Central sensitization: a matter of concern

Michiel Tack said:
And while pain thresholds rise after exercise in healthy people, they seem to drop in ME/CFS-patients (i.e. patients experience more pain after exercise while they should be feeling less) [20-22]. These findings suggest that there is something wrong with pain modulation in ME/CFS.
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It could also mean that there is nothing wrong in pain modulation, but - since too much activity can lead to worsening in ME - that the body correctly tries to protect via pain, as is very common.

“due to central sensitization being present, it is no longer possible to rely on symptoms such as pain or fatigue. These are not an accurate representation of what is happening in the bodies of persons with fibromyalgia/CFS.” [43]
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My personal, hurtful experience was this is simply WRONG. Plus the fact they have no proof of such claims (as always).
 
Inara said:
It could also mean that there is nothing wrong in pain modulation, but - since too much activity can lead to worsening in ME - that the body correctly tries to protect via pain, as is very common.
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Good point. But if pain is chronic and/or widespread (as it seems to be in some ME/CFS patients), changes are rather small that this represent an adaptive response of the body.

Yet even if that's the case, this doesn't mean that ignoring pain is the best way to go. Especially since research in ME/CFS points at just the opposite direction.
 
Michiel Tack said:
Good point. But if pain is chronic and/or widespread (as it seems to be in some ME/CFS patients), changes are rather small that this represent an adaptive response of the body.

Yet even if that's the case, this doesn't mean that ignoring pain is the best way to go. Especially since research in ME/CFS points at just the opposite direction.
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The following is not scientific: It is just my impression that the body always tries to get to an optimal state and tries to keep it as long as possible, given the ressources and circumstances. Assuming this is true (which remains to be shown to my knowledge), it follows pain cannot be misregulated. I don't know of any proof that pain can be misregulated (I remember more proofs that pain is not misregulated).

What could be an argument for my claim:
I hope I remember correctly that particles in physics always take the optimal path (often the shortest, usage of minimal energy). In chemical reactions, particles seek the optimal state. Why should this be different in the body? If quantum mechanics is correct - and in Chemistry, for instance, quantum mechanics is everything - its principles also hold in the body.

So why should the body accept misregulation? This would be a non-minimal energy state. I think the body would identify any misregulation and would bring it into regulation as best as the circumstances allow. So one can assume that if there is widespread pain this is the "optimal state" the body can create and hold, and that there's a good reason for this.
 
One could argue that the body is a little defective in many ways by design. It's designed to try different genetic configurations, and sometimes that works out to an advantage and other times it doesn't. Even what seems like a defect can be good in certain circumstances. Where malaria is present, mutations that change the molecular structure of hemoglobin confer an advantage, while in other areas they are more a disadvantage.

What advantage the mutations that increase the risk of ME/CFS confer remains to be seen. If there are any.
 
Sly Saint said:
Just found this:
"The brains of people with CFS feel any painful stimuli more easily, a condition known as central sensitization."

it's in an excerpt from A book Understanding Chronic fatigue syndrome - from Harvard Medical school.
They seem to be using the IOM report a lot. Is this statement in there too?/generally accepted?

https://www.health.harvard.edu/diseases-and-conditions/understanding-chronic-fatigue-syndrome
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I believe that most people with ME/CFS do feel pain more easily, but a minority (including me) don't.
 
Esther12 said:
Don't most people respond to painful stimuli more when they're exhausted? I thought that it used to before falling ill, eg: stubbing my toe when run-down would seem to hurt more than at other times.
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Sounds like a perfectly normal response to illness. It's just another safety mechanism to ensure the sick person has the best chances of recovery.
 
Sly Saint said:
"The brains of people with CFS feel any painful stimuli more easily, a condition known as central sensitization."
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I think this is a load of rubbish. Some days I feel more discomfort from others, usually after over-extending what I do. I'm sure if I stood on a drawing pin it would hurt just as much now as it did when I was healthy. So what "painful stimuli" are they talking about? It's the usual excuse to ignore reported pain.
 
Sly Saint said:
Just found this:
"The brains of people with CFS feel any painful stimuli more easily, a condition known as central sensitization."
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This is not true in my case.

Since being diagnosed with ME, I have had to have a lot of dental work done. Like most of us I can't handle locals containing adrenaline, so my dentist uses an alternative local anaesthetic without adrenaline.

My dentist is always very concerned about keeping procedures painfree. He constantly checks I'm okay. When I told him I'm fine, I'm not that delicate he explained - the alternative local is a bit less effective than the usual one and the vials/cartridges are smaller, which means the injection contains less anaesthetic too.

Some of the work I have had done is at the very limit of what they will do under local anaesthetic. I have never really had an issue with pain and my dentist certainly doesn't seem to consider me to be particularly sensitive to pain.

However, whether I might be more sensitive to pain while in PEM might be a different matter.

Edit -spelling
 
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Esther12 said:
Don't most people respond to painful stimuli more when they're exhausted? I thought that it used to before falling ill, eg: stubbing my toe when run-down would seem to hurt more than at other times.
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A really excellent and overlooked point IMO. The consistent lack of restful sleep over months years or decades would make an experts determination of a lot of things rather subject to assessing things without important facts included. I don't think I said that quite clearly enough.
 
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