Touch
Clothing, a blanket, a hand on the skin or massage may become unpleasant or painful.
Understand your symptoms
Central sensitisation
When the pain system becomes more responsive and the same input suddenly feels much stronger.
The pain is real. The amount of pain does not always correspond one-to-one with the amount of tissue damage present at that moment.
In plain language
What is central sensitisation?
The nervous system continually processes signals from the body. In central sensitisation, pain-processing neurons in the central nervous system respond more strongly to normal or even weak input. In everyday language: the alarm system may become more sensitive.
The same input can produce a different response
A light or ordinary stimulus may be experienced as much more intense. This “volume control” is only a metaphor: pain is not a simple measurable volume and central sensitisation cannot be read from one scan or one test.
Normal processing: illustrative 3/10More sensitive system: illustrative 8/10
An important distinction
Central sensitisation is a neurophysiological mechanism, not a simple diagnosis that can be proven with one blood test, MRI scan or questionnaire.
IASP stresses that sensitisation in people can only be inferred indirectly from phenomena such as hyperalgesia and allodynia.
Allodynia: normally non-painful input hurtsHyperalgesia: painful input feels more painfulPain may linger longer
Recognition
What can it feel like?
Experiences differ. With a more sensitive pain system, input may feel stronger than before, sometimes beyond the place where pain first began.
Heat and cold
Temperature differences may feel much more intense than they used to.
Other input
Some people also report increased sensitivity to light, sound or smells.
Fatigue
Disturbed sleep, fatigue and concentration problems often occur alongside features of nociplastic pain.
“I hardly did anything unusual, yet my body reacts as though I did something enormous.”
An illustration of recognition, not a verbatim patient quotation.
An illustration of recognition, not a verbatim patient quotation.
Numbers without false certaintyChronic pain The Netherlands Low-back pain research CSI questionnaire
How common is it?
We know a fair amount about chronic pain, but there is no reliable general prevalence figure for central sensitisation itself. A major reason is that there is no gold-standard test that gives a simple yes-or-no answer in a person.
>20%
of the European population lives with chronic pain according to the Dutch guideline.
This concerns chronic pain overall, not central sensitisation.12%
of people aged 12 and over reported in 2021 that pain interfered with normal activities.
Dutch guideline, based on Statistics Netherlands data.13–71%
was the range across individual studies of “presumed central sensitisation”, depending on method and study population.
This is not a prevalence estimate for the general population.43.2%
of 2,347 participants with chronic low-back pain scored above a commonly used CSI cut-off in a systematic review.
A CSI score is a screening measure, not a direct physiological measurement.Why do the figures vary so widely?
A questionnaire, pressure-pain threshold and response to repeated stimuli measure different things. The wide range is itself a warning against a spectacular claim that “x% have central sensitisation”.
Not all pain is the same
Three ways to describe pain
Central sensitisation is often mentioned alongside nociplastic pain, but the terms are not exact synonyms. These mechanisms can also coexist.
Nociceptive pain
Pain from actual or threatened damage to non-neural tissue, with activation of nociceptors.
For example, a wound or inflamed joint.
Neuropathic pain
Pain caused by a lesion or disease of the somatosensory nervous system.
For example, certain forms of nerve damage.
Nociplastic pain
Pain arising from altered nociception without clear evidence that tissue damage or a nerve lesion fully explains it.
Central and/or peripheral sensitisation may play a role.
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It can be mixed
A person may have demonstrable physical damage and altered pain processing at the same time. “Something is visible on the scan” and “the nervous system has become more sensitive” do not automatically exclude one another.
Mechanism
How can central sensitisation develop?
There is no single cause and no simple rule that long-lasting pain automatically leads to central sensitisation. Research points to several processes that may influence pain processing and modulation.
Several factors may interact
Persistent or repeated nociceptive inputChanged inhibition and facilitationSleep, recovery and capacityBiological, psychological and social context
A simplified model. These factors do not prove that any one factor caused the mechanism in an individual.
The system may respond more sensitively.
Responses to normal or weak input may increase.
Responses to normal or weak input may increase.
Pain inhibition and facilitation may change.
The nervous system has systems that dampen and amplify signals.
The nervous system has systems that dampen and amplify signals.
Pain may become less tightly linked to current damage.
An original injury need not fully explain why pain persists.
An original injury need not fully explain why pain persists.
Context matters without making pain “psychological”.
The Dutch guideline describes chronic pain as a dynamic interaction of biological, psychological and social factors.
The Dutch guideline describes chronic pain as a dynamic interaction of biological, psychological and social factors.
No simple test
How is it recognised?
There is no gold standard that directly establishes central sensitisation in a person. Clinicians therefore consider the overall pain pattern and indirect indications.
Pain pattern
Has the pain become regional, multifocal or widespread? Is its intensity fully explained by one known cause?
Hypersensitivity
Responses to touch, pressure, temperature or repeated stimuli can provide indirect clues.
