Central sensitization: a matter of concern

I walk too much I get terrible pain in my legs, do things with my arms, pain in arms and so on. The pain is a direct result of doing too much and is best explained, for me anyway, by the low AT findings.

In MS, whichever nerve becomes damaged is where the disability comes. They emphasise that someone in a wheelchair just has different nerves damaged from someone who walks well and does not necessarily have a more serious disease.

In ME, if it is energy production in the gut, say, that is most affected there will not be the same pain as if the legs were affected.

I cannot take enough painkillers to get rid of my pain so I actually thole it better than most people as I live with it constantly. I have had root canal work done without anaesthetic. It was unpleasant but I have tricks for tuning out pain.

 

This Central Sensitisation idea should be tested in other patient populations for veracity, for bias. Because no one who is exhausted, (parents of babies, the overworked), and/or suffering from an illness can cope well with additional pain.

Or are they saying that Central Sensitisation is the cause of our illness? And therefore not giving in to our symptoms, ignoring them, "toughening up", is the cure? Probably.

How IS it tested anyway? They don't have a base line of how pain sensitive each of us were BEFORE we got ill. How can they tell that we're ALL so much more sensitive to painful stimuli now?

They can't. I think they generalise from a tiny sample they handpick, and extrapolate. Then smear us all with this label. This pejorative label.

 

"Central sensitisation" is code for: there is something wrong in the brain that is amplifying the perception. The implication is the perception is inaccurate. It is a hypothetical concept that dates back centuries.

The irony is there are no demonstrable biological models for central sensitisation. Peripheral sensitisation has been demonstrated in animal models, but generalisations of this is by analogy only.

 

Just from memory I think there is research it is based on. The problem is that it would be imaging (MRI) on the hypothalamus-pituitary axis (HPA). And whatever is showing up is being interpreted. Our understanding of the brain and it's functioning is primitive. Some basic knowledge of the HPA is being used to hypothesize way beyond what is reasonable IMO.

And I think they are also using as support the work by Ramachandran on phantom limb pain.

 

As I understand it central sensitization has been demonstrated, even in humans, but it referred to something very specific, namely a change in the excitability of the central nervous system that is autonomous of the peripheral input that triggered it. This was demonstated by experiments of Clifford Woolf and Robert LaMotte more than 25 years ago.

Since then there has been an inflation of the term central sensitization. Woolf, who has championed this expansion of the term, now defines it as “genus of all forms of pain sensitization that arise within the central nervous system". But this has been a controversial development as in this interpretation CS is no longer evidence based but merely a hypothesis or theoretical concept. Others like Daniel Clauw suggest to use other terms for this concept such as ‘central pain’ or ‘central augmentation’ instead of CS, giving that the term CS was originally used in the context of a sustained peripheral noxious input in an experimental (not a clinical) setting.

There's more information about this on MEpedia.

 

I've screen shot this page, to have on hand to rebut the baseless assertions of anyone foolish enough to utter the words, "Central" and "Sensitisation" in my direction.

Thanks for the science, @Michiel Tack @Snow Leopard and @Snowdrop

Hands up, who's monumentally fed up with these terms being bandied about in relation to us, with absolutely no proof behind them? It feels like slander, not theorising in search of treatment.

 

The CNS sensitisation demonstrated was short term and specific to the nerve(s) stimulated due to the initial injury.

They didn't demonstrate widespread, long term (months to years) increased CNS sensitivity throughout the body, which is what most people now mean when they say central sensitisation.

 

Yes, thats what I meant. Some use the biological evidence for the original, restricted meaning of central sensitization and act like it also applies to the expanded version, which is now dominant.

Now I'm not against the hypothesis of central sensitization, the idea that changes in excitability of the CNS can help explain the chronic pain in many poorly understood diseases. But then they should acknowledge it's merely a hypothesis, one that goes far beyond what experiments have demonstrated. You can't have your cake and eat it.

 

This article gives a good overview of how restricted our knowledge about central sensitisation actually is: https://f1000research.com/articles/7-1325/v1

 

Central Sensitisation 'gains prominence'
Headaches/Migraines in Fibromyalgia and Chronic Fatigue Syndrome
January 28, 2019

https://www.verywellhealth.com/headaches-and-migraines-in-fibromyalgia-and-cfs-716166

 

If it is central sensitization then injury pain would have it too but it does not in my case. ME pain and pain from a bad injury at the same time respond different.
I noticed that when I had a flare and a horse in full galop flung an iron pipe against my shinbone

 

This came in my twitter feed:

https://twitter.com/user/status/1096145761966977025


https://twitter.com/user/status/1096147128500535303


https://twitter.com/user/status/1096150407368396805


https://twitter.com/user/status/1096150408383422465

 

I found this article written by him (NOT a recommendation);

https://bodyinmind.org/in-the-mind-...al-sensitization-in-chronic-fatigue-syndrome/

Other ME/CFS articles on that site;

https://bodyinmind.org/catastrophizing-depression-chronic-fatigue-syndrome/

https://bodyinmind.org/cfs-and-understanding-pain-physiology/

Pain specialist, Lorimer Moseley, is a creator of the above site. Not sure if it has been mentioned yet, but it looks like his Tame the Beast video promotes Central Sensitization as an explanation for chronic pain (also NOT a recommendation);

https://www.tamethebeast.org/#tame-the-beast

The tame the beast video/site is targeted at patients, and appears to be a popular education tool for physiotherapists, etc to recommend to patients.

The following suggestion is from
https://www.tamethebeast.org/understanding/

"How do I know if my health professional understands modern pain science?

Ask them these questions (they should say yes to each one!):

Do you understand and believe the biopsychosocial model of pain?"

Hmmm...

 

I had a catharact surgery on monday and the pain was not bad enough to take a painkiller.

How can that be if it is central sensitization?

The operation was so complicated I had to go for an extra check yesterday. The doctor was very relieved to see the lens was in place and everything seemed okay.

 

This.

But the exact opposite.

 

This doesn't sound good: "Association between child maltreatment and central sensitivity syndromes: a systematic review protocol."
https://www.ncbi.nlm.nih.gov/pubmed/30782933

CFS is included in the planned review

 

I wonder how many of the 'maltreated' children will actually have had ME or EDS or some other un-acknowledged symptoms interpreted as parental abuse, only later to receive a diagnosis, thereby showing how abusive parents cause a whole range of symptoms.

When in fact, they've misdiagnosed symptoms as abuse, then later diagnose the physical symptoms, attributing them to the aforementioned abuse. Cause, meet effect. (Or, bias, meet harm.)

 

More GIGO. The problem is the lack of prospective studies. What you get is selection bias - eg only people who believe in the association actually submit their questionnaires to the researchers.