My Current Education for Patients with High Central Sensitisation Scores
- Pain Education
- Physical Activity & Sleep
- Stress Management & Behavioural Modification
- Environment Influences
188.8.131.52.1 Pain Education
- Pain is an output of the brain. It’s not just a simple signal that travels from the painful body part to the brain, but rather, the brain processes a range of information and makes a decision on how much pain to produce.
- Central sensitization is a process that occurs in the nervous system, where the brain and spinal cord become more sensitive to pain signals. This means that the brain may interpret harmless or low-intensity signals as being painful, leading to a heightened perception of pain.
- Central sensitization is a normal process that occurs in response to tissue damage or injury. However, in chronic pain conditions, this process can become overactive, leading to persistent and widespread pain.
- The good news is that the brain can also be retrained to become less sensitive to pain signals. By understanding the role of central sensitization and learning strategies to manage pain, patients can take an active role in reducing their pain experience.
- Strategies for managing central sensitization include:
- Engaging in regular physical activity, as this can help to dampen down the overactive pain response in the brain.
- Reducing stress and promoting relaxation, as stress can increase pain sensitivity.
- Maintaining good sleep hygiene, as sleep disruption can contribute to central sensitization.
- Learning and practicing techniques such as mindfulness, deep breathing, and progressive muscle relaxation to promote relaxation and reduce stress.
- Seeking the help of a pain specialist or physical therapist who can provide tailored education and exercises to address central sensitization.
By understanding the mechanisms behind their pain and learning strategies to manage it, patients with chronic overlapping pain conditions can improve their quality of life and take back control of their pain.
Inflammation is a normal response of the body’s immune system to injury or infection. However, when inflammation becomes chronic, it can lead to pain, gut symptoms and anxiety. Chronic inflammation is linked to a condition called central sensitization, which means that the nervous system becomes hypersensitive and can produce pain even in the absence of an actual injury.
The gut and brain are also closely connected through what is known as the gut-brain axis. This means that inflammation in the gut can affect the brain and vice versa. Studies have shown that people with gut issues such as irritable bowel syndrome (IBS) are more likely to experience pain and anxiety.
So, how can we reduce inflammation and break this cycle? One way is to focus on a healthy diet that avoids irritating the gut. This may include avoiding coffee and consuming high glutamine foods such as caviar, fermented beans, meats, mushrooms, seafood, soy products, spinach, tomato and small amounts of cheese and salami. It is also important to consume omega-3s from sources such as salmon, mackerel, chia seeds or milled flax seeds to help reduce inflammation.
In addition to diet, physical activity and sleep can also play a role in reducing inflammation. Low-level physical activity such as walking can help improve sleep and energy levels, while higher intensity exercises such as tabata can help reduce stress and promote overall health. Finally, stress management techniques such as meditation can help improve the balance of the autonomic nervous system and reduce inflammation.
In summary, chronic inflammation may be the key link between pain, gut symptoms and anxiety. By focusing on a healthy diet, physical activity, sleep and stress management techniques, we can reduce inflammation and break this cycle to improve our overall health and wellbeing.
184.108.40.206.2 Physical Activity & Sleep education
- Stick to a consistent sleep schedule: Try to go to bed and wake up at the same time every day, even on weekends. This helps regulate your body’s internal clock and can improve the quality of your sleep.
- Create a relaxing bedtime routine: Develop a routine that helps you wind down before bed. This could include taking a warm bath or shower, reading a book, or practicing relaxation techniques like deep breathing or meditation.
- Create a sleep-conducive environment: Make sure your bedroom is dark, quiet, and cool. Use comfortable bedding and a supportive mattress.
- Avoid stimulants: Avoid caffeine, nicotine, and alcohol, particularly in the hours leading up to bedtime. These can interfere with sleep quality.
- Limit screen time before bed: The blue light emitted by electronic devices like smartphones and laptops can interfere with your body’s production of melatonin, a hormone that helps regulate sleep. Try to avoid using electronic devices for at least an hour before bed.
- Exercise regularly: Regular exercise can help promote better sleep quality. However, try to avoid exercising too close to bedtime, as it can stimulate your body and make it harder to fall asleep.
- Consider cognitive-behavioral therapy (CBT): CBT is a form of talk therapy that can help you identify and address negative thought patterns and behaviors that may be interfering with your sleep.
Improving your sleep can have a positive impact on your pain levels, particularly if you are experiencing central sensitisation. By following these tips, you may find that you feel more rested and refreshed, and that your pain levels are reduced.
Exercise and physical activity are important for everyone’s health, including those with central sensitization pain. However, it’s important to approach exercise in a way that won’t make your pain worse.
Here are some tips:
- Start small: Don’t push yourself too hard when you first start exercising. Begin with gentle movements that don’t cause pain or discomfort. Gradually increase the duration and intensity of your exercise as your body becomes accustomed to it.
- Listen to your body: Pay attention to your body’s signals. If you feel pain, stop or reduce the intensity of your exercise. If you’re feeling fatigued or experiencing other symptoms, take a break.
