Sensitization Syndrome

[svetoslav80]

Has anyone ever demonstrated a chronic sensitisation effect? It seems the research shows an acute sensitisation effect that lasts a few days-weeks at most. Any 'parallels' are hypothetical at the moment.

In research, I'm not sure, but otherwise I would say I am a typical example. Unfortunately. I've been abusing with food and alcohol for years. Now my whole digestive system is hypersensitive. From esophagus to gut. Just eating one piece of lemon, or even sneezing or coughing on an empty stomach makes me sick for weeks - with pain, fatigue, nausea, brain fog. All tests show no evidence for structural disorder. I read one article where it says that pain in patients with central sensitization "echoes", fading more slowly than general pain. This quite well describes my condition. Both my fatigue and pain "echo" and fade very slowly. And fatigue is pain. At least I feel mine that way. Of course I know my condition may be different from yours.

 

[Old Bones]

I sure am glad I no longer have neighbors living six inches away from me. I don't think I could take it.

I agree, the hyper-sensitivity associated with this illness makes even the very best neighbours seem like the "enemy". Fortunately, I also no longer have neighbours living six inches away. But unfortunately, this hasn't removed the impact of scent sensitivity. The neighbours on one side use the most vile scented laundry products. With teenagers in the household, "toxic dryer stench" belches out of their vent almost daily, sometimes for hours at a time. My headaches, burning eyes and sore throat start almost immediately. I have to go inside and close the windows to protect our indoor air quality. The scent chemicals, designed to last for weeks, attach to items in our garden, which means I smell them even when the neighbours' dryer isn't running.

Similarly, a few weeks ago I knew I wasn't pacing adequately when I noticed the body scent (not B.O.) of a couple of acquaintances -- so strong I felt nauseated and like I was going to vomit. Yet, when I later questioned my husband who had been right beside while chatting with these individuals, he hadn't noticed a thing.

 

[Effi]

However, the people studying central sensitivity syndrome (CSS) are a different group; if you search through PubMed for papers on central sensitization, you find that the vast majority of researchers of CSS work in neurology, not psychology.

Funny thing, when I was writing the thing about psychosomatic illness, I was actually thinking about a neurologist who we talked about in a very long thread (can't be bothered to look for her name, she wrote that book 'All in the mind'). She couldn't stop talking about how the proof of psychosomatic illness is the fact that a patient has physical symptoms but nothing shows up on scans etc. There is a part of neurology that seems to be very hocus pocus, just like BPS, so I'm always a bit cautious when I see research coming from neurology. But I do agree that we need to be careful not to throw the baby out with the bathwater. I'm not against the idea of CSS, it sounds like an ok hypothesis. However, I would be interested in reading actual in-depth, sound scientific research into this field. So far all I've seen is mumbo jumbo tbh...

 

[Woolie]

I'm not at all bothered by the concept, as they're not suggesting it's a psychological condition. True the therapy here focuses on psychological interventions but that doesn't mean it's a psychosomatic condition, just that the psychological is a component of it. Not such a big surprise, it is the brain after all.

The beauty of the concept - to the psychobabblers - is that it provides a framework into which you can insert psychological factors as the main causal factors, without it looking obvious that you're doing so. These guys are getting better and better at concealing the true meaning underlying their labels. I've also read a lot of Mark Edwards' stuff and he is a master at this. His theories look very "neurological", but when you read carefully you find that the factors he claims trigger and/or sustain the illness are psychological: depression/anxiety, an unhealthy focus on bodily states, social interactions that have created undue fear about, or focus upon certain symptoms (think Phoenix Rising and the like!).

I think the psychobabblers are attracted to central sensitisation theory for two reasons. First, it conceals the true nature of the diagnosis from their patients (and this is a major priority of psychobabblers - concealment - with many papers written on how to name disorders and how to lie to patients about what you think is wrong with them). Second, it sounds more "scientific". Its completely predictable that they too would jump on the neuroscience bandwagon, as is the fashion right now.

As you note, the treatments are still the same, and more importantly, its moving us further away from finding out what's really wrong with us. And aren't they our two biggest worries about psychological theories?

