Article in Verywell: An Overview of Central Sensitivity Syndromes What It Is and Treatment

[Sly Saint]

Central sensitization syndromes (CSS) are a collection of disorders where the central nervous system misfires and amplifies sensory input resulting in pain, fatigue, brain fog, and sleep problems. Fibromyalgia (FMS), chronic fatigue syndrome (ME/CFS), and other chronic pain conditions fall under the CSS umbrella.1

Central sensitization syndromes are sometimes known as functional somatic syndrome, medically unexplained syndrome, and somatoform disorders.2 Fibromyalgia, chronic fatigue, and other central sensitization syndromes have a broad range of physical and psychological symptoms that span multiple systems and can be hard to classify.

This article discusses central sensitization syndromes, the underlying mechanisms behind CSS, and available treatment options.

Treating Central Sensitivity Syndromes
The different individual symptoms and mechanisms of each CSS require a customized treatment approach, but in general, most CSS tend to respond to some of the same types of treatment, especially antidepressants (which help correct neurotransmitter dysregulation), exercise, and cognitive-behavioral therapy (CBT).5


However, it should be noted that people with ME/CFS have special considerations when it comes to exercise, and CBT is a highly controversial treatment for this illness, especially when it's paired with graded exercise.

A Word From Verywell
The CSS classification is good news for all of us with these conditions. It signifies a positive change in how these illnesses are understood and viewed by the medical community.

hmm

https://www.verywellhealth.com/central-sensitivity-syndromes-716160

 

[Wyva]

An Adrienne Dellwo article again. She keeps writing these as if they were fact.

 

[Charles B.]

How is the designation of ME as a somatoform disorder good news for anyone? How does it signify a change, let alone a positive one, for patients? Who is this author, and how does anything she publishes pass the laugh test?

 

[chrisb]

Apparently she also writes works of fiction.

 

[Arnie Pye]

That article made me feel sick - and very angry.

 

[Trish]

You can give feedback at the end. I did a brief comment just saying CSS is a hypothesis without evidence and should not be published as fact, and that the article should be withdrawn.

 

[rvallee]

Apparently she also writes works of fiction.

Also?

 

[Andy]

About Adrienne. On the website it includes a link to her LinkedIn profile.

"Highlights

• Nominee, WEGO Health Awards, Best in Show: Blog
• Columnist for the UK-based Fibromyalgia Magazine (formerly FaMily Magazine)
• Experienced journalist diagnosed with fibromyalgia in 2006

After leaving my TV news career due to fibromyalgia, I've been able to focus on my health and become functional once again. The journalist in me has driven me to share my own experience and the knowledge I've gained with other people facing the pain, fear and frustration.

— ADRIENNE DELLWO

Experience
Adrienne Dellwo is a writer and editor for Verywell Health covering fibromyalgia, ME/CFS, lupus, and thyroid disease. She has more than 25 years of experience researching and writing about health-related issues. She's also a published fiction author, filmmaker, playwright, actor, and musician.

Adrienne is a WEGO Health Awards Nominee and her work was named one of 50 Great Blogs for Fibromyalgia Support by Masters in Health Care.

Education
Adrienne earned her bachelor's degree in journalism and communications from the University of Oregon in 1996. She also earned an associate's degree from Cottey College in Missouri."

https://www.verywellhealth.com/adrienne-dellwo-715510

The article was medically reviewed by Grant Hughes.

"Highlights

• Associate professor at the University of Washington (UW) School of Medicine in Seattle, Washington
  
  
• Currently holds the Robert F. Willkens, MD - Lucile T. Henderson Endowed Professorship in Rheumatology at UW School of Medicine
  
  
• Head of Rheumatology at Harborview Medical Center in Seattle
  

I’m so excited to be part of Verywell and its mission of bringing reliable, practical, and up-to-date health information to the public. My work for Verywell and Dotdash Meredith is independent from my duties at the University of Washington.

— GRANT HUGHES, MD

Experience
Grant Hughes, MD, provides rheumatology care at Harborview Medical Center and UW Medical Center. His current academic interests include medical education and clinical immunology research. He has written on the topic of reproductive hormones and autoimmune rheumatic diseases in journals such as Nature Reviews Rheumatology, Autoimmunity Reviews, and The Journal of Immunology. Dr. Hughes’s research and teaching efforts have been supported by the National Institutes of Health, Leap for Lupus, the Society of Family Planning, the Arthritis Foundation, and the Lupus Foundation of America.

