Friday, January 18, 2013

Central Sensitivity Syndrome: Umbrella Term for Fibromyalgia, Chronic Fatigue Syndrome

Central Sensitivity Syndrome: Umbrella Term for Fibromyalgia, Chronic Fatigue Syndrome By Adrienne Dellwo, January 16, 2013

Have you heard the term central sensitivity syndrome (CSS)? It's a good one to know - researchers are using it more and more as an umbrella term for fibromyalgia, chronic fatigue syndrome and several other related illnesses. These conditions have been called a lot of things, ranging from "not real" to "functional somatic syndromes" to "neuroendocrineimmune disease." However, as researchers learn more about them, some are coming to the conclusion that CSS fits best because it's based on their common underlying physiology - central sensitization. That's what makes us hyper-sensitive to pain, sensory input, and, well, the world. See what CSS means and which illnesses it covers:

• Central Sensitivity Syndromes
Why does an umbrella term matter? A couple of reasons. First, it can separate us from what we aren't, such as psychological or some vague category like "poorly understood conditions." Second, it could allow for research on multiple conditions at once. A well-defined classification would mean researchers could delve further into the underlying problems and, possibly, find treatments that go right to the heart of them. For those of us who have 4 or 5, wouldn't one really great treatment for all of them be amazing? Continue Reading: Read What Central Sensitivity Syndromes Are Central Sensitivity Syndromes A 'Family' of Related Illnesses By Adrienne Dellwo, Guide Updated January 18, 2013 Health's Disease and Condition content is reviewed by the Medical Review Board See More About: • overlapping conditions • understanding fibromyalgia • understanding chronic fatigue syndrome Fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) are difficult illnesses to classify. Both have a broad range of physical symptoms that span multiple systems, and they're associated with multiple psychological symptoms as well. In addition, they're often accompanied by a slew of other illnesses — many of which are also hard to classify. As scientists are getting more of a handle on FMS, ME/CFS and other related illness, an umbrella term that's more frequently used to describe them is central sensitivity syndromes, or CSS. Some researchers argue that this term should replace other terms, such as functional somatic syndrome, medically unexplained syndrome, and somatoform disorders, because they believe CSS is more accurate.

What is a Central Sensitivity Syndrome? An illness described as a CSS involves central sensitization. "Central" refers to the central nervous system, which is made up of the brain and spinal cord. "Sensitization" describes the end result of a process that leaves someone sensitive to a particular kind of input. Allergies are the type of sensitivity people are generally the most familiar with, as they involve an inappropriate physical response to something that other people can tolerate just fine. While the sensitivities of a CSS don't cause the same physical reaction as an allergy, they do trigger an inappropriate physical response. In a CSS, we become sensitive to the things that are processed by the central nervous system, which can include bright lights, loud noises, strong smells, rough textures, and pressure on the body. It may also involve certain foods or chemicals. Especially in FMS, the body is sensitized to anything unpleasant, called "noxious stimuli" by researchers. Aside from FMS and ME/CFS, the following conditions have been proposed to be part of the CSS family:

*Chronic pelvic pain, including vulvodynia
• Certain Forms of Chronic Headache
• Idiopathic low back pain
• Interstitial cystitis (painful bladder)
• Irritable bowel syndrome
• Migraine
• Multiple chemical sensitivity
• Myofascial pain syndrome
• Primary dismenhorrhea (painful period)
• Restless legs syndrome
• Temporomandibular joint disorder

Psychiatric disorders are common in CSS as well. Research suggests that's because they all involve dysregulation of the same neurotransmitters, with the dysregulation in CSS in different regions of the brain than in psychiatric disorders. Psychiatric conditions that commonly overlap with CSS include: •

Major depression
• Obsessive-compulsive disorder
• Bipolar disorder •
 Post-traumatic stress disorder
• Generaized anxiety disorder
• Panic attack

Features of CSS Neurotransmitters that are involved in at least some CSS include:

• Serotonin
• Norepinephrine
• Dopamine
• GABA & glutamate

The pain of CSS comes from a couple of different abnormal pain types: hyperalgesia and allodynia. Hyperalgesia takes normal pain from things that everyone considers painful (a broken limb, an infected tooth, etc.) and makes it worse. It's often referred to as "turning up the volume" of pain. This makes things like injuries, surgeries, and chronic sources of pain especially debilitating. Allodynia makes you feel pain from things that shouldn't hurt, such as the brush of fabric against your skin, or your arm resting against your side when you sleep. Allodynia can make your clothes painful even when they're not too tight, or make you unable to enjoy a hug. It turns all manner of ordinary experiences into painful ones, which can cause people to make significant changes to their lives to minimize it.

Other proposed mechanisms of CSS include:

• Inflammation in or originating in the nervous system
• Autonomic nervous system dysfunction
• Dysfunction of the HPA axis, which is part of the body's stress-response system

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). 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 involves graded exercise.

Learn More About CSS The resources below can help you learn more about individual CSS. Because of the similar symptoms they can have, it's important that each one is diagnosed by a doctor.

• Chronic pelvic pain, including vulvodynia
• Headache and migraine
• Idiopathic low back pain
• Interstitial cystitis (painful bladder)
• Irritable bowel syndrome
• Multiple chemical sensitivity
• Myofascial pain syndrome
• Primary dysmenorrhea (painful period)
• Restless legs syndrome
• Temporomandibular joint disorder (TMJ)

Sources: Chong YY, Ng BY. Annals of the academy of medicine, Singapore. 2009 Nov;38(11):967-73. Clincal aspects and management of fibromyalgia syndrome. Mayer TG, et al. Pain practice. 2012 Apr;12(4):276-85. The development and psychometric validation of the central sensitization inventory. Smith HS, Barkin RL. American journal of therapeutics. 2010 Jul-Aug;17(4):418-39. Fibromyalgia syndrome: a discussion of the syndrome and pharmacotherapy. Smith HS, Harris R, Clauw D. Pain physician. 2011 Mar-Apr;14(2):E217-45. Fibromyalgia: an afferent processing disorder leading to a complex pain generalized syndrome. Yunus MB. Seminars in arthritis and rheumatism. 2008 Jun;37(6):339-52. Central sensitivity syndrome: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Yunus MB. Seminars in arthritis and rheumatism. 2007 Jun;36(6):339-56. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes.

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