Managing Chronic Pain: Central Sensitisation

What is a consequence of using narcotic analgesics for chronic pelvic pain?

Why should narcotic analgesics be avoided in chronic pelvic pain management?

What is a strategy for managing pain while minimising the use of narcotic analgesics?

What type of pain is narcotic analgesics often relatively ineffective in treating?

What is a consequence of reducing the dose of narcotics after prolonged use?

What is a characteristic of central sensitisation?

What is an example of hyperalgesia?

What is a potential side effect of exercising too much with central sensitisation?

What is the purpose of explaining the physical changes in nerve pathways to patients?

What is a recommended starting dose of amitriptyline?

Why should Pilates-style core-strength exercises be avoided?

What is a recommended type of exercise for pain management?

Why is regular exercise considered essential for pain management?

Central Sensitisation

Central sensitisation is a chronic pain condition that affects chronic back pain, postinjury pain, and pelvic pain.
It is essential to manage this condition, especially when pain is present on most days.

Characteristics of Central Sensitisation

Normal sensations felt as pain (allodynia)
Painful sensations becoming more painful (hyperalgesia)
Pain felt over a larger area when severe (wind-up pain)
Poor sleep, fatigue, anxiety, and low mood
Nausea, dizziness, or sweating

Treatment of Central Sensitisation

Explanation of the physical change and sensitization of nerve pathways
Use of neuropathic medications, such as:
- Low-dose amitriptyline (5-25 mg daily)
- Pregabalin (25-300 mg daily)
- Duloxetine (30-60 mg daily)
Regular exercise, which is considered essential for pain management
Activities with strong personal motivating factors, such as playing with children, sport, or craft

Exercise Considerations

Start with a 10-minute walk daily and increase slowly
Avoid too much exercise suddenly, which can result in more pain the next day
Avoid Pilates-style core-strength exercises until pain improves
Prefer exercises like walking, dancing, or gentle team sports

Avoiding Dependence

Avoid narcotic analgesics due to high risk of dependence and potential to worsen chronic pain
Narcotics are often relatively ineffective in neuropathic and pelvic muscle spasm pain
Reducing the dose of narcotics later is difficult

Learn about central sensitisation, a chronic pain condition where normal sensations are felt as pain. Understand how to manage chronic back pain, postinjury pain, and pelvic pain. Discover the symptoms of allodynia, hyperalgesia, and wind-up pain.