Let’s talk about pain today, and specifically a type of pain that remains one of the most poorly-recognized and poorly-appreciated disorders in medicine, despite it being 2024. We need to understand the types of pain to understand centralized pain.
Three Types of Pain
Nociceptive pain is the pain that occurs from physical damage — cuts, joint deterioration, bone-on-bone contact, or organ issues like kidney stones. This is the type most people think of when they think of pain. Something is damaged, we feel it.
Neuropathic pain stems from nerve irritation or inflammation. This is commonly seen in diabetes, pinched nerves, and autoimmune diseases. The nerves themselves are the problem here — they’re being compressed, inflamed, or damaged directly.
Centralized pain (also called nociplastic pain) represents a fundamentally different mechanism. The brain amplifies normal nerve signals disproportionately. Those usual, normal signals might not just feel like a touch — our brain might tell us it’s a burning sensation, or worse, it’ll tell us it thinks an ice pick just went through our skin!
The Amplifier Analogy
Think of it like a guitar amplifier. Normal sensations come through like a guitar signal — most people’s amplifiers operate at a comfortable volume 2 or 3. But in centralized pain, that amplifier is cranked to a 5, 6, 7, or even 10 out of 10. While most people experience mild discomfort from stubbing a toe, those with amplified pain processing might feel like someone just ran an ice pick through the entire foot, multiple times for hours, days.
The Invisibility Problem
Unlike visible injuries or detectable nerve compression on imaging, centralized pain leaves no physical evidence. All of the scans, all of the blood tests, all the eyes out there — nothing at all will ever find anything that should be causing pain where there can be so, so much pain. This is what makes it profoundly frustrating for patients and healthcare providers alike.
Fibromyalgia: The Primary Expression
Centralized pain primarily manifests as fibromyalgia, a syndrome often accompanied by brain fog, abnormal sensations, digestive issues, headaches, and severe fatigue. Despite it being 2024, the condition remains one of the most poorly-recognized and poorly-appreciated disorders in medicine, with patients sometimes waiting a decade for diagnosis.
Aggravating Factors
Modifiable Factors
- Insomnia and poor sleep — affecting 60-65% of fibromyalgia patients, this is often the single biggest factor that can be addressed
- Uncontrolled mental health conditions — anxiety and depression amplify the amplifier
- High stress levels
- Poor diet
Non-Modifiable Factors
- Genetic predisposition — family history plays a role
- Past traumatic experiences — serious accidents, assault, combat, and other trauma can permanently alter pain processing
Treatment Approaches
There is no single magic bullet for centralized pain. The approach is multifaceted:
Medications serve temporarily to reduce pain and improve sleep, with the goal of tapering when possible. These are a bridge, not a destination.
Supplements showing promise include curcumin, palmitoylethanolamide (PEA), omega-3 fatty acids, Vitamin D, and magnesium glycinate.
Physical therapy and physical activity (at the right intensity!) time and again has been shown to improve fibromyalgia pain. This is one of the most consistently effective interventions we have.
Complementary therapies include acupuncture, yoga, dietary modifications, and counseling. These aren’t replacements for the above but work alongside them.
Lifestyle modifications targeting sleep optimization and stress reduction form the foundation of treatment. Without addressing sleep and stress, the other interventions have a much harder time making a difference.
Hope and Resources
Full remission is possible for some patients, while others achieve significant symptom improvement. The key is a comprehensive, patient approach that addresses the condition from multiple angles simultaneously.
For support and education, the National Fibromyalgia Association and Fibromyalgia Action UK are excellent patient advocacy organizations.