Understanding Centralized Pain 

For some people with arthritis, chronic pain is its own disease. 

First used to describe pain that occurs after a brainstem or spinal cord injury, centralized pain now describes any pain that happens when the central nervous system doesn’t process pain signals properly. The condition can also be called “central sensitization” “central amplification” and “central pain syndrome.”   

Arthritis pain stems from inflammation, joint damage or both, so it makes sense that getting inflammation under control with disease modifying drugs or replacing a badly worn hip or knee would eliminate it. Sometimes it does. But for some people with rheumatoid arthritis, psoriatic arthritis or osteoarthritis, pain persists despite aggressive treatment. It seems they experience changes in the way the brain and spinal cord process and transmit pain signals. The result is that pain that starts in the body (peripheral pain) is amplified in the brain. 

“The best analogy is that the volume control is involuntarily turned up on pain and other symptoms [that often occur with it] including poor sleep, depression and anxiety,” explains John Davis, MD, rheumatology practice chair at Mayo Clinic in Minnesota.   

This problem can also occur on its own in people who don’t have another type of arthritis. The most common centralized pain condition is fibromyalgia.

More doctors now understand the importance of treating centralized pain as its own disease. Your doctor can help you find treatments that address the changes in the brain and treat the condition that jump-started your pain. Here is how you can help your doctor find the right treatment for you.
 

Managing Centralized Pain

Don’t tough it out. Take steps to stop pain before it becomes chronic or centralized. You may be worried about medication side effects or you feel like you can handle the pain. But knowing how pain affects the brain, it may be wiser to address the underlying issue to prevent the brain changes that can come with untreated pain.

Give your doctor details. Make discussing your pain a priority. Consider keeping a pain diary to track how you feel daily and discuss it with your doctor at each appointment. Be specific about what you’re experiencing. Depending on your symptoms, your doctor may refer you to a pain center where you have access to a mix of physicians, physiatrists, psychiatrists, physical therapists and psychologists.
 

Chronic Pain and the Brain

Pain messages are continually being sent to the brain. Because the central nervous system (CNS) is changeable, nerves that deliver pain messages get better at it over time. Then, the body may begin to respond to small messages of pain as if they are big ones. Also, if you keep experiencing pain, your brain may develop a “pain memory.” Then, it may have faster and stronger responses to pain signals. With centralized pain, you may feel pain more strongly, and your ability to tolerate pain is decreased. Something that doesn’t cause pain for others may feel painful to you (allodynia).  

Engage in Self-Care

“Sleep and exercise are the two most important analgesics,” says Daniel Clauw, MD, a professor at the University of Michigan, director of the Chronic Pain and Fatigue Center there and a noted authority on chronic pain. “They turn the pain volume down. When you have good, restful sleep, when you’re active and not under stress, you can control centralized pain. Exercise doesn’t have to be high-intensity aerobic training; it can be as simple as walking as far as you can for as long as you can without feeling worse. Think of exercise as medicine. You don’t want to overdose, but if you skip a dose, your symptoms get worse.” 

Discuss Medications

Combining self-care and cognitive-behavioral therapy is the most effective treatment for fibromyalgia. But medication may be needed. The drugs used for fibromyalgia work to turn down “pain volume” in the central nervous system (CNS) and address fatigue, mood, sleep and other problems associated with the disease. Duloxetine (Cymbalta), milnacipran (Savella) and pregabalin (Lyrica) are FDA-approved to specifically treat fibromyalgia. Others are used “off-label,” meaning they’re used by doctors because of observed benefits but are not FDA-approved for fibromyalgia. Some of those drugs are antidepressants, but that doesn’t mean that getting a prescription means you are depressed. All medications come with risks, so ask your doctor about possible side effects.