Pain that doesn’t follow expected anatomical patterns, pain that spreads beyond the original site, or pain that feels “out of proportion” are familiar and often challenging presentations in general practice. One useful framework for understanding these symptoms is central sensitisation.
Central sensitisation isn’t simply another medical term — it’s a concept that helps explain why some patients continue to experience significant pain even after tissues have healed. Appreciating this mechanism can support more targeted, empathetic care and may help avoid unhelpful treatment pathways.
What is Central Sensitisation?
In simple terms, central sensitisation refers to an amplified pain response arising from changes in the central nervous system (brain and spinal cord). It behaves like a hyperactive alarm system: even minor inputs — or sometimes no obvious inputs — can trigger strong, persistent pain.
Common features include:
- Increased sensitivity to pain (hyperalgesia)
Pain in response to normally non-painful stimuli (allodynia)
Pain that spreads beyond the initial area
Unlike nociceptive pain (related to tissue injury) or neuropathic pain (related to nerve damage), central sensitisation reflects altered pain processing rather than ongoing physical damage.
Why It Matters in Clinical Practice
Central sensitisation is common, frequently under-recognised, and often contributes to chronic pain conditions such as:
Chronic low back pain
Chronic headaches and migraines
Persistent pelvic pain
Irritable bowel syndrome
Complex regional pain syndrome
When central mechanisms are at play, investigations, interventions, or medication escalation may provide limited benefit, and patients can become understandably frustrated. Recognising the pattern early can help guide more effective management strategies.
Recognising Central Sensitisation
Central sensitisation has no single defining test; instead, it often emerges through clinical pattern recognition. Helpful clues may include:
Pain disproportionate to findings: Severe or widespread pain despite minimal objective pathology.
Diffuse pain distribution: Pain that extends beyond expected anatomical or dermatomal patterns.
Multiple pain sites: Symptoms that shift locations or affect several areas.
Heightened sensitivity: Pain with light touch, temperature change, or gentle pressure.
Associated symptoms: Fatigue, sleep disturbance, cognitive fog, mood changes, and heightened stress reactivity.
Emotional factors: Fear-avoidance behaviours or high levels of worry about symptoms.
Limited response to standard treatments: Only short-lived or minimal benefit from medications, surgeries, or passive therapies.
Communicating the Concept to Patients
Explaining central sensitisation with clarity and compassion can be therapeutic in itself. It’s often useful to frame it as a change in the sensitivity of the nervous system rather than a psychological issue.
Examples that some clinicians find helpful:
“Your nervous system has become more sensitive over time, so it’s sending strong pain signals even without new damage.”
“It’s a bit like the pain system’s volume has been turned up. Our goal is to help turn it back down.”
This approach validates the patient’s experience and reframes the problem in a constructive, non-blaming way.
Management Approaches
Effective care generally involves a biopsychosocial framework, often with contributions from multiple disciplines:
Education: Pain neuroscience education to help patients understand their symptoms.
Graded activity and exposure: Gentle, consistent reintroduction of movement.
Psychological support: CBT, ACT, and mindfulness-based approaches can be valuable.
Medications: Selected agents targeting central mechanisms may have a role as part of a broader plan.
Sleep and stress management: Improving sleep quality and addressing stress can substantially influence pain sensitivity.
When Referral May Be Helpful
Referral to a pain specialist or multidisciplinary pain service may be useful when:
Pain persists despite initial biopsychosocial strategies
Functional impairment is significant
Complex psychosocial or psychiatric comorbidities are present
Diagnostic uncertainty remains
Central sensitisation can initially feel like a complex concept, but understanding it can provide a clearer framework for supporting patients with persistent pain. GPs and allied health professionals play an essential role in early recognition and collaborative management, helping guide patients away from repeated investigations and toward approaches that calm and retrain the nervous system.
