Reply To: Central Hypersensitivity in Chronic Musculoskeletal Pain

[Aaron Hartstein]

Awesome suggestions, thanks for sharing! I am definitely an over-educator and have been trying to focus more on just the tip of the iceberg to share with my patients lately. It’s easy to forget not everyone has the same educational background and when you are thinking you are helping with giving them information, they may only be retaining bits and pieces and sometimes, those bits can be construed into something completely different than what you intended. I am learning, less is more.

For patients whom I suspect have some central hypersensitivity, I have found it helpful to explain to them that when you are in pain, your brain changes and starts to interpret touch that is not harmful as painful (easily proven by gently touching their leg, for example and helping them make the connection that touch from their finger gently on the skin does no damage, however, for some reason, they still feel pain). I think patients appreciate when we acknowledge that there are actual changes in their brain that they can’t control, versus them making it up or being crazy (I find that a lot of patients that have dealt with many doctors or unsupportive family members suffer from this fear). Once they understand that the brain has made some changes, I then tell them it is their job to help retrain the brain and help reteach it what is painful/harmful and what isn’t again. If they can understand that the brain is faulty at interpreting pain, and not that they are actually hurting themselves, then they are more willing to work through some pain in an attempt to help play an active role in “reteaching” it. This hasn’t been enough for everyone, but it has helped me get over the hump of willing to participate despite some pain with some patients.