Chronic Pain Explained: How Central Sensitization Rewires Your Nervous System

Dr. Ahmed Alhamdan, BSc, DC - Doctor of Chiropractic

Acute vs Chronic Pain: A Quick Refresher

Acute pain is the body’s alarm system, usually linked to clear tissue damage or inflammation, and it fades as healing occurs. Chronic pain, by contrast, lingers for three months or longer, often after the injury has resolved, and is now understood to involve changes within the nervous system itself – not just the original tissues.

How Pain Messages Travel

1. Peripheral Nociception

When you sprain an ankle, specialized nerve endings (nociceptors) in the ankle fire, sending electrical signals through peripheral nerves to the spinal cord.

2. Central Processing

Those signals are handed off to the spinal cord and then to multiple brain regions where meaning, threat level, memories, and emotions are attached. In chronic pain, this central “meaning‑making” machinery can become oversensitive.

Central Sensitization: Turning Up the Volume

Central sensitization describes a state in which spinal cord neurons and pain‑related brain circuits fire more easily, stay active longer, and spread to new areas. Key features include:

• Amplification – normal touch can feel extremely painful.

• Spread – pain can migrate beyond the original injury.

• Sensitivity to non‑pain stimuli – bright lights, odors, or sound may worsen symptoms.

These changes are driven by neuroplastic shifts in regions such as the insula, anterior cingulate cortex, and thalamus, alongside chemical mediators like glutamate and inflammatory cytokines.

Why the Brain Keeps the Pain Going

• Predictive coding gone wrong – the brain learns to expect pain and “fills in” discomfort even without fresh danger.

• Threat memories – prior painful episodes prime the system for rapid re‑activation.

• Emotional circuitry – stress, anxiety, and low mood loop back into pain pathways, raising baseline sensitivity.

Is My Pain Centrally Driven?

You might suspect a central component if you notice:

1. Pain lasting beyond normal tissue healing timelines (more than 12 weeks).

2. Widespread or shifting pain zones not confined to one joint or muscle.

3. Sensitivity to temperature, sound, light, or gentle touch.

4. Fatigue, “brain fog,” or sleep disruption alongside pain.

Treatment Implications

A purely tissue‑focused approach (rest, ice, injections) may fall short once central sensitization sets in. Evidence supports an integrated plan:

Strategy	How It Helps the CNS	Key Takeaways
Therapeutic movement	Normalizes sensory maps, releases endorphins	Start with tolerable, graded activities
Cognitive Behavioral or Acceptance‑based therapies	Reframe threat perception, lower limbic arousal	Brief weekly sessions can reduce pain intensity and disability
Sleep, stress, and nutrition optimization	Dampens neuro‑inflammatory signals	Prioritize consistent sleep, anti‑inflammatory diet
Targeted manual therapy & neuromodulation	Modulates spinal cord excitability	Short sessions combined with active rehab show better carry‑over

Where Wellness for the Body Fits In

At Wellness for the Body, our clinicians blend Chiropractic Treatment, evidence‑based movement therapy, manual therapy, and pain education to calm the nervous system while restoring confident movement. We tailor each plan after assessing peripheral drivers and central contributors, ensuring you receive care that matches the true source of your pain.

Key Takeaways

• Chronic pain often reflects a nervous‑system makeover, not lingering tissue damage alone.

• Central sensitization can amplify and prolong pain, making everyday sensations feel threatening.

• Multimodal care – exercise, psychological strategies, and lifestyle tweaks – best addresses the nervous‑system roots of chronic pain.

• Partnering with clinicians trained in both musculoskeletal and neuroplastic principles maximizes recovery.

References: PubMed | PubMed | PMCccjm.org | Nature | Physiopedia | The Washington Post