explain
pain
section
4
page
82
The sensitised central alarm system
Can you spot it?
S
ensitisation of the brain and spinal cord is called central
sensitisation. Read through the common features below.
Perhaps you have some of them. Theymay provide a clue
that your pain ismore related to central nervous system
processes than tissue processes.
Your label:
Because tissues heal, and because your alarm
system and brain have changed to protect you, diagnoses
based on tissue processes no longer fit. Often you end up
withmultiple diagnoses including fibromyalgia, somatoform
pain disorder, chronic fatigue syndrome, myofascial
syndrome, non-specific back pain, psychosomatic pain
syndrome, repetitive strain injury, non-specific neuropathic
pain etc. Your diagnosis often depends onwhere you live
andwhich particular health professional you see. Some
diagnosesmay have been given to get you out of the clinic
as quickly as possible. The signs and symptoms of all of
these ‘diagnoses’ can readily be explained by sensitisation
of the central alarm system and by contemplating how the
orchestra in your brain is playing.
Because tissues are no longer themain issue, it is oftennot
helpful to seek anunderstanding of the diagnostic label. It is
better to seek anunderstanding of the particular symptoms
which are a feature of your unique presentation. Here are
some common symptoms of a sensitised alarm system.
The pain persists:
Self-analysis is needed here. The known
healing time for tissues involved has long passed. Is there
any reason that the damaged tissue wouldn’t have healed?
After all, broken bones are almost healed in sixweeks.
The pain spreads:
There are no fences in the nervous
system. Sensitisation of the alarm system and brainmeans
the brain is (wrongly) told that more of the body is in
danger and the brain therefore spreads pain.
The painworsens:
This is themost obvious strategy for
your alarm system and brain if it wants you to escape. Most
of the changes in the alarm system aim to increase the
frequency of dangermessages sent to your brain. It is,
therefore, sensible for your brain to conclude that the danger
level has actually increased. Thiswill make it hurtmore.
Lots ofmovements (even small ones) hurt:
Each
increase in the sensitivity of the alarm systemwill reduce
the amount of movement that can occur before the alarm
system stops you from going further. If there is ongoing
inflammation in the tissues, the danger sensors in the
tissues are also sensitive, further reducing the amount of
movement you can performwithout pain. When the
orchestra becomes really used to playing the pain tune,
even imagining amovement can produce pain.
eg.130
This is
a highly protectivemechanism.
