Central Sensitivity Syndrome

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Diseases

Central Sensitivity Syndrome (CSS)

In 1984, Dr. Muhammad B. Yunus included a number of difference processes with shared characteristics in CSS, all of them with unknown causes but similar physiopathology.

The main symptoms of this pathology include:

Patients with these symptoms are frequently diagnosed, by different specialists, with Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, Migraine or Tension Headache, Restless Legs Syndrome, Multiple Chemical Syndrome, among others. Central Sensitivity Syndrome (CSS) currently encompasses all of these pathologies, which, instead of being independent entities have shared production mechanisms. This means that the patient does not have several diseases but a single disorder that can cause all of the symptoms described.

Further study of the SSC revealed a hyperexcitability of the neurons, which causes a central sensitisation to different peripheral stimuli: pain, smell, noise, food, chemicals, electromagnetic fields, weather changes, stress, infections, use of drugs, etc., and also presents an immune hypersensitivity to different food antigens, chemical antigens (drugs, detergents, soaps, creams, make up, etc.), physical antigens (light, noise, heat, cold weather change, etc.). Together, the deregulation to these two systems, the immune and central systems, produces an imbalance in the endocrine system.

MECHANISMS

Central and immunological sensitisation are responsible for lowering the thresholds to the various stimuli and, therefore, for increasing sensitivity, causing the wind-up phenomenon and persistent pain in spite of having removed the stimulus.

This wind-up phenomenon can also be responsible for an excessive response to different stimuli. When this sensitisation is sustained over time, changes in neuroplasticity occur that can be shown in imaging tests such as functional MRIs. Characteristic findings can also be shown in SPECT (single photon emission computed tomography) or magnetoencephalography, among others.

The malfunctioning of the CNS and the immune system ends up affecting the endocrine system.

In CSS, therefore, there is a neurosensorial deregulation that produces neuroendocrine and immune system alterations, creating a vicious circle that is the origin of the multiple symptoms and syndromes that appear in this process.

The chronification of the process leads to an increase in oxidative stress and free radicals, triggers the release of pro-inflammatory and immunological substances, causes dysfunction in the mitochondria, etc. As a result of the deregulation of all of these closely related systems, a complex and varied symptomatology appears as no organ is free from the action of these systems.

SCIENTIFIC PAPERS

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Yunus, M. B. (2007). Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Practice & Research Clinical Rheumatology, 21(3), 481-497.
Ren, K., & Torres, R. (2009). Role of interleukin-1β during pain and inflammation. Brain research reviews, 60(1), 57-64.
Desmeules, J. A., Cedraschi, C., Rapiti, E., Baumgartner, E., Finckh, A., Cohen, P. & Vischer, T. L. (2003). Neurophysiologic evidence for a central sensitization in patients with fibromyalgia. Arthritis & Rheumatism, 48(5), 1420-1429.
Katano, T., Furue, H., Okuda‐Ashitaka, E., Tagaya, M., Watanabe, M., Yoshimura, M., & Ito, S. (2008). N‐ethylmaleimide‐sensitive fusion protein (NSF) is involved in central sensitization in the spinal cord through GluR2 subunit composition switch after inflammation. European Journal of Neuroscience, 27(12), 3161-3170.
Yunus, M. B. (2008, June). Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. In Seminars in arthritis and rheumatism (Vol. 37, No. 6, pp. 339-352). WB Saunders.
Kindler, L. L., Bennett, R. M., & Jones, K. D. (2011). Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders. Pain Management Nursing, 12(1), 15-24.
Lorduy, K. M., Liegey‐Dougall, A., Haggard, R., Sanders, C. N., & Gatchel, R. J. (2013). The prevalence of comorbid symptoms of central sensitization syndrome among three different groups of temporomandibular disorder patients. Pain Practice, 13(8), 604-613.