Cleveland Clinic Journal of Medicine (CCJM)Central Sensitization, Chronic Pain, and Other Symptoms: Better Understanding, Better Management

Central sensitization fundamentally changes how the central nervous system processes pain and sensory stimuli, creating a heightened state of neural reactivity that can persist independently of peripheral input. This pathophysiologic process affects approximately 20% of Americans who experience chronic pain that significantly impacts their quality of life. Recent research demonstrates that patient education about pain physiology and central sensitization can markedly improve outcomes and reduce symptom burden.

Key Points:

• Central sensitization manifests through three primary mechanisms: hyperalgesia (increased pain from painful stimuli), allodynia (pain from non-painful stimuli), and global sensory hyperresponsiveness (heightened sensitivity to external and internal stimuli)
• The central nervous system undergoes structural, functional, and chemical changes that maintain a persistent state of heightened neural reactivity, leading to chronic, widespread pain and fatigue even without ongoing peripheral input
• Patient education about pain physiology significantly improves outcomes – studies show reduced pain severity, improved physical function, better mood, and enhanced quality of life compared to standard management approaches
• Evidence-based non-pharmacologic treatments include cognitive behavioral therapy, mindfulness-based stress reduction, graded exercise therapy, and stress management techniques that help rewire neural pathways
• Treatment should transition from a diagnostic to rehabilitative mindset, combining targeted pharmacologic approaches (NSAIDs, neuromodulators) with non-pharmacologic strategies while avoiding unnecessary diagnostic testing

HCN Medical Memo
Understanding central sensitization as the underlying mechanism for chronic pain conditions enables physicians to shift focus from diagnostic pursuit to rehabilitative strategies, improving patient outcomes through targeted education and evidence-based management approaches.

Pain Management Summaries