Central sensitization - Can your mind change it?

I’ve read a lot of papers on the topic of central sensitization as I seem to have this type of pain in my pelvic area and thighs. There generally seems to be two schools of thought: 1) that persistent pain re-wires your receptor cells in a biological manner whereby more glial cells and receptors are produced as well as other biological processes changed. The inference is that this is a biological process beyond which one’s mind has no control and is essentially irreversible or; 2) central sensitization is produced by one’s mind (primarily the amygdala) where the fear-pain cycle creates greater sensitivity causing nerves to fire at a lower level of stimulation. Viewed from this model your mind can change the process and reverse chronic pain.

I read the below article by Paul Ingraham (former PT, now science writer) who wrote a well sourced article relating to the issue of plasticity of the mind regarding de-sensitization and re-wiring the pain process.

https://www.painscience.com/articles/mind-over-pain.php

It seems MBS favors the second view but this article is concerning to me. Has anyone researched this issue or given thought on how sensitization should be viewed? I would appreciate your perspectives as I think, at least for me, this issue seems a fundamental part of the MBS work I am doing.

 

TMS work is about separating yourself from over intellectualization and reading/researching, and turning inward.
The Boulder Pain study totally debunks theory 1. The pain “science” guy makes money from people’s pain -he is no different than anyone who tries to benefit from the suffering of others.
@mbo recently posted a great interview with Dr. Schubiner who discusses the true mechanisms of pain. #1 is really the fear pain loop. It’s not biological, but yes, you can get totally stuck in this loop. It’s basically where you are at now.
But there truly is a way out. Schubiner discusses the science of tms work with a medical Doctor. It’s the best interview I’ve seen him do.

 

I took a practitioner course with Dr. Schubiner and this was addressed in class. It seems to be the in vogue label "du jour" these days. "Central sensitization" is total nonsense and it's used by conventional doctors who are clueless. It implies a "locked in" disease or inflammatory condition of the brain and it's completely false. Throw it out the window. It's patent rubbish.

 

Thank you Cactusflower and miffybunny. I very much want to believe the TMS approach as it provides an opportunity to eliminate my chronic pain. I'm a lawyer and by my nature I analyze everything I can get a hold of to make the best case I can based on where the facts lead me - taking the world as it is, not as I wish it to be. It's not might intent to be difficult but inconsistent information is troublesome and erodes my confidence in the evidence. It's hard to get rid of the fear of the pain if you don't fully grasp the concept by which you're to achieve it. It also bothers me a bit that there are so few TMS doctors when Sarno's work has been around for decades, one would think a compelling approach would have caught on in the medical community more that it has. I suspect nearly everyone on this site wishes to free themselves from chronic pain. For me at least grasping the concept that the mind can change chronic pain seems essential in order to make progress. Trust me, I'm really, really trying to get there but it's hard for me to adopt the approach in a sort of faith-based way, logical support seems essential for me, and I assume others, to fully embrace the TMS approach. If it's available it would make all the difference to me but I've read several medical papers based on the biomedical sensitization model that it gives me pause.

 

Those medical theories have been roundly debunked. The mind body approach is not faith based , it’s fact based. If you want more science, I recommend the PPDA bibliography on peer reviewed research studies. The biomedical model is outdated and skewed.

 

In my opinion, all sorts of healthcare providers regard central sensitization as irreversible because they cannot treat it effectively. Ergo the problem must be irreversible. Clifford J. Woolf is a physician and neurobiologist, now at Harvard, who is famous for his pioneering research on central sensitivation. Here is something he wrote in Central sensitization: Implications for the diagnosis and treatment of pain, Pain. 2011 Mar: 152(3): “The following conclusions can be made from this survey of the published studies of experimental pain hypersensitivity in human volunteers. Central sensitization is a robust phenomenon, readily induced in human volunteers in response to diverse ways of activating nociceptors [i.e., neurons involved in the creation of pain] . . . . Generally this activ[ation]-dependent plasticity manifests immediately, but its effects persist for many hours beyond the inducing conditioning stimulus, eventually returning, however, back to baseline, indicting its usual full reversibility.” (I added the emphasis.)

