Central Nervous System: Brain & Spinal Cord

Central sensitization is a term that is being used more frequently across all medical professions, osteopaths, physio’s, psychotherapists and consultants alike but was first coined by the neuroscientist Clifford Woolf in 1983.  CS, as I will call it  for the rest of this blog,  is linked with disproportionate  musculoskeletal and other kinds of pain and more specifically is thought to be a discrepancy between the pain the patient is experiencing and whatever is  causing it. Central is referring to the brain and the spinal cord, our processing centres, anything outside of this is our periphery.

Ascending & Descending Pain Pathways.


In normal circumstances if the tissue is sufficiently irritated, often inflammation, the brain will be interested by that impulse and interpret it  as some kind of pain. This will be dealt with in the above way by the descending pathways modulating that stimuli and this will continue until the ‘threat’ to the tissue is reduced or gone away, this is a short term pain memory described by Woolf 1983 as ‘acute phase central sensitization’. Sometimes this ‘dampening down’ doesn’t occur and CS stays switched on even tho’ the tissues have had time enough to heal, this causes altered representations of our tissues in the brain. Which can lead to chronic injury and/or over sensitivity of the tissues, know as ‘late phase CS’ by Woolf.

Acupuncture to help reduce knee pain.

There are numerous reasons why this may happen in some people and not others but it is more recently thought ho be due to psychological factors. such as excessive worrying, fear of movement with ie low back pain, memory of previous injury or memory of previous unsuccessful  treatment. It is know that excessive anxiety can suppress our immune system and this will in-turn reduce our ability to heal. CS and musculo-skeletal pain can also occur without any physical injury, triggered by psychological disorders, stress or a viral infection. The psychological disorder can then lead to amplification of the sensory nervous system which can even lead to noise or light sensitivity, as found in fibromyalgia patients. It is now  thought that people that develop CS are likely to have a genetic disposition.

Patients with chronic central pain, that which originates in the brain and spinal cord, are often linked with problems such as irritable bowel syndrome (IBS), severe fatigue, tension headaches or pain may manifest in one local area ie low back.

So as an osteopath we treat each patient individually, taking a significant amount of time to record a case history of not only the presenting pain and symptoms but a full medical history. This is to achieve an over-all profile of the patient before diagnosing and deciding on the appropriate treatment plan. Treatment may include advice on reducing stress levels, exercise or referral for CBT (cognitive behavioural therapy) alongside osteopathic techniques.