There's another thread on this here:
http://forums.phoenixrising.me/index.php?threads/central-sensitization-syndrome.41298/#post-665844

 

[Woolie]

Funny thing, when I was writing the thing about psychosomatic illness, I was actually thinking about a neurologist who we talked about in a very long thread (can't be bothered to look for her name, she wrote that book 'All in the mind'). She couldn't stop talking about how the proof of psychosomatic illness is the fact that a patient has physical symptoms but nothing shows up on scans etc. There is a part of neurology that seems to be very hocus pocus, just like BPS, so I'm always a bit cautious when I see research coming from neurology. But I do agree that we need to be careful not to throw the baby out with the bathwater. I'm not against the idea of CSS, it sounds like an ok hypothesis. However, I would be interested in reading actual in-depth, sound scientific research into this field. So far all I've seen is mumbo jumbo tbh...

@Effi, that'd be Suzanne O'Sullivan's "Its all in your head!".
Here's a review of the book.

 

[Kati]

The beauty of the concept - to the psychobabblers - is that it provides a framework into which you can insert psychological factors as the main causal factors, without it looking obvious that you're doing so. These guys are getting better and better at concealing the true meaning underlying their labels. I've also read a lot of Mark Edwards' stuff and he is a master at this. His theories look very "neurological", but when you read carefully you find that the factors he claims trigger and/or sustain the illness are psychological: depression/anxiety, an unhealthy focus on bodily states, social interactions that have created undue fear about, or focus upon certain symptoms (think Phoenix Rising and the like!).

I think the psychobabblers are attracted to central sensitisation theory for two reasons. First, it conceals the true nature of the diagnosis from their patients (and this is a major priority of psychobabblers - concealment - with many papers written on how to name disorders and how to lie to patients about what you think is wrong with them). Second, it sounds more "scientific". Its completely predictable that they too would jump on the neuroscience bandwagon, as is the fashion right now.

As you note, the treatments are still the same, and more importantly, its moving us further away from finding out what's really wrong with us. And aren't they our two biggest worries about psychological theories?

There's another thread on this here:
http://forums.phoenixrising.me/index.php?threads/central-sensitization-syndrome.41298/#post-665844

There is also discussion by Dr A about perpetuation of symptoms. And if one follow the CSS hypothesis, psycho-social factors and deconditioning are 2 main reasons explaining perpetuation of symptoms, hence the urgent need of CBT and GET.

Edit to add:
I am not quite sure how they can explain very severe cases and also how the newest papers suggesting auto-immunity, immune activation fit in this hypothesis.

Add #2:
They are probably also saying the looking too closely at the science is not permitted

 

[Snow Leopard]

In research, I'm not sure, but otherwise I would say I am a typical example. Unfortunately. I've been abusing with food and alcohol for years. Now my whole digestive system is hypersensitive.

More sensitive or damaged? Alcohol abuse can damage the gut (e.g. it can be a key risk factor for chronic colitis), but I wouldn't call it 'sensitisation'.

 

[svetoslav80]

More sensitive or damaged? Alcohol abuse can damage the gut (e.g. it can be a key risk factor for chronic colitis), but I wouldn't call it 'sensitisation'.

I guess if there was damage, it would have been noticed after 2 gastroscopies and 2 x-rays. At least for the esophagus.

 

[mermaid]

In research, I'm not sure, but otherwise I would say I am a typical example. Unfortunately. I've been abusing with food and alcohol for years. Now my whole digestive system is hypersensitive. From esophagus to gut. Just eating one piece of lemon, or even sneezing or coughing on an empty stomach makes me sick for weeks - with pain, fatigue, nausea, brain fog. All tests show no evidence for structural disorder. I read one article where it says that pain in patients with central sensitization "echoes", fading more slowly than general pain. This quite well describes my condition. Both my fatigue and pain "echo" and fade very slowly. And fatigue is pain. At least I feel mine that way. Of course I know my condition may be different from yours.

From my own experience, I suspect there are a huge number of people with painful gut issues that could come under this CSS umbrella. I have had an endoscopy this year after years of pain and was diagnosed with Non Ulcer (Functional) Dyspepsia - ie nothing to be seen but it blooming well hurts just like an ulcer, and reacts to acidic foods just like an ulcer.

I found out via Googling that Non Ulcer Dyspepsia is remarkably common, though I have never actually met anyone else with this unlucky label. I used to think it was all part of my ME/CFS as it developed after a relapse, but most people with ME have gut issues lower down (I have IBS too though....).

It's chronic because I have had it for around 6 years, and it has gradually worsened over the years, though I can get some control with care of foods that I eat, and how I eat. Articles about the condition talk of a visceral hypersensitivity in the stomach, and a kind of overreaction to normal changes in the body.

