Central sensitivity syndrome is characterized by an increased sensitivity and subsequent reactivity to stimuli. The stimulation could be targeted towards pain, noise, touch, light, or even smell.
Normal amounts of stimulation that would not bother most, can lead to pain, migraine headaches, increased startle response, and anxiety in patients who present with this condition. There can be associated fatigue, fight or flight reactions, sleep disturbances, and especially cognitive impairments or "brain fog".
In the patients that I see, it is not unusual to have this develop after chronic inflammation triggered by chronic infection or exposure to toxins such as those from mold.
Background
As hinted by in the name of the condition, this condition is characterized by having a central nervous system that has become increasingly sensitive. A certain stimulation, such as mild pressure on the muscles, may be amplified in its interpretation by the brain, causing a pain response. This can be in addition to any afferent nerve impulses (information carried from sensory receptors to the central nervous system) that may be inappropriately amplified as well.
Many different things can cause central sensitization. An initial trigger can be an infection, viral or bacterial, or can come from exposure to mycotoxins. It is important to note that not everyone exposed to the same trigger will develop central sensitization. It depends on genetic susceptibilities as well as whatever else that patient has to deal with in terms of other impediments to health (stress, other conditions, etc).
In many cases, the initial trigger to the condition has been resolved or removed, but unfortunately time has not healed the central sensitivity syndrome, and thus many of the symptoms persist. This can be due to immune dysregulation that is persisting, or often from dysregulated neural networks.
Thus, investigations and treatments might be aimed at the trigger, at immune dysregulation, or neurological dysregulation - and often a combination of these.
Diagnosis
There have been various criteria proposed for the diagnostic criteria of central sensitization syndrome. It is also a considered a diagnosis of exclusion, in that other conditions that can cause all of the symptoms are ruled out.
We can also consider that central sensitization syndrome may develop secondary to another condition though. For example, in a publication on CSS in rheumatoid arthritis found central sensitization was likely occurring in patients with active rheumatoid arthritis. Understanding that central sensitization can contribute to symptoms in patients with other active diseases can help with designing a helpful treatment plan.
Treatment options
CSS is a chronic condition that can be challenging to manage, but several treatment options are available that may help reduce symptoms and improve quality of life. These treatment options can be broadly categorized into medications, supplements, mind-body therapies, breathing techniques, and lifestyle modifications.
As mentioned above, treatment is also targeted against any persisting triggers (if any are identified, such as toxins or infections, or inflammation).
Medications
Several medications can be used to manage the symptoms of CSS. Antidepressants, such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), as well as especially SNRIs (affecting norepinephrine as well as serotonin) have been shown to be effective in reducing pain and improving sleep in patients with CSS. One simple example with duloxetine and recovery from knee arthroplasty is here, though many articles will come with other conditions as well. Anticonvulsants, such as gabapentin and pregabalin, can also be used to manage pain and other symptoms of CSS.
These medications can have significant side effects, like any other therapy, and these should be weighed against any benefit in quality of life seen.
A common worry that I see in my practice is that such treatments would only be a symptomatic approach and be life long. This could certainly be the case, though I would educate and consider that if side effects were minimal, the improvement in quality of life can be substantial. But also, importantly, I do see that patients are able to come off these medications after a period of time. It depends on the case, but likely neuroplasticity is playing some role. Of course, if there are active triggers that are addressed concurrently, this may contribute to why some patients can come off these medications more readily without relapsing.
Supplements
Supplements tend to form a foundation of treatment. There is a lot of clinical guesswork involved, but many seem to benefit from discussion of:
- magnesium (in a variety of forms)
- omega 3 fatty acids and sometimes specific pro-resolving mediators
- neurotransmitter supportive amino acids such as theanine and GABA
- mitochondrial supportive agents such as creatine, coq10, B vitamins
Mind-body therapies
Mind-body therapies such as meditation, mindfulness, and relaxation techniques can help manage the symptoms of CSS. These therapies work by reducing stress and improving the body's response to stress. They can also help improve sleep quality and reduce fatigue. These therapies can be practiced at home and may be beneficial in reducing the need for medications.
I especially like different non-directive medication techniques and yoga nidra (non sleep deep rest).
Three easy way to learn non-directive meditation techniques include:
1giantmind app (free app on Google Play and Apple App store) - gives 15 min lessons which include the meditation
The book, or videos online, of the "Relxation Response" technique by Herbert Benson, MD
The $25 program with pdf and audio on "Clinically Standardized Meditation" by Pat Carrington.
Breathing techniques
Breathing exercises can also be beneficial in reducing stress and managing the symptoms of CSS.
A simple technique is to focus on having an exhalation duration longer than the inhalation. It can be as simple as inhaling to a 4-6 second count, and then exhaling to the same count +2. Doing this for 2-3 minutes can help set a parasympathetic, rest/relax tone.
In a study on different breathing techniques - cyclic sighing, or a physiologic sigh, was quite effective and easy to learn.
This technique was described as follows:
Participants were informed they should sit down in a chair or, if they prefer, to lie down, and to set a timer for 5 min. Then they were told to inhale slowly, and that once their lungs were expanded, to inhale again once more to maximally fill their lungs -- even if the second inhale was shorter in duration and smaller in volume than the first, and then to slowly and fully exhale all their breath. They were told to repeat this pattern of breathing for 5 min. They were also informed that ideally, both inhales would be performed via their nose and the exhale would be performed via their mouth, but that if they preferred, they were welcome to do the breathing entirely through their nose. They were also informed that it is normal for the second inhale to be briefer than the first.
Then they were told to return to breathing normally.
Lifestyle modifications
Lifestyle modifications, such as stress reduction and sleep hygiene, can also help manage the symptoms of CSS. Regular exercise (when tolerated, and low intensity), healthy eating habits, and reducing exposure to environmental toxins, such as mold, can also be beneficial in reducing inflammation and improving overall health.
Niko-niko running and zone 2 cardio (which depending on conditioning and HR, might be very, very slow), are often tolerated as part of a reconditioning program as patients start to improve.
In conclusion, CSS is a complex condition that can be challenging to manage, but several treatment options are available that can help reduce symptoms and improve quality of life. A holistic approach that includes a combination of medications, supplements, mind-body therapies, breathing techniques, and lifestyle modifications may be necessary to manage the symptoms effectively. Identifying and addressing any persisting triggers to sensitization, and any triggers to inflammation, may be key.