- Choose the right exercise: Low-impact activities like walking, swimming, cycling, and yoga are generally better for people with central sensitization pain. These activities are less likely to cause injury or exacerbate your pain.
- Seek guidance: Consider working with a physical therapist or other healthcare professional who can help you develop a safe and effective exercise program. They can help you choose the right exercises and teach you proper technique to prevent injury.
- Make it a habit: Consistency is key. Aim to exercise regularly, even if it’s just a few minutes a day. This can help improve your overall fitness and reduce your pain over time.
Remember, exercise should never cause you significant pain or discomfort. Always consult with your healthcare provider before starting any new exercise program, especially if you have a medical condition or have been sedentary for a long period of time.
- Avoid irritating the gut: Irritation of the gut can contribute to inflammation and dysregulation of the immune system, which can worsen central sensitization pain. To reduce gut irritation, it’s important to identify and avoid any foods or substances that may trigger inflammation or aggravate existing gut issues (such as irritable bowel syndrome). This may involve working with a healthcare practitioner to identify potential triggers and develop a personalized dietary plan.
- Support a healthy gut microbiome: The gut microbiome plays an important role in regulating immune function and inflammation, and imbalances in gut bacteria can contribute to central sensitization pain. To support a healthy gut microbiome, it’s important to consume a diverse range of fiber-rich plant foods (such as fruits, vegetables, legumes, and whole grains), as well as fermented foods like kimchi, sauerkraut, and kefir. Probiotic supplements may also be helpful in some cases.
- Consider dietary neurotransmitters: Some neurotransmitters (such as serotonin and GABA) are produced in the gut, and imbalances in these neurotransmitters can contribute to central sensitization pain. Consuming foods that are high in precursors to these neurotransmitters (such as tryptophan and glutamine) may help support healthy neurotransmitter production. Foods that are high in glutamine include caviar, fermented beans (such as tempeh), meats, mushrooms, seafood, seaweeds, soy products (such as miso), spinach, tomato, and tamari and oyster sauces.
- Consume omega-3 fatty acids: Omega-3 fatty acids have anti-inflammatory properties and may help reduce central sensitization pain. The current best guess for optimal omega-3 intake is around 2 grams per day for a healthy adult weighing 70kg. Good sources of omega-3s include fatty fish like salmon and mackerel (eating 50g of either will provide 1g of omega-3s), as well as chia seeds and flax seeds.
- Typically I recommend a mediterranean style diet. The Mediterranean diet emphasises whole, nutrient-dense foods such as fruits, vegetables, whole grains, legumes, nuts, and fish, while limiting processed and refined foods. This can help to reduce inflammation in the body, which is a key factor in central sensitization pain.
- The diet is high in anti-inflammatory nutrients such as omega-3 fatty acids, antioxidants, and polyphenols, which can help to decrease inflammation and oxidative stress in the body.
- The Mediterranean diet also includes healthy fats such as olive oil, which has been shown to have anti-inflammatory effects and may help to reduce pain and inflammation.
- The diet is low in processed and refined carbohydrates, which can contribute to inflammation and insulin resistance. By reducing these foods, the Mediterranean diet can help to regulate blood sugar levels and decrease inflammation.
- The diet is rich in fiber, which can help to improve gut health and support a healthy gut-brain axis. This is important for those with central sensitization as gut health can affect pain and inflammation in the body.
- The Mediterranean diet emphasizes moderate consumption of alcohol, primarily red wine, which has been shown to have anti-inflammatory and antioxidant effects. However, it is important to note that excessive alcohol consumption can have negative effects on health and should be avoided.
- Overall, the Mediterranean diet can help to improve overall health and reduce inflammation in the body, which may help to reduce central sensitization pain.
- Generally I would recommend a more mediterranean diet however it may be worth trying a ketogenic diet and seeing how you feel. The ketogenic diet is a high-fat, low-carbohydrate, and moderate-protein diet that has been shown to have a variety of health benefits, including potentially reducing central sensitization pain. Here are some possible mechanisms by which the ketogenic diet may help with pain:
- Reduced inflammation: The ketogenic diet has been shown to reduce inflammation throughout the body. Inflammation is a major contributor to pain and can increase the sensitivity of the nervous system. By reducing inflammation, the ketogenic diet may help to decrease pain sensitivity.
- Improved mitochondrial function: The ketogenic diet may improve mitochondrial function, which is important for energy production in cells. By improving mitochondrial function, the ketogenic diet may help to reduce oxidative stress, which is another contributor to pain.
- Reduced glucose metabolism: The ketogenic diet shifts the body’s metabolism away from glucose and toward ketones. This may be beneficial for people with central sensitization pain because glucose metabolism can lead to the production of advanced glycation end products (AGEs), which are known to contribute to pain.
- Increased GABA: The ketogenic diet may increase the production of gamma-aminobutyric acid (GABA), a neurotransmitter that has been shown to have a calming effect on the nervous system. By increasing GABA production, the ketogenic diet may help to reduce pain sensitivity.
- Improved gut health: The ketogenic diet may improve gut health by reducing inflammation and improving the balance of gut bacteria. This is important because gut health is closely linked to overall health, and poor gut health has been linked to a variety of chronic pain conditions.