 

I just read your most recent post. Now that I know you are a lawyer (like I was for 42 years) and are doggedly analytic (like I am), I will recommend a couple things to read. I’d say start with David Butler & Lorimer Moseley, Explain Pain (2d 2015). That is essential foundation to then read Moseley & Butler, Explain Pain Supercharged (2017). Moseley and Butler started out as physical therapists. Moseley then got a PhD in neuroscience and did a postdoc research fellowship at Oxford University. The key parts of the latter book are the first three chapters and pages 207-08 of Chapter 9. Chapter 3, titled Supercharge Your pain Biology, was written by Moseley alone. It goes into the neuroimmunology of chronic pain in molecular detail and is a tough slog because it requires the patience to become familiar with some weird terminology. Moseley quipped in the intro to the chapter that Butler read it five times “and he almost gets it.” In a video interview, Moseley said that to really understand the chapter, it is necessary to read the professional research upon which it is based. So I did that, but I’m not sure that is necessary. The core objective of Moseley and Butler’s treatment approach to chronic pain is to shift one’s conceptualization of pain from that of a marker of tissue damage or disease to that of a marker of the brain’s falsely perceived need to protect body tissue.

Explain Pain Supercharged was written to educate healthcare providers who treat chronic pain. Moseley and Butler say patients only need to know a tiny percentage of what is in Explain Pain Supercharged, things, like like “your pain system is being overprotective” and “you can change it.” Being highly analytic all my life, I had to know the full story in detail. Being retired, I had the time to do it.

If you don’t have the time to learn all that, I have more recently found what I think might be a simpler way for one to conclude that there is nothing structurally wrong and that one’s chronic paid is due to a mistake by the brain. It is something Moseley has recently gotten into, as has Dr. Howard Schubiner. It is called predictive processing. Neuroscientist Lisa Feldman Barrett explains the scientific basis for the predictive processing concept, which is becoming a big deal in cognitive neuroscience, in a short book titled 7 1/2 Lessons About the Brain (in The Half-Lesson and Lesson No. 4). She does not go into chronic pain in the book, but the relevance is clear if you think about it. (She talked about chronic pain in the context of predictive processing in her more technical book How Emotions Are Made.)

If you go either route--Explain Pain Supercharged or 7 1/2 Lessons About the Brain--I’d be happy to try to answer any questions you have.

 

... said anyone throughout human history who was desperate to deny a new possibility - from ancient times to today's deniers. Pick your topic.

@JDSR71, what makes you think that the medical community is any less susceptible to doubt than you are, when it comes to physical symptoms that they've been taught must have a cause that they can cure with modern drugs and surgery? Doctors live to "fix" things, after all. How do you think they feel, and what do you think they do, when faced with an obviously physical issue that they can't fix? The medical community has been duped before, after all, many times, and quite recently (eg: the word is finally getting out about the ineffectiveness of back surgery for chronic pain, never mind all of the recent dietary reversals). And for crying out loud, don't forget how beholden the medical industry is to the biotech and pharmaceutical industries. There is no research money from those guys for mindbody research.

Look, over-thinking is one of the primary functions of our "TMS brains" - it comes from our need to analyze threats. It's also a great distraction a la Dr. Sarno, because you can be so easily convinced that you're accomplishing something by spending a ton of time analyzing what it considers to be a threat.

You are not.

What you're doing is spinning your wheels and avoiding doing the emotional work, which your brain reeeeally doesn't want you to do. Which is inherently silly, because doing the emotional work is non-invasive, and costs practically nothing - other than time, which I get is not easy for someone who has a job and possibly family. Popping a pill or going to PT once a week would sure be easier, right?

The mindbody approach to physical conditions has been around for centuries, way before Dr Sarno. All he did was repackage some of that knowledge in an efficient format that makes sense in today's world, although some of the details of his original theory (such as oxygen deprivation) are outdated and mostly ignored by most of us who have been evolving our understanding along with neuroscience. Nevertheless the central premise remains valid, as has been proven over and over by many of us who simply sat down and forced ourselves to do the work.

