The Central Sensitization Syndrome (CSS) brings together several diseases that have a common denominator: the lowering of the sensory threshold and, therefore, the alteration in the perception of stimuli. These include fibromyalgia, chronic fatigue, tension or migraine headaches, temporomandibular joint disorders, restless legs syndrome, irritable bowel syndrome… Epidemiological studies indicate a high prevalence of approximately 5% in our population.
Characteristic symptoms of Central Sensitization Syndrome
The main triad of symptoms of Central Sensitization Syndrome are pain, fatigue and stress. The pain is chronic and generalized in many parts of the body, grouping various muscle groups. Fatigue is continuous, with crises of exhaustion as if the patient’s “battery” were running out and forcing him to rest. In addition, episodes of stress and anxiety, combined with “lows”, are very frequent and worsen the patient’s situation. In addition to these symptoms, there are other reported symptoms, among the most frequent: attention and concentration deficits, bowel rhythm disturbances, urinary incontinence, emotional lability, reactive depressive symptoms, etc.
Why does Central Sensitization Syndrome occur?
The causes of Central Sensitization Syndrome are multifactorial. Under a component of genetic susceptibility (still to be determined), many causes have been described in addition: viral infections, bad eating habits, smoking, lack of physical exercise, insomnia, trauma, surgical interventions and stress overload (work or family).
In CSD there is an increase in the excitability of the neurons of the central nervous system, especially those responsible for processing information from outside the brain. In a state of CSS, therefore, neurons are more easily activated by the input of signals that amplify transmission and can contribute to the generation of pathological clinical states.
How to diagnose Central Sensitization Syndrome
As it is a pathology that encompasses several systems and involves several disorders, it must be qualified by specialists in Rheumatology, Endocrinology and Psychiatry, in order to rule out other internal or mental diseases that may simulate a CSS.
From Rheumatology (internal medicine of the musculoskeletal system and systemic autoimmune diseases) a rheumatic disease that simulates a CSS must be ruled out. For this, the specialist will perform a complete medical history and a physical examination with appropriate complementary tests, which usually include analytical and ultrasound of the joints.
On the other hand, and from Endocrinology, there are a large number of endocrinological pathologies that occur with fatigue. The sum of fatigue with weight loss is strange, with a large number of differential diagnoses including constitutional syndromes. It is more common for patients to have fatigue combined with weight gain and hypothyroidism or diabetes must be ruled out. A high percentage of women with chronic autoimmune thyroiditis also suffer from chronic fatigue despite being treated with thyroid hormones. They are often accompanied by acquired immunity (elevated defenses) against various viruses, such as Epstein-Barr virus, Cytomegalovirus or Parvovirus.
From the point of view of psychiatry, there are two stages. The first stage is based on assessing the psychic state and stressors that may compromise it. In the second stage, the diagnosis of accompanying diseases will be established: insomnia, anxiety disorder, affective disorders (monopolar or bipolar depression), concentration and attention difficulties.
How to treat Central Sensitization Syndrome
To treat Central Sensitization Syndrome correctly, it is necessary to understand the bio-psycho-social context of the patient and to design a good therapeutic work plan with a multidisciplinary approach. Among the therapies usually used are nutrition, psychological support, drugs, physiotherapy, osteopathy and acupuncture.
On the other hand, from the nutritional point of view it should be noted that the most frequent deficits are of Magnesium, Selenium, Zinc and Iodine, as well as some amino acids. In this regard, there are several effective diets to treat SSC: antioxidant-rich, gluten-free (more prevalence of non-celiac gluten sensitivity/subclinical celiac disease), alkalinizing and anti-inflammatory diets, among others.
The psychological and psychopharmacological approach is essential. It will make it possible to treat all the symptoms and disorders that arise. It must be a personalized treatment, so it will depend entirely on the personality and symptomatology of the patient.
Likewise, physiotherapy and osteopathy have a global effect at the level of the central, autonomic and peripheral nervous system, and at the muscular and articular level. They are therapies that help with stress, fatigue and pain, as well as muscle tone imbalances with manual techniques, thermotherapy, personalized exercises and postural re-education.
Medical acupuncture is also useful for its analgesic, anti-inflammatory, anxiolytic and antidepressant effects, and is indicated as a first line of therapy. Its mechanism of action as a neuromodulator allows desensitizing the central nervous system and improving the symptoms of CSS.
Central Sensitization Syndrome: prognosis
The prognosis of CSS is good if a personalized treatment and follow-up is carried out. Otherwise, crises will be frequent and pain, stress and fatigue can undermine a person’s health.