Allodynia is a neurological condition where non-painful stimuli—like a breeze, the pressure of clothing, or even light touch—cause pain. It’s often associated with central sensitization, where the brain and spinal cord become overly responsive to nerve signals. But sometimes, the trigger is more than just misfiring nerves. Sometimes, it’s caused by an infection, such as Lyme disease and with the proper treatment symptoms can resolve.

Allodynia frequently overlaps with other forms of neuropathic pain, including:

Allodynia frequently overlaps with other forms of neuropathic pain, including:

• Burning or freezing sensations

• Pins and needles

• Electric shock-like pain

These symptoms often point toward small fiber neuropathy, a disorder of the small nerve fibers that transmit sensory and autonomic signals.

When Allodynia Comes with Autonomic Dysfunction

The patient I’m referring to also suffered from POTS, a form of dysautonomia. He experienced dizziness, rapid heart rate upon standing, and extreme fatigue—signs that the autonomic nervous system was under stress.

He had seen several specialists, undergone extensive testing, and tried a wide array of therapies. Despite this, his symptoms continued to worsen.

The Missed Diagnosis: A History of Exposure

During our initial consultation, what stood out to me was his background. He had spent significant time outdoors and had a vague memory of a summer illness—one that was brushed off at the time as a virus.

Despite the absence of a classic bull’s-eye rash or a positive two-tier test, his symptom profile raised strong clinical suspicion for Lyme disease with neurological involvement. Given the high prevalence of Lyme disease in his region and his complex presentation, we began treatment based on a clinical diagnosis.

What Happened Next: Improvement with Antibiotic Therapy

After starting Lyme disease treatment with antibiotics, his symptoms began to resolve.

• The burning pain in his limbs began to fade.

• His allodynia improved for the first time in over a year.

• The shock-like nerve pain diminished.

• His POTS symptoms stabilized.

This improvement was not only physical—it restored his hope and quality of life.

The Science Behind It: Lyme and Small Fiber Neuropathy

Lyme