"Pump Up the Volume"
Central Sensitization and a Nervous System on Fire
Imagine your body is an instrument… a vintage Strat plugged into an amp, for example. Now imagine that amp is cranked to 11, the gain is maxed out, and even the faintest hum from the next room sends screeching feedback through your entire system.
That’s central sensitization.
It’s when your brain and nervous system amplify every signal (pain, light, sound, emotion) until life itself feels like noise. Not because you’re weak or broken, but because your system adapted to survive in a world that didn’t feel safe.
Central sensitization isn’t a character flaw, though. It’s a neurobiological phenomenon. And if you've ever been labeled a “difficult patient,” handed a vague diagnosis like “IBS” or “fibromyalgia,” or referred to psych for “stress-related symptoms” when your left arm has been numb for three weeks… this may just be the missing link.
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Central Sensitization: Your Nervous System’s Drama Mode
Picture your nervous system as a car alarm that’s supposed to go off when someone smashes a window. In a sensitized system, that alarm starts blaring if a squirrel sneezes three blocks away.
Bringing the guitar amp a metaphor back into the equation: central sensitization is like your internal volume knob getting stuck at max. Even small, harmless signals, like gentle touch, light, or a slightly anxious thought, are blasted through your internal speakers with distortion, reverb, and way too much treble.
Central sensitization happens when the brain and spinal cord become hypersensitive to input. Over time, normal experiences are perceived as threatening or painful. It’s like your nervous system keeps shouting, “Did you feel that? That was BAD! Sound the alarm!”
This hypersensitivity isn’t just about pain. It’s why some people:
Get dizzy or panicky in fluorescent lights.
Cry at commercials and don’t know why.
Feel like their GI tracts are plotting against them.
Feel soul-sucking fatigue for days after a stressful interaction or family gathering.
Have 57 symptoms that don't fit neatly into one specialty.
In short, their bodies are stuck in a looping security alert, and every sensation becomes an emergency—-with the amp turned up, no noise gate, and zero rest between songs.
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The Science-y Stuff: A Neurobiological Cascade
Source: Cleveland Clinic
Central sensitization arises from both peripheral and central nervous system changes that amplify the perception of pain and sensory input.
When tissue damage, inflammation, or emotional trauma occurs, peripheral nociceptors (pain-sensing nerves) send repeated signals to the spinal cord dorsal horn. Over time, this persistent input can lead to:
1. Increased excitability of dorsal horn neurons, which become more responsive to both painful and non-painful stimuli (a process known as "wind-up"). Basically, a snowball effect leading to a more significant pain response over time.
2. Reduced inhibition. The body’s natural dampening mechanisms, including GABAergic and glycinergic interneurons, become less effective. An example of a functioning inhibition system would be as follows: You stub your toe. The pain sends a signal to your brain that there was an injury. Your awareness focuses on the toe and how to protect it. Your nervous system releases inhibitory chemicals to bring the pain level down. Pain is the message and, once your body is aware of what is going on, there is no longer a need for such intensity of messaging.
3. Activation of glial cells in the spinal cord, which release pro-inflammatory cytokines and perpetuate the sensitized state.
4. These signals travel up the ascending pathways towards the brain (particularly the thalamus, amygdala, insula, and somatosensory cortex), where pain is interpreted and emotional reactivity can further amplify the experience.
5. Dysfunction in descending modulatory pathways, especially from the periaqueductal gray (PAG) and rostroventromedial medulla (RVM), reduces the brain’s ability to dampen pain signals.
This leads to hyperalgesia (increased response to painful stimuli) and allodynia (pain from stimuli that are not usually painful), as well as increased sensitivity to sound, light, touch, and even internal sensations.
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The Body Keeps the Score — and It’s a Spiteful Accountant
In Bessel van der Kolk’s classic, The Body Keeps the Score, he explains how trauma changes the way we process reality:
“Trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on the mind, brain and body.”
That imprint? It’s central sensitization in a trench coat.
After trauma, whether it’s Big-T trauma (abuse, war, loss) or chronic micro traumas (neglect, societal stress, medical gaslighting), your nervous system rewires itself for survival. That means it stops asking “Is this dangerous?” and starts assuming everything is dangerous.
The result? An exhausted, inflamed, dysregulated system that never gets the memo that the threat is over. Have you ever made a rational decision based on fear? Well, turns out your body is just as guilty!
