Central Sensitization Syndrome (CSS) encompasses a series of diseases that have a common denominator: the lowering of the sensory threshold and, therefore, the alteration in the perception of stimuli. Among them we can include fibromyalgia, chronic fatigue, tension or migraine headaches, temporomandibular joint disorders, restless legs syndrome, irritable bowel syndrome… Epidemiological studies point to a high prevalence of approximately 5% in our population.
What are the 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. The fatigue is continuous with crises of exhaustion, as if the “battery” were running out, forcing the patient to rest. In addition, episodes of stress and anxiety, combined with “lows”, are very frequent and worsen the picture. To these symptoms are added a series of referred symptoms, among the most frequent: attention and concentration deficit, alterations of the intestinal rhythm, urinary incontinence, emotional lability, reactive depressive symptoms, etc.
Why does Central Sensitization Syndrome occur?
The causes of this syndrome are multifactorial. Under a component of genetic susceptibility (still to be determined) many causes have been described: 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 thus contribute to the generation of pathological clinical states.
Diagnosis of Central Sensitization Syndrome
Being 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, considered the internal medicine of the locomotor system and systemic autoimmune diseases, it is necessary to screen for a rheumatic disease that simulates a CSS. For this, the specialist will perform a complete medical history and a physical examination to request the appropriate complementary tests, which usually include blood tests and ultrasound scans of the joints.
On the other hand, and from the point of view of Endocrinology, there are a large number of endocrinological pathologies that occur with fatigue. The sum of fatigue with weight loss is strange, offering a large number of differential diagnoses including constitutional syndromes. Thus, it is more common for patients to suffer 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 psychiatric point of view, two stages are established. The first is based on an assessment of the psychic state and stressors that may compromise it. In the second stage, the diagnosis of the accompanying pathologies will be established: insomnia, anxiety disorder, affective disorders (monopolar or bipolar depression), concentration and attention difficulties.
Treatment of Central Sensitization Syndrome
In order 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. Thus, among the therapies usually used are nutrition, psychological support, drugs, physiotherapy, osteopathy and acupuncture.
On the other hand, from a nutritional point of view, it should be noted that the most frequent deficiencies are Magnesium, Selenium, Zinc and Iodine, as well as some amino acids. In this sense there are several effective diets to treat SSC: diets rich in antioxidants, gluten-free diets (more prevalence of non-celiac gluten sensitivity/subclinical celiac disease), alkalizing diets and anti-inflammatory diets.
The psychological and psychopharmacological approach is a pillar. It will make it possible to treat all the accompanying symptoms and disorders. 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. These therapies are of great help in stress, fatigue and pain, as well as in muscle tone imbalances with manual techniques, fear therapy, personalized exercises and postural re-education.
Medical acupuncture, for its analgesic, anti-inflammatory, anxiolytic and antidepressant effects, is indicated as a first line of therapy. Its mechanism of action as a neuromodulator makes it possible to desensitize the central nervous system and improve the symptoms of CSS.
Prognosis of Central Sensitization Syndrome
The prognosis of CSS is good as long as a personalized treatment and follow-up is carried out. Otherwise, crises are frequent and pain, stress and fatigue can significantly impair a person’s health.