In short
Central sensitisation is when the nervous system becomes more sensitive, so it produces pain more easily and amplifies it. Pain that comes mainly from this process is called nociplastic pain. It’s real, it’s common in conditions like fibromyalgia, and it responds to approaches that calm the nervous system.
On this page
What is central sensitisation?
Pain is produced by the brain and nervous system, based on signals from the body and on context such as stress, sleep and past experience. Usually this system is well calibrated. With central sensitisation, the spinal cord and brain become more responsive: signals are amplified, pain spreads beyond the original area, and things that shouldn’t hurt can start to.
A common comparison is a car alarm that has become so sensitive it goes off when someone walks past. The alarm is real. The problem is the sensitivity.
What is nociplastic pain?
In 2017 the International Association for the Study of Pain added a third category of pain alongside pain from tissue damage (nociceptive) and nerve damage (neuropathic). Nociplastic pain is pain that comes mainly from altered processing in the nervous system, without clear tissue or nerve damage to explain it. A 2021 review in The Lancet described it as the main mechanism in conditions such as fibromyalgia.
Living with pain that hasn’t settled?
Talk it through with an Australian doctor online. No referral needed.
Signs that sensitisation may be involved
- Pain that has spread beyond the original area, or moves around
- Pain that’s out of proportion to any injury, or lasts long after healing
- Sensitivity to touch, pressure, light, sound or smells
- Fatigue, poor sleep and trouble concentrating
- Pain that’s strongly affected by stress
Conditions where it’s common
- Fibromyalgia
- Many cases of chronic low back pain
- Irritable bowel syndrome
- Chronic pelvic pain, including in some people with endometriosis
- Tension-type headache and migraine
- Temporomandibular (jaw) disorders
Sensitisation can also exist alongside other types of pain. For example, someone with knee arthritis can have both joint pain and a sensitised nervous system.
What helps
- Understanding it. Learning how pain works is a treatment in itself. It reduces fear and makes activity easier.
- Graded activity and exercise, increasing slowly so the nervous system gets used to movement again.
- Sleep, which has a strong effect on pain sensitivity.
- Psychological approaches that reduce stress and threat, such as CBT, ACT and mindfulness.
- Medicines that act on the nervous system, which help some people. Your GP can talk this through.
Treatments aimed only at a body part, such as repeated scans, injections or surgery, tend to help less when sensitisation is the main driver.
When to see a GP
See a GP if pain has lasted more than three months, is spreading, or comes with fatigue and poor sleep. A GP can check for other causes and help you build a plan.
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- Fitzcharles MA, Cohen SP, Clauw DJ, et al. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet. 2021;397(10289):2098-2110.
- Nicholas M, Vlaeyen JWS, Rief W, et al. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019;160(1):28-37.
- Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. 2021;397(10289):2082-2097.
- Louw A, Zimney K, Puentedura EJ, et al. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract. 2016;32(5):332-55.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.