- It’s important to note that the ketogenic diet is not for everyone and should be approached with caution. It’s best to work with a healthcare practitioner who is knowledgeable about the ketogenic diet before making any major changes to your diet. Additionally, it’s important to make sure that you’re getting all the necessary nutrients on a ketogenic diet, as it can be easy to miss out on certain vitamins and minerals.
- Limit caffeine intake: Caffeine is a stimulant that can exacerbate central sensitization pain by activating the stress response and increasing cortisol levels. The recommended daily limit for caffeine is 400mg for a 70kg healthy weight individual. One cup of coffee contains approximately 100mg of caffeine, while Moka coffee contains about 200mg. Black tea contains around 47mg of caffeine, and green tea has around 30mg. It is recommended to limit caffeine intake, especially in the afternoon and evening.
- Limit alcohol intake: Alcohol can disrupt sleep and increase inflammation, which can contribute to central sensitization pain. It is recommended to limit alcohol intake to moderate levels, which is defined as up to one drink per day for women and up to two drinks per day for men.
- Avoid sugary drinks: Sugary drinks can increase inflammation and disrupt gut microbiome balance, leading to gut dysbiosis, which is associated with central sensitization pain. It is recommended to avoid sugary drinks and opt for water, herbal teas, and low-sugar alternatives.
- Consider the impact of drinks on histamine and glutamate levels: Certain drinks, such as fermented drinks, may contain elevated levels of histamine and glutamate, which can exacerbate central sensitization pain. It is recommended to be mindful of the impact of drinks on histamine and glutamate levels and to limit intake of these drinks if necessary.
Remember that every individual is unique, and what works for one person may not work for another. It’s essential to work with a healthcare professional to develop a personalized nutrition and lifestyle plan to manage central sensitization pain effectively.
220.127.116.11.4 Stress Management & Behavioural Modification
- Practice relaxation techniques: Relaxation techniques such as deep breathing, meditation, and yoga can help to reduce stress and anxiety, which in turn can help to reduce central sensitization pain.
- Develop a positive mindset: Focusing on positive thoughts and feelings can help to shift your attention away from pain and reduce stress. It can also help to cultivate resilience and reduce the risk of developing depression and anxiety.
- Exercise regularly: Exercise can help to reduce stress and improve mood, which can be beneficial for people with central sensitization pain. However, it’s important to start with low-impact exercises and gradually increase intensity to avoid triggering pain.
- Get enough sleep: Sleep is essential for the body to repair and regenerate, and getting enough sleep can help to reduce stress and improve mood. Aim for 7-9 hours of sleep per night and establish a regular sleep routine.
- Practice mindfulness: Mindfulness involves being present and fully engaged in the moment, and can help to reduce stress and improve mood. Consider practicing mindfulness meditation or other mindfulness-based activities.
- Seek support: It can be helpful to seek support from friends, family, or a support group. You may also consider talking to a mental health professional who can provide additional support and guidance.
- Identify and modify negative behaviors: Negative behaviors such as procrastination, avoidance, and negative self-talk can increase stress and exacerbate pain. Identifying and modifying these behaviors can help to reduce stress and improve overall well-being.
18.104.22.168.5 Environmental exposure
- Aim to get at least 15 minutes of sunlight a day where possible, preferably first thing in the morning
- Exposure to moonlight before bed may also be beneficial
- Take 1000 IU of vitamin D when not getting good sun exposure
Time in Nature:
- Get a 10-15 minute walk in nature daily where possible, even if it’s just a park in the city
- Spending time in nature decreases levels of pro-inflammatory cells that increase our sensitivity to painful stimuli
- Positive social interactions are very beneficial for reducing systemic inflammation
- The quality of our relationships directly affects our levels of inflammation
- If you have a pet you enjoy spending time with, prioritize this! It increases oxytocin levels in both you and your pet, improving stress handling and psychological health, which is closely associated with outcomes in chronic pain
- A cold shower first thing in the morning appears to improve testosterone levels, pain tolerance, immune markers, and maybe longevity. Even as little as 30 seconds can help.
- Do not use a cold shower post-exercise as it may diminish the immune response
Baths or Hot Showers:
- A 10-20 minute bath before bed is ideal
- Adding 4 cups of Epsom salts may aid relaxation
- Long-term sauna usage is associated with lower levels of systemic inflammation
- Music you enjoy can improve pain tolerance and immune function
- London tap water may contain antibiotic-resistant bacteria, so avoid it where possible
- Poorer air quality increases levels of inflammation in the brain
- If you live in an area of poor air quality, get away as often as you can
- Preliminary research suggests WiFi signals may influence our immune cells and skin bacteria
- Limit exposure to WiFi where possible, e.g. turn it off at night
- Paints, in particular, can contain toxic substances that increase cancer risk, respiratory symptoms, and “sick building syndrome”
- Mold can cause fatigue, brain fog, and musculoskeletal symptoms
- Avoid damp environments and get assessed if you have these symptoms for no obvious cause.