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The Pain Rehabilitation Center (PRC) recognizes what is known as Central Sensitization Syndrome (CSS). This is an umbrella term used to describe pain and symptoms that arise from hypersensitization of the nervous system.
To best understand CSS, it is important know about the nervous system. Our nervous system is made up of two main parts: the central nervous system and the peripheral nervous system. The central nervous system acts as the control center of the body, consisting of the brain and spinal cord. The peripheral nervous system consists of all the nerves outside of the brain and spinal cord that act as the communication network. The peripheral nervous system sends sensory information to the central nervous system and delivers the central nervous system's commands to the rest of the body. Together, the central and peripheral nervous system work as a team to control the body's functions.
CSS is a phenomenon that alters how sensory stimuli is processed by the nervous system. Imagine your nervous system as a highway and that the neurons are vehicles carrying information along it. The highway is usually monitored by a patrol that regulates traffic, ensuring that the vehicles travel efficiently. However, with CSS, the highway becomes dysfunctional and allows too many vehicles to travel too frequently and at higher speeds. As a result, the highway becomes hypersensitive. Now, even the most minor disturbance, such as the vehicle in front of you lightly taping their breaks, causes a major chain reaction.
Increased traffic along the highway can be compared to the hyperexcitability of the nervous system. The nervous system sends too many alert signals even when there is no real danger, much like a congested highway with no major accident. Ultimately, CSS turns a once-efficient neural highway into a hypersensitive, traffic-jammed system in which sensory signals are sent too often and too intensely. The brain becomes accustomed to this influx of signals and now has a decreased threshold for pain and symptoms.
Our nervous system has the incredible ability to functionally and structurally change so that we can adapt to new situations and absorb new knowledge. However, this ability can become maladaptive just as it has with CSS. Although the cause of the highway traffic has been resolved, the effects progress on. Once the central nervous system is altered, it cannot return to its previous form because the brain has structurally created these new traffic systems. This is why CSS cannot be cured with medication or procedures. However, by applying an interdisciplinary approach to rehabilitation, we can leverage the mechanisms that enable our nervous system to learn and adapt to also manage CSS.
To learn more about CSS visit the Video Resources tab.
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@sarahotd This is a very helpful road map (no pun intended) in simplifying what CSS is. Many folks are unsure of why their bodies respond the way they do with little stimuli, I know I was, and with doctors looking for more specified cause and typically staying in their specialty lane, much of this diagnosis and explanation is overlooked.
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2 ReactionsI have burning mouth syndrome and red ear syndrome. I asked a doctor why I get weird things like this. You tell someone and they look at you like you're crazy. So I don't mention them any more. But a bit doctor said that the nervous system can cause all sorts of things to happen or go on
Some of us just have to live with it and try our best to cope
That's why I see a psychiatrist beside my panic attacks nl. I feel that I'm strange with all this
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3 ReactionsHi @lilly71, I don't think you're strange, but understand how you feel that way. It helped me to learn about central sensitization syndrome and the nervous system and how it's an umbrella to many different chronic conditions. More than feeling strange, I used to feel like I was going crazy and it was all in my head. It was not!
Mayo's Pain Rehab Center (PRC) teaches many coping skills. Besides seeing a psychiatrist, what other coping mechanisms help you live with your conditions?
U r not strange. I have had burning mouth for at least two yrs. Do u have any other pain? I have had back pain for over 40 yrs. Coped pretty good with ibuprofen/ Valium/ prozac. I unfortunately had to have 2 extensive prolapse surgeries and now have burning in pelvic area. Trying nerve block and pelvic therapy.
I watched the Video. Everything has stopped working for my chronic back pain but I just thought it was because my DDD is getting worse (which it is, a degenerating condition). The thought of removing the pain medication is terrifying...but I do hate it along with the side effects of bad constipation. Has anyone else had better results from STOPPING the pain medication?
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1 ReactionHi @lucasmom. Sorry you're struggling with chronic back symptoms. I agree with you and equally hated being on pain medication.
As a graduate of the PRC program, I can say a resounding yes, removing pain medication (opioids) made a big change overall for me. Not only to reduce nagging side effects, but to help calm down the central nervous system and help reduce symptoms.
I think what's most important to think about when it comes to management and rehabilitation of chronic pain is that the main focus is shifting power and control from the medical world back to ourselves, which can be a tall order. I understand your terrified feeling because I felt the same exact way before going to the PRC.
Dr. Sletten teaches:
Rehab = bravery with the acceptance of doing things differently
It does take discipline and commitment, but small steps can lead to bigger changes overall for chronic pain management. I'd love to hear what you thought of Dr. Sletten's video on CSS? What parts resonated with you most?
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1 ReactionHi, thank you for your reply.
May I ask how much pain meds were you on when you stopped? Where was your pain...the back? Degenerative disease?
Stopping the meds isn't the scay part...Its the thought that IF it doesn't work...then what? The "Pain" industry here in California as horrible and very scary. We have too few Dr.s, too may patients đ and too many "laws" that inhibit Dr.s from truly helping the most severe cases...so lots of folks just suffering, diabled...and some just take their lives which I can understand and have actually thought about. I would never commit such a sin (I beleive in God)
Thank you, Rachel, for the invite. Hello everyone! I need a recommendation for a CSS specialist in the Pacific Northwest. I live North Idaho, so as close to here as possible would be great, though I can drive to a nearby state if needed. I have an upcoming surgery at Mayo Rochester and need a consult with someone about how the surgery might impact my CSS. For example, I'm concerned about how a spinal block might affect my central nervous system. I cannot get guidance from the Mayo surgeon since I am not technically his patient until I travel out there and I really don't want to make two 20 hour trips in order to do a consult and then return for the surgery. So...I'm hoping I can find someone local to advise me so I can decide whether I am ready for this surgery or should postpone it. Thank you in advance for any recommendations!
I have - was on Oxy for about 1.5 months -
I am learning ways to cope with CSS and it is helping tremendously! Breathing work three times a day..cut out sugar - moving my body by walking and doing PT and knowing that pain does not equal harm has been huge! Also..hormones has improved my pain to my joints - I was literally thinking I was going to die two months ago. Pace yourself is also huge for me because I am type A and would go and go until I couldnât - having acceptance to putting my health before âdoingâ has changed my life!
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3 ReactionsI just began Testosterone pump applied to my shoulder after shower. I have been on HRT (hot flashes) for years, my Dr. prescribed the testosterone in addition saying it might help with energy and strength....it's day 2....waiting.
Me too Type A. I also thought I was dying, I still think this pain is killing me. Still learning.
Your words are good advice!