Doing the work with self-honesty and personal integrity is not at all easy for most individuals, because we are fighting against a primitive fear-based survival mechanism that is extremely strong. The problem that the medical community has is that they can't measure or explain why some people can do the work more easily and achieve results while others struggle for months with many setbacks, and still others never get it. It's really hard to quantify, and thanks to the ever-changing and ever-increasing stressors in our modern lives, there is no such thing as a permanent cure without a 180-degree change in the way we think and react to stressors.

I'm still existing somewhere between 75%-90% freedom from symptoms most of the time - which is not bad enough for me to do what I know needs to be done to get to 100%, which is to meditate at least 45 minutes a day. My brain completely sabotages me all the time, by convincing me that I'll do it "later". And "later" never happens. Still - even a 75% day is significant compared to where I was at when I discovered Dr. Sarno eleven years ago at age 60, when I was well on the path to becoming housebound with multiple pain, GI, neuro, and mental symptoms. It's starting to get a little more difficult for me to separate TMS from age-related issues, but I'm still so much better off at 71 than I was then - and I owe that 100% to incorporating mindbody knowledge, techniques, and belief into my life.

You've received excellent advice from @miffybunny, @Cactusflower, and @Duggit, all of them well-established "luminaries" of this forum. Don't discount it because your brain wants to convince you that it's not valid or somehow not relevant to you. This is your brain on TMS - I know, because I've been there, they've been there - we've all been there. As human beings, we're all in this together - and the forum is here for you when you're ready to do the work.

~Jan

 

Jan, the area of meditation always confuses me. I’m never quite sure how I should go about it. You mentioned that you’d like to do it 45 minutes a day. I’m just wondering if you were to do that, how would you go about it? Would you do a guided meditation, a silent meditation, a meditation where you concentrate on a certain topic, or would you follow your breathing? I’m wondering what your intention for meditation would be. Any thoughts on this from members of the forum would be appreciated. I sometimes meditate and start thinking of my shopping list. Lol. I’d really like to be able to meditate in a way that would be helpful. Thanks.

 

LOL, @tgirl, that's part of the problem, right? There is no one way, and there are too many choices. Some appeal to me more than others, but the one thing that would really work for me is to find a regular practice that involves me making a commitment to someone other than myself to show up. This works great for me when it comes to exercise and yoga, which I do five days a week, and to which I attribute my mostly 90% days. During session breaks in those activities is when I tend toward feeling like I'm only at 75% or so, in spite of the fact that I have access to two enormous vaults of online on-demand curated exercise videos tailored for "active older adults". The problem is the "on demand" combined with the" later syndrome". Which is just another function of my lovely TMS brain, I know!

I occasionally look for meditation classes and groups, but the ones that appeal to me for whatever reason have a schedule or location that just doesn't work. I have two very good apps, but I rarely use them.

@TG957 is our resident expert at self-actuated meditation, and she has written frequently about it here. She also credits it for her eventual recovery from a severe case of CRPS and other mindbody conditions, as she describes in her self-published book.

 

Thanks Jan. I have the Calm app which is good, but again, it offers many options, and I never know which one to choose, so I usually choose playing wordle instead or something equally effective. Lol. I’ll look into the meditation TG957 finds useful. Best of luck with it!

 

To lower one’s central sensitization and fear, has anyone a recommendation on how best to achieve that? I’ve read about mindfulness, meditation, somatic tracking, journaling, focusing upon that it's the mind – not the body causing pain, as well as other methodologies. I’m curious if there’s any consensus regarding the best method(s) to employ in reducing fear and sensitization, or is it essentially a process of trying different approaches to see what works best for you? If there are any experienced practitioners who have recommendations of a method and their technique in employing it I'd find it very helpful.

 

The best way to eliminate fear is with accurate information (logic, science, common sense). The "sensitization" goes away on its own as a side effect of accurate knowledge, clearing out doubt, and doing any emotional or practical work needed. The tools you listed are all great ways of helping the process along. Another recommendation I have is to throw away terms like "sensitization" (or "vagus nerve" or "brain retraining" or any other marketing nonsense) because they serve no purpose but to create more fear and the nocebo effect. The more you normalize the human condition and get away from all of these terms that "pathologize" anxiety and negative thought habits , the better. This is a common, normal , and reversible scenario...no matter what your symptoms look like.