Education
Dr. Hughes earned his undergraduate degree in biology from Oregon State University (1990) and his medical degree from the Oregon Health and Science University (2001, magna cum laude), where he was inducted into the Alpha Omega Alpha Honor Medical Society. He completed internal medicine (2003) and rheumatology training (2006) at the UW. Dr. Hughes did his post-doctoral research training in the laboratory of Edward A. Clark, PhD, UW Departments of Immunology and Microbiology and Division of Rheumatology."

https://www.verywellhealth.com/grant-hughes-md-4685031

 

[Andy]

Also the reference that she is using to support "Central sensitization syndromes (CSS) are a collection of disorders where the central nervous system misfires and amplifies sensory input resulting in pain, fatigue, brain fog, and sleep problems. Fibromyalgia (FMS), chronic fatigue syndrome (ME/CFS), and other chronic pain conditions fall under the CSS umbrella." is this

Central Sensitization Syndrome and the Initial Evaluation of a Patient with Fibromyalgia: A Review, 2015, Kevin C. Fleming and Mary M. Volcheck

ABSTRACT

In both primary care and consultative practices, patients presenting with fibromyalgia (FM) often have other medically unexplained somatic symptoms and are ultimately diagnosed as having central sensitization (CS). Central sensitization encompasses many disorders where the central nervous system amplifies sensory input across many organ systems and results in myriad symptoms. A pragmatic approach to evaluate FM and related symptoms, including a focused review of medical records, interviewing techniques, and observations, is offered here, giving valuable tools for identifying and addressing the most relevant symptoms. At the time of the clinical evaluation, early consideration of CS may improve the efficiency of the visit, reduce excessive testing, and help in discerning between typical and atypical cases so as to avoid an inaccurate diagnosis. Discussion of pain and neurophysiology and sensitization often proves helpful.

https://www.rmmj.org.il/issues/20/Articles/476

The authors, at time of writing, were employed by the Mayo Clinic....

 

[shak8]

I love how she puts OCD in that category of CSS. Why not toss in some watermelons?

 

[Sly Saint]

An Adrienne Dellwo article again. She keeps writing these as if they were fact.

her latest offering
Medications & Stimulants for Chronic Fatigue
Some doctors prescribe stimulants commonly used to manage ADHD to treat CFS

https://www.verywellhealth.com/adhd-drugs-for-chronic-fatigue-syndrome-716030

 

[Trish]

her latest offering
Medications & Stimulants for Chronic Fatigue
Some doctors prescribe stimulants commonly used to manage ADHD to treat CFS

https://www.verywellhealth.com/adhd-drugs-for-chronic-fatigue-syndrome-716030

I have voted it down with this response:

The evidence for the drugs in ME/CFS is too limited to be sensible to recommend them. The key symptom that distinguishes ME/CFS from idiopathic chronic fatigue is Post Exertional Malaise. Some patient may be seriously harmed by taking stimulants that give them a temporary artificial increase in energy, leading to short term illusory improvement, increase in activity and consequent severe relapse. It is irresponsible to promote these unevidenced treatments for people with ME/CFS.

 

[alex3619]

If CFS and even ME are poor names, and I think they are, then CSS is the pits. Totally misleading, unproven and irrrelevant.

If the clinical and research definitions of ME are gold standard, arguably (ICC for example), then CSS is lead.

CSS is still hypothetical. At least we understand that while we find a great many things wrong in ME we still do not have a proven cause.

"especially antidepressants (which help correct neurotransmitter dysregulation)" ... I hope this is not about the serotonin deficiency hypothesis. SSRIs do not work by boosting serotonin (or at least not by itself), that is marketing not science. This was known to serotonin pharmacologists in the 80s. Perfect SSRIs with high specificity were developed, that raise serotonin in hours, and they did nothing for depression. SSRIs are only more specific than the previous drugs, which if I recall correctly were second generation tricyclics. To a biochemist these drugs have low specificity, so they may be binding with all sorts of things. I have not kept up with this research lately, so if anyone has more up to date information please comment.

 

[alex3619]

"exercise, and cognitive-behavioral therapy (CBT)" She does realize that the FINE trial for CFS failed, the second largest trial, and that every trial using objective evidence has failed (for both CFS and ME cohorts), and that at least five government reviews of these in practice show they fail in the real world. As for the biggest trial, PACE, is she happy that it uses a critical calculation of SD for SF36PF which is mathematically invalid, this was known to the principal investigator, and yet he went with it anyway? Not to mention various independent reviews including NICE. The first two Cochrane reviews, and possibly the unpublished third (we don't have evidence on that), were not independent. Cochrane has an independent team writing the new third (fourth?) review. The IOM report did not support these views either.

The original PACE paper still needs to be retracted, which will invalidate every consequent paper. The Lancet is still not acting.