Years ago I did have a diagnosis of gastritis and duodenitis via a previous endoscopy (which was treated at the time) so I wonder if my sensitivity developed then and somehow the brain now overreacts to stimuli in the stomach.

Luckily I don't have much other pain in my limbs, but the chronic stomach pain is pretty grim at times, though I do think that PPIs sometimes help to switch it off. Also am trying out CBD oil on it more recently.

 

[svetoslav80]

From my own experience, I suspect there are a huge number of people with painful gut issues that could come under this CSS umbrella. I have had an endoscopy this year after years of pain and was diagnosed with Non Ulcer (Functional) Dyspepsia - ie nothing to be seen but it blooming well hurts just like an ulcer, and reacts to acidic foods just like an ulcer.

I found out via Googling that Non Ulcer Dyspepsia is remarkably common, though I have never actually met anyone else with this unlucky label. I used to think it was all part of my ME/CFS as it developed after a relapse, but most people with ME have gut issues lower down (I have IBS too though....).

It's chronic because I have had it for around 6 years, and it has gradually worsened over the years, though I can get some control with care of foods that I eat, and how I eat. Articles about the condition talk of a visceral hypersensitivity in the stomach, and a kind of overreaction to normal changes in the body.

Years ago I did have a diagnosis of gastritis and duodenitis via a previous endoscopy (which was treated at the time) so I wonder if my sensitivity developed then and somehow the brain now overreacts to stimuli in the stomach.

Luckily I don't have much other pain in my limbs, but the chronic stomach pain is pretty grim at times, though I do think that PPIs sometimes help to switch it off. Also am trying out CBD oil on it more recently.

I can't tell if dyspepsia can be classified as a form of central sensitization, but it is definitely not my problem. My symptoms are triggered not just by irritating foods, but also by physical movement such as jumping, running, stretching the esophagus (I used to stretch my back), and continue very long time, usually 3-4 weeks. If during this period I make another "mistake", the symptoms become so severe that I feel more like dead than sick. Anyway I'm glad that you have a proper diagnosis.

 

[Dufresne]

I can't tell if dyspepsia can be classified as a form of central sensitization, but it is definitely not my problem. My symptoms are triggered not just by irritating foods, but also by physical movement such as jumping, running, stretching the esophagus (I used to stretch my back), and continue very long time, usually 3-4 weeks. If during this period I make another "mistake", the symptoms become so severe that I feel more like dead than sick. Anyway I'm glad that you have a proper diagnosis.

How does drinking alcohol affect your symptoms?

 

[chipmunk1]

CSS is based on bio-psycho-social theories and is another (modern) way of saying Hysteria.

 

[svetoslav80]

How does drinking alcohol affect your symptoms?

I can't afford to drink anymore. For the last few years I made this mistake once, I drank 50 ml of vodka and it was the biggest mistake. As I wrote in my previous post, I was half-dead half-alive for a month.

 

[Cheshire]

Curr Rheumatol Rev. 2015 Dec 30. [Epub ahead of print]
Neuroimaging of Central Sensitivity Syndromes: Key Insights from the Scientific Literature.
Walitt B1, Ceko M, Gracely J, Gracely RH.
Author information
Abstract
Central sensitivity syndromes are characterized by distressing symptoms, such as pain and fatigue, in the absence of clinically obvious pathology. The scientific underpinnings of these disorders are not currently known. Modern neuroimaging techniques promise new insights into mechanisms mediating these postulated syndromes. We review the results of neuroimaging applied to five central sensitivity syndromes: fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, temporomandibular joint disorder, and vulvodynia syndrome. Neuroimaging studies of basal metabolism, anatomic constitution, molecular constituents, evoked neural activity, and treatment effect are compared across all of these syndromes. Evoked sensory paradigms reveal sensory augmentation to both painful and non-painful stimulation. This is a transformative observation for these syndromes, which were historically considered to be completely of hysterical or feigned in origin. However, whether sensory augmentation represents the cause of these syndromes, a predisposing factor, an endophenotype, or an epiphenomenon cannot be discerned from the current literature. Further, the result from cross-sectional neuroimaging studies of basal activity, anatomy, and molecular constituency are extremely heterogeneous within and between the syndromes. A defining neuroimaging "signature" cannot be discerned for any of the particular syndromes or for an over-arching central sensitization mechanism common to all of the syndromes. Several issues confound initial attempts to meaningfully measure treatment effects in these syndromes. At this time, the existence of "central sensitivity syndromes" is based more soundly on clinical and epidemiological evidence. A coherent picture of a "central sensitization" mechanism that bridges across all of these syndromes does not emerge from the existing scientific evidence.

