This is the third article in a 3-part series centered around the multiple contributors to chronic pain. In the first two articles, I discussed (1) the anatomic/ biomechanical contributors and (2) the internal/external environmental factors. In this article, I will discuss the third component, central sensitization, or the biochemical hypersensitivity in the brain and spinal cord that sends the pain signals into your body. This is a very important component to pain as it is an interpretation by the brain and cannot be modified by interventions focused in the anatomic location of pain. As a matter of fact, if there is a high central component to the pain, surgery, injections, dry needling, manual therapy, and even topical agents can exacerbate the pain. What is happening is the brain starts to sense any sensory input from the damaged part of the body as pain. In some instances, even light touch can be interpreted as pain.
The brain is very neuroplastic throughout life, meaning it can form new pathways and learn new things; most of the time this is a very positive thing. It allows you to learn new things like playing the piano, throughout your life. However, it can also apply to negative things such as the interpretation of pain. The neuroplasticity of the brain turns on a biochemical pathway like a light switch and every time the focus is on the anatomic portion of the pain input, that pathway gets reinforced and gets stronger. So not only is the light switch on, but someone has changed the light bulb from a 60W to a 120W bulb. When the anatomic abnormality is compared to the degree of pain, there is often a large discrepancy. No one’s soft tissues are perfect. As we move and live life, the body is constantly remodeling and compensating for other parts of the body which, for one reason or another, isn’t working optimally.
When the autonomic nervous system is activated, there is a global vasoconstriction and relative decreased blood flow to the body. That decreased blood flow will be felt in the soft tissues that are not perfect. Since the underlying issue is within the brain itself, not in the imperfect soft tissues, down regulating or resetting the biochemical pathways in the nervous system is how this is optimally addressed. Dedicated therapy to calming the autonomic nervous system and activating the parasympathetic nervous system through a biopsychosocial approach is crucial to healing. This may include breath work, meditation, acupressure/acupuncture, energy healing (such as Reiki), vibrational therapies (such as vibrational mats, shaking, chanting, sound healing), slow methodical movements in whole body systems approaches such as traditional Chinese medicine (Tai Chi or Qi Gong) or Ayurvedic medicine (yoga), and cognitive behavioral therapy. The mind-body is very strong and cannot be ignored. There is a percentage of a central component in all chronic pain, so even if it is not the predominate component, it is important to address it so the body, soul, and mind can be healed.