How to Talk About Pain: Central Hypersensitivity

It’s amazing how sometimes a piece of writing that’s only a few paragraphs long can help to clarify something you’ve been thinking about for a while.

I found a great article on Body in Mind last night that I felt did a great job summarizing the concepts I’m trying to get at on this blog.

I’ve been struggling to find a catch-phrase to use on my blog, a succinct way of referring to the changes that can take place in a person’s nervous system following a traumatic event that cause her or him to be more sensitive to pain.  (If you are new to my blog, I talk more about how this process occurs here).

I knew that these changes are brought about by a process known as “central sensitization,” but I was struggling to find a way to refer to the end result of this process.  I mean, “chronic pain” and “fibromyalgia” are good terms, but there are a lot of theories floating around about what causes them.  In my blog, I focus on the pain people feel as a result of changes in the way their nervous system processes pain.  I needed a snappy term that would allow me to be very specific about this condition.

Luckily, this article provided me with just that.  The author uses the term central hypersensitivity, which makes so much sense.  (At least, it makes sense if you’re a dork like me who reads about this stuff in her spare time).

For the non-dorks, let’s take a look at this word.  In medical terminology, central pertains to the central nervous system: the brain and spinal cord.  Hypersensitivity, means, well, that something is extra sensitive.  So in central hypersensitivity, a person’s brain and spinal cord are extra sensitive.

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I also liked how this article discussed central hypersensitivity not as some freak occurrence that happens to very few people, but instead, as something that can happen to anyone.  In fact, it probably happens, to some extent, to anyone who experiences pain from a musculoskeletal injury for over six months.  Central hypersensitivity is way more common than science previously thought.

The author of this article (Tracy Paul) discusses this concept in the context of shoulder pain, but that’s because when scientists conduct studies, they have to be very, very specific, lest anyone accuse them of jumping the gun.

She writes, “People who are experiencing central hypersensitivity may continue to perceive pain even after adequate treatment for their shoulder and time to heal, which may be due to hypersensitivity not shutting off as it should in the normal situation.”

But this quote applies to just about any musculoskeletal condition that causes someone to be in pain for months on end.  Paul clarifies that central hypersensitivity has been associated with “…many other chronic conditions such as whiplash injury, fibromyalgia, low back pain, osteoarthritis and hemiplegic shoulder pain.”

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When I look back at what’s happened to me over the past decade or so, I can see how Paul’s description of central hypersensitivity describes me perfectly, if you just substitute the words “lower legs” in the place of “shoulder.”

After I had surgery for chronic exertional compartment syndrome, I still experienced strange symptoms in my lower legs.  For the first few months after surgery, especially, I felt as though my lower legs were full of water. It was a physical therapist who explained to me that these were actually nerve sensations, and that by all objective measures, my legs were ok.  For the first year or two following surgery, my lower legs and feet were extremely sensitive.  It was really hard for me to adjust to new shoes, even if those new shoes were flats.  (This may be hard for anyone who knew me in high school to believe, but I will never, ever wear heels again).

Things have gotten better now.  Some of the more crazy neurological symptoms in my legs went away over time.  I still experience central hypersensitivity, but even that is a work in progress, and I feel as though it is slowly diminishing over time.  Once I learned some of the techniques to work with the nervous system that I will be discussing more on this blog (check out this post to start) my nervous system began to calm down a bit, and I am hopeful for the future.