Questionnaires
The Central Sensitization Inventory (CSI) can map symptoms, but does not directly measure whether central nervous system neurons are sensitised.
A high CSI score is not a blood result
A questionnaire may help identify a broad symptom pattern. It is too strong to conclude from one score that central sensitisation has been physiologically “proven”.
Treatment and living with symptoms
What may help?
No treatment “resets a sensitive nervous system” for everyone. The approach depends on the pain type, other conditions, capacity and what someone needs in order to function better.
Keep assessing treatable causes
New or clearly changed symptoms deserve ordinary medical assessment. The label “sensitisation” should not stop further clinical thinking.
Appropriate movement
Guidelines recommend physical activity and, where appropriate, supervised exercise for chronic primary pain—adapted to goals and capacity, not simply “pushing through”.
Sleep and recovery
Sleep disturbance and fatigue may form part of the broader picture and belong in assessment and treatment planning.
ACT or pain-focused CBT
NICE lists Acceptance and Commitment Therapy and cognitive behavioural therapy for pain as possible options for chronic primary pain.
Medication is individual
No medicine “cures central sensitisation”. Choice depends on the particular pain condition, other illnesses, benefits and adverse effects.
More than one discipline
In complex chronic pain, physical, psychological and social factors may all be relevant. Collaboration between professionals can then be useful.
The Netherlands: access to pain rehabilitation is changing
Since April 2026, reimbursement conditions for interdisciplinary specialist medical rehabilitation (IMSR) for chronic pain have changed. IMSR is no longer automatically covered for people who have not completed a full primary-care programme. Temporary coverage remains possible for a group whose primary-care treatment was insufficient while further research is conducted.
This is information about the Dutch healthcare system, not individual treatment advice.
Practical
What can genuinely help in daily life?
With persistent pain, the first goal is not always reaching “zero pain”. More control, better functioning, fewer setbacks and room for meaningful activities may be valuable outcomes. What helps differs between people.
Move, but do not blindly push through pain
- Start at a manageable level. Choose an amount you can repeat instead of catching up on one good day.
- Build gradually. Consider function and capacity, not only one pain score.
- Choose something that fits. Walking, cycling, swimming or strength work may all be relevant.
- Discuss fear of movement. Support can help distinguish danger from a familiar pain response.
Not “all in your head”, but mental health still matters
- ACT may help keep pain from determining every life choice.
- Pain-focused CBT may help identify and change unhelpful cycles around pain, fear and activity.
- Set meaningful goals, such as shopping independently, walking the dog or returning to a hobby.
- Seek help for depression, anxiety or trauma. They deserve treatment in their own right.
Prepare a simple “bad-day plan” before a bad day
Check whether this is your familiar pattern or something genuinely new.
Scale back temporarily, rather than automatically stopping everything.
Choose one or two manageable things you still want to do.
Use what has helped before.
Discuss repeated setbacks with an appropriate professional.
A general self-management structure, not a personal medical treatment plan.
Mindfulness and relaxation?
They may be helpful for some people, but evidence is not strong enough to call them the treatment for central sensitisation. Use them as optional tools, not as a compulsory nervous-system “reset”.
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A broader goal than “I want no pain”
A plan can also aim at better sleep, more movement, less fear of activity, greater independence, work or participation in family life. Pain reduction is welcome, but not the only measure of success.
For a conversation with your clinician
Questions that may help you regain more control
- Do you think my pain is mainly nociceptive, neuropathic, nociplastic or mixed?
- Which findings make you consider central sensitisation?
- Are there treatable causes that need separate attention?
- What is a realistic goal in my situation?
- Which movement can I build up safely?
- Would a physiotherapist, pain psychologist or rehabilitation physician be useful?
- What should I do during a flare-up?
- Which change should prompt renewed medical assessment?
A typical care-trap question
When an explanation helps—and when it becomes a new label
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An explanation can bring relief
It can provide words for a real experience: the pain is genuine, while more may be happening than only at the place that hurts.
But it must not become the end point
“It is central sensitisation” must not mean that every new symptom is automatically attributed to the same mechanism. A person with a sensitive pain system can still develop a new, treatable condition.
Experiences wanted
Do you recognise this?
We want to understand how central sensitisation is explained in practice and what happens afterwards—not to collect diagnoses, but to make patterns in care pathways visible.
Share your experience with ZorgfuikThis uses the existing general experience form.
Sources
Reliable information and help
- IASP pain terminology — international definitions of central sensitisation, allodynia, hyperalgesia and nociplastic pain.
- Systematic review of central sensitisation — definitions, indirect measures and varying estimates in chronic low-back pain.
- NICE guideline on chronic primary pain — recommendations on exercise, ACT, pain-focused CBT and medicines.
- Dutch guideline on chronic pain rehabilitation — self-management, functioning, participation and quality of life.
- Dutch Healthcare Institute: IMSR since April 2026 — current Dutch reimbursement information.