Fibromyalgia and central sensitization
Last updated 28/02/2024 by The pain clinics - Interdisciplinary Health
Fibromyalgia and central sensitization: The mechanism behind the pain
Central sensitization is considered to be one of the main mechanisms behind fibromyalgia pain.
But what is central sensitization? Well, here it helps to break down the words a bit. Central refers to the central nervous system - ie the brain and the nerves in the spinal cord. It is this part of the nervous system that interprets and responds to stimuli from other parts of the body. Sensitization is a gradual change in how the body responds to certain stimuli or substances. Sometimes it is also called pain sensitivity syndrome.
- Fibromyalgia is linked to an overactive central nervous system
Fibromyalgia is a chronic pain syndrome that can be defined as both neurological and rheumatological. Among other things, studies have shown that the diagnosis causes extensive pain in combination with a number of other symptoms (1). In the study we link to here, it is defined as a central sensitivity syndrome. In other words, they believe that fibromyalgia is a pain syndrome in which overactivity in the central nervous system leads to errors in the pain interpretation mechanisms (which are thus increased).
What is the Central Nervous System?
The central nervous system is the part of the nervous system that refers to the brain and spinal cord. In contrast to the peripheral nervous system which involves nerves outside these areas - such as branches further out into the arms and legs. The central nervous system is the body's control system for receiving and sending information. The brain controls the majority of body functions - such as movement, thoughts, speech function, consciousness and thinking. In addition to this, it has control over sight, hearing, sensitivity, taste and smells. The fact is that one can consider the spinal cord to be a kind of 'extension' of the brain. The fact that fibromyalgia is linked to oversensitization of this can therefore cause a wide variety of symptoms and pain - including effects on the intestines and digestion.
We take a closer look at central sensitization
Sensitization involves a gradual change in how your body responds to a stimulus. A good and simple example can be an allergy. In the case of allergies, it is an overreaction from the immune system that is behind the symptoms you experience. With fibromyalgia and other pain syndromes, it is believed that the central nervous system has become overactive, and that this is the basis for episodes of hypersensitivity in muscles and allodynia.
Central sensitization in fibromyalgia means that the body and brain overreport pain signals. This may also help explain why and how the pain syndrome causes widespread muscle pain.
- At our interdisciplinary departments at Vondtklinikkene in Oslo (Lambert seats) and Viken (Eidsvoll Sound og Raw wood) our clinicians have a uniquely high professional competence in assessment, treatment and rehabilitation training for chronic pain syndromes. Click on the links or here to read more about our departments.
Allodynia and hyperalgesia: When touch is painful
Nerve receptors in the skin send signals to the central nervous system when touched. When lightly touched, the brain should interpret this as stimuli that are not painful, but this is not always the case. In so-called flare-ups, ie bad periods for fibromyalgia patients, even such light touches can be painful. This is called allodynia and is due - you guessed it - to central sensitization.
Allodynia thus means that the nerve signals are misinterpreted and overreported to the central nervous system. The result can be that light touching is reported as painful - even if it is not. Such episodes occur more frequently during bad periods with a lot of stress and other strain (flare-ups). Allodynia is the most powerful version of hyperalgesia - which of the latter means that pain signals are amplified to varying degrees.
- Fibromyalgia is linked to episodic flare-ups and remission
Here it is very important to point out that such episodes can vary from person to person. Fibromyalgia often goes through periods of time with more intense symptoms and pain - called flare-ups. But, fortunately, there are also periods of minor pain and symptoms (remission periods). Such episodic changes also explain why light touching can be painful at certain times.
Fortunately, there is help available to control the pain in a better way. In a chronic pain syndrome, there is of course pain - in the form of both muscle pain and often joint stiffness. Seek help for both assessment, treatment and rehabilitation of sore muscles and stiff joints. A clinician will also be able to help you identify which rehabilitation exercises and self-measures are best for you. Both muscular therapy and adapted joint mobilization can help reduce tension and pain.
What is the cause of central sensitization in fibro patients?
No one questions that fibromyalgia is a complex and extensive pain syndrome. Central sensitization is due to physical changes in the nervous system. For example, that touch and pain are interpreted differently / errors in the brain. However, researchers are not entirely sure how these changes occur. It has been seen, however, that in most cases the changes appear to be linked to a specific event, trauma, course of the disease, infection or mental strain.
Studies have shown that up to 5-10% of those affected by stroke may experience central sensitization in parts of the body after the trauma (2). A significantly higher incidence has also been seen among people after spinal cord injuries and in those with multiple sclerosis (MS). But it is also known that central sensitization occurs in people without such injuries or trauma - and here it is speculated, among other things, whether there may be certain genetic and epigenetic factors at play. Research has also shown that poor sleep quality and lack of sleep - two factors that often affect fibromyalgia patients - are linked to sensitization.