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The “Difficult Patient” Nobody Knows How to Help
If you’ve ever bounced between specialists like a human game of medical pinball, you know the drill:
Rheumatology says it’s not autoimmune.
GI says your colonoscopy was “normal.”
Neurology orders another MRI “just to be safe.”
Psychiatry raises an eyebrow.
Primary care quietly panics and offers another referral.
And when no clear cause is found (spoiler alert!…there won’t be), you get branded:
“Somatic.”
“High-utilizer.”
“Anxious.”
“Non-compliant.”
“Maybe just depressed?”
It’s not that these providers are malicious. It’s that central sensitization lives in the in-between; the no-man’s-land of medicine where body and mind refuse to stay in their lanes. It defies siloed specialties and doesn’t show up on labs or radiographic images.
Over time, patients start to internalize the medical shrug. They feel like:
A medical mystery
A financial drain
A complainer
A hypochondriac
A failure
And, unfortunately, that emotional distress further activates the nervous system, deepening the sensitization loop. It’s a perfect storm of fear, shame, confusion, and inflammation.
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Yes, it's real.
This isn’t “in your head.” It’s in your brain and body, which are inseparably linked, despite Western medicine's historical attempt to put them in their own buckets.
Functional MRI (fMRI) scans show heightened activity in pain-processing areas of the brain in people with fibromyalgia and PTSD, even without injury.
Central sensitization is now recognized as a core mechanism in disorders like fibromyalgia, IBS, chronic fatigue syndrome, chronic Lyme Disease, and more.
A high Adverse Childhood Experience (ACE) score predicts adult chronic illness, depression, and even early death.
This isn’t new-age fluff. This is neuroscience finally catching up to what patients have known all along: your body remembers what your mind can’t always explain. When we just “push it down” and “move on"“ without addressing each trauma, the body will ultimately accumulate them in physically form.
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So, Can You Fix It?
You don’t “fix” central sensitization with willpower, hustle, or cognitive tricks. You heal it by helping your nervous system feel safe again.
That means regulating from the bottom-up through sensation, movement, and relationship—not just through insight.
What seems to help:
Somatic therapies like EMDR, somatic experiencing, Internal Family Systems, or polyvagal-informed therapy
Movement that is gentle, non-punitive, and joyful (think: yoga, walking, dancing, strength training with kindness). In a world full of “Rise and Grind” and 1-rep maxes, this is sadly not the norm when it comes to exercise.
Breathwork and vagus nerve stimulation.
Co-regulation through safe, warm relationships (community is medicine).
Body-based mindfulness (not just “clear your mind” meditation).
Boundaries and pacing, especially with people, screens, and demands that drain your system.
And yes, medication can sometimes help turn the volume down enough so you can do the deeper healing work. Neuromodulators, such a tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and anticonvulsants (ie: gabapentin, Lyrica, etc.) can help modulate pain pathways in various ways, helping patients “turn down the dial.”
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The Takeaway:
If you feel like a human stress ball, with a symptom list that scares doctors, and a nervous system that reacts to everything… you are not broken.
You are sensitized.
And once you name it and start to understand it, you can begin to unwind it. Slowly. Gently. From the inside out. For the real question is not “What's wrong with me?” Rather, “What happened to me?”
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A Simple Nervous System Regulation Checklist
Gentle movement (walk, stretch, yoga, or slow strength).
5+ minutes of deep, diaphragmatic breathing.
One moment of safe connection (text a friend, hug a pet, smile at a barista).
Limit screens and overstimulation (especially before bed).
Eat something nourishing and grounding. If it gives you diarrhea, that may not be it.
Pause to notice a pleasant sensation in your body.
Verbalize one kind thought toward yourself.
Spend time in nature, or at a window if you can’t.
Say NO to one thing that drains you.
Rest. Actual rest. Not scrolling. Not numbing. Just being.
Print this. Stick it to your fridge. Tattoo it on your soul.
Your nervous system will thank you.
Sources
Woolf, C.J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3), S2–S15.
Loggia, M.L., et al. (2015). Disrupted brain circuitry for pain-related reward/punishment in fibromyalgia. Arthritis & Rheumatology, 67(8), 2168–2177.
Fitzcharles, M.A., et al. (2018). The dilemma of diagnosing fibromyalgia: What do we need to know? Nature Reviews Rheumatology, 14, 645–656.
Felitti, V.J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258.