So, no proof at all CSS exists apart in the mind of its proponents...


http://www.ncbi.nlm.nih.gov/pubmed/26717948

 

[Chrisb]

http://www.ncbi.nlm.nih.gov/pubmed/26717948

"This is a transformative observation for these syndromes which were historically considered to be completely of hysterical or feigned in origin."

That seems a little off message. And there we were believing that these conditions were regarded as "real". Whatever that might mean.

 

[Effi]

A defining neuroimaging "signature" cannot be discerned for any of the particular syndromes or for an over-arching central sensitization mechanism common to all of the syndromes. Several issues confound initial attempts to meaningfully measure treatment effects in these syndromes. At this time, the existence of "central sensitivity syndromes" is based more soundly on clinical and epidemiological evidence.

It always amazes me how they have their hypothesis carved in stone, are then repeatedly slapped in the face by reality through their own scientific research, yet will not deduct from it that their hypothesis is flawed. I bet they expect reality to adapt to their hypothesis. Fools.

 

[chipmunk1]

http://www.practicalpainmanagement....tization-common-etiology-somatoform-disorders

Yunus has proposed that the term central sensitivity syndrome (CSS) be used for nonorganic somatoform disorders that share this CS etiology.3-5As will be discussed in this review, the CSS model provides a very appealing theoretical construct that can be used to categorize a wide array of related syndromes. Unlike in the past, when various symptom presentations were viewed as individual somatoform disorders, the CSS model is a unifying one, in which these various symptom presentations are conceptualized as simply many forms of a common CSS construct, with CS as the fundamental root cause.5-8

How Does CS Occur?
How CS comes about is not yet entirely clear. Many patients who develop CS have a history of early childhood—even prenatal—trauma; an abusive, alcoholic, or absent parent; and/or a conflicted, unhappy home life.

It's the usual unhappy childhood/life BS.

this article is for healthcare professionals so they are more honest about what they are really doing/thinking.

http://www.manualtherapyjournal.com/article/S1356-689X(11)00073-7/fulltext

Therefore it is crucial to change the patient’s maladaptive illness perceptions and maladaptive pain cognitions and to reconceptualise pain before initiating the treatment. This can be accomplished by patient education about central sensitization and its role in chronic pain, a strategy frequently referred to as ‘pain (neuro)physiology education’ or ‘pain biology education’. Patients with ‘unexplained’ chronic musculoskeletal pain who are misinformed about pain, consider their pain as more threatening and demonstrate lower pain tolerance, more catastrophic thoughts and less adaptive coping strategies (Jackson et al., 2005). Treatment adherence for active treatments is often low in these patients. Therefore, education will increase motivation for rehabilitation in those with chronic musculoskeletal pain due to central sensitization. This requires a biopsychosocial assessment and an in-depth education of altered central nervous system processing of nociceptive and non-nociceptive input. This will be the focus of the present paper.

For example, remember the patient with chronic whiplash convinced that the initial neck trauma caused severe cervical damage that remains invisible to modern imaging methods. Simply providing education about the fear avoidance model to encourage a graded activity approach is unlikely to be beneficial. Detailed pain physiology education is required to reconceptualise pain, and to convince the patient that hypersensitivity of the central nervous system rather than local tissue damage is the cause of their presenting symptoms

 

[Forbin]

I don't know if something like CSS could, at some point, be an issue for ME/CFS patients, but I do know that elevated cytokine levels can cause an increased sensitivity to light, sound, pain, etc., as is often seen in infections such as the flu.

Assuming that Columbia is right and that ME/CFS patients have an elevation in cytokine levels that lasts for years, then, at a minimum, trying to treat ME/CFS patients for CSS while their cytokines are still elevated (and are thus most likely making them hypersensitive) may well be like trying to remodel your house while it is on fire.

 

[halcyon]

So, no proof at all CSS exists apart in the mind of its proponents...

Hopefully not a sign of things to come from the NIH.

Walitt B1, Ceko M, Gracely J, Gracely RH.
Author information

• 1National Center for Complementary and Integrative Health, National Institutes of Health 10 Center Drive Bethesda, MD 20814. Brian.walitt@nih.gov.

 

[halcyon]

I don't know if something like CSS could, at some point, be an issue for ME/CFS patients

The proponents of the CSS model are saying that CFS is caused by CSS.