Central Sensitization Syndromes

Chronic Pain

Fibromyalgia is a sneaky condition since all that pain doesn’t ever manifest in any concrete damage to the organs. The work of one doctor, Muhammad B. Yunus, MD, and his colleagues in documenting the clinical signs of fibromyalgia some 25 years ago, did, however, bring about the first formal recognition of the disease by the greater medical community. But Dr. Yunus didn’t stop there; in 2007 he once again made a significant donation to the study of chronic pain and fatigue by creating the concept known as central sensitivity syndromes, or CSS.

CSS

Some 2 percent of Americans have fibromyalgia, a classic example of the group of illnesses known as CSS. Such maladies have their roots in abnormalities in the neurochemical systems of the body and include such conditions as restless leg syndrome, migraines, and irritable bowel syndrome.

Although CSS is not the cause of fibromyalgia, it is a decided factor in the persistent pain. CS is believed to start when persistent pain signaling (nerves telling body it hurts) causes cells in the spinal cord to become over-activated. The pain-transmitting cells become more sensitive as a result which causes stimuli that would normally be perceived as mildly painful to be perceived instead as extremely painful. Even a light touch can be perceived as very painful – an effect called allodynia.

CSS and Fibromyalgia Connection

Central sensitization is well documented in fibromyalgia and it may cause a substantial increase in the exacerbation of pain. However, it seems that CSS begins as a result of persistent pain input rather than being a cause for the pain itself.

There are several concepts as to how fibromyalgia begins. In some cases it starts as a result of pain that is sourced in a trauma such as a car accident, operation, childbirth, or a sports injury. However, that is not always the case. Fibromyalgia more often seems to begin as a result of psychological stress or, in about 40 percent of cases, for no apparent reason at all.

Dr. Yunus’ Research

Dr. Yunus and his team reviewed more than 225 publications and found that the data described 13 different conditions that are connected to central sensitization (CS). In CS, the spinal cord and brain or central nervous system, becomes hypersensitive at specific body points so that a light touch may cause significant pain. Associated conditions would include sleep disturbances and chronic fatigue.

“CSS are the most common diseases that are based on real neurochemical pathology and cause real pain and suffering. In some patients stress and depression may contribute to the symptoms but they are all based on objective changes in the central nervous system,” says the indefatigable Dr. Yunus.

Commenting on the findings of Dr. Yunus, Dr. Norman L. Gottlieb, Editor of Seminars in Arthritis and Rheumatism, says he believes the published report, “advances our understanding of fibromyalgia, unifies and advances concepts, and suggests that this and several other common disorders have much in common in terms of their biopsychosocial development. This, hopefully, will expand both clinical and research interest in this group of diseases and lead to advances in therapy for many of them.”

An editorial that accompanied the Yunus report by John B. Winfield, MD, states, “Science and medicine now have a rational scaffolding for understanding and treating chronic pain syndromes previously considered to be ‘functional’ or ‘unexplained.’ …Neuroscience research will continue to reveal the mechanisms of CS, but only if informed through a biopsychosocial perspective and with the interdisciplinary collaboration of basic scientists, psychologists, sociologists, epidemiologists, and clinicians.”

Dr. Yunus believes that the CSS concept must now be tested to see how it directs research and patient care protocols. Says Dr. Yunus, “Each patient, irrespective of diagnosis should be treated as an individual, considering both the biological and psychosocial contributions to his or her symptoms and suffering.”