Conditions and diagnoses linked to central sensitization
As there is more and more research in the field, a possible connection has been seen with several diagnoses. Among other things, it is believed that sensitization explains the pain associated with a number of chronic musculoskeletal diagnoses. Among other things, this includes mechanisms seen by, for example:
Fibromyalgia
Irritable Bowel Syndrome (IBS)
Chronic Fatigue Syndrome (CFS)
Migraine and chronic headache
Chronic jaw tension
Chronic lumbago
Chronic neck pain
Pelvic syndrome
Neck sprain
Post-trauma pain
Scar pain (after surgery for example)
Rheumatic arthritis
Rheumatoid arthritis (RA)
Endometriosis
As we see from the list above, further research on this topic is incredibly important. Perhaps the increased understanding can eventually be used to develop modern, new investigation and treatment methods? At least we hope so, but in the meantime the primary focus is on preventive and symptom-relieving measures that apply.
Treatments and self-measures for pain sensitization
(Image: Treatment of muscle tension and joint stiffness in between the shoulder blades)
Bad and more symptomatic periods among fibromyalgia patients are called flare-ups. These are often the cause of what we call triggers - that is, triggering causes. In the article linked to here are we talking about seven common triggers (the link opens in a new reader window so you can finish reading the article here). We know that it is especially stress reactions (physical, mental and chemical) that can lead to such bad periods. It is also known that stress-reducing measures can have a preventive, but also soothing effect.
- Physical treatment has a documented effect
Treatment methods that can help include physical therapy techniques such as muscle work, custom joint mobilization, laser therapy, traction and intramuscular acupuncture. The purpose of the treatment is to desensitize pain signals, reduce muscle tension, stimulate improved circulation and improve mobility. Special laser therapy - which is performed at all departments The pain clinics - has shown extremely good results for fibromyalgia patients. The treatment is usually performed by a modern chiropractor and / or physiotherapist.
A systematic review study consisting of 9 studies and 325 fibromyalgia patients concluded that laser therapy was a safe and effective treatment for fibromyalgia (3). Among other things, it was seen, in comparison with those who only did exercises, that when combined with laser therapy, a significant pain reduction, reduction in trigger points and less fatigue were seen. In the research hierarchy, such a systematic overview study is the strongest form of research - which emphasizes the importance of these results. According to the Radiation Protection Regulations, only a doctor, physiotherapist and chiropractor are allowed to use this type of laser (class 3B).
- Other good self-measures
In addition to physical therapy, it is important to find good self-measures that work relaxing for you. Here there are individual preferences and results, so you have to try and find the right measures for yourself. Here is a list of measures we recommend trying:
1. Daily free time on acupressure mat (massage point mat with accompanying neck pillow) or use of trigger point balls (read more about them via the link here - opens in a new window)
(Picture: Acupressure mat with own neck pillow)
Regarding this tip, we have received several questions from interested parties regarding how long they should stay on the acupressure mat. This is subjective, but with the mat we have linked to above, we usually recommend from between 15 to 40 minutes. Feel free to combine it with training in deep breathing and awareness of the right breathing technique.
2. Training in a hot water pool
Contact your local rheumatology team to inquire if there are any regular group classes near you.
3. Yoga and movement exercises (see video below)
In the video below shows chiropractor Alexander Andorff in Lambertseter Chiropractor Center and Physiotherapy developed customized movement exercises for rheumatologists. Remember to adapt the exercises to your own medical history and daily form. Our Youtube channel also has significantly kinder training programs than this if you find this to be too difficult.
4. Take a daily walk
Adapted length and duration in relation to own disease history and daily form.
Spend time on hobbies you relax with
If we like what we do, it becomes easier to have a good routine.
Map out negative influences - and try to weed them out
Don't let negative forces ruin your everyday life.
Exercises that can help with desensitization and relaxation
In the video below you can see a movement program whose main purpose is to stimulate joint movement and to provide muscle relaxation. The program is prepared by chiropractor Alexander Andorff (feel free to follow his Facebook page) by Lambertseter Chiropractor Center and Physiotherapy in Oslo. It can be done daily.
VIDEO: 5 mobility exercises for fibromyalgia patients
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With wishes for good health on to you and yours,
The pain clinics - Interdisciplinary Health
Click here to see an overview of our clinics. Remember that our modern interdisciplinary clinics are happy to help you with your ailments in muscles, tendons, nerves and joints.
Sources and research
1. Boomershine et al, 2015. Fibromyalgia: the prototypical central sensitivity syndrome. Curr Rheumatol Rev. 2015; 11 (2): 131-45.
2. Finnerup et al, 2009. Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurol. 2009 Sep; 8 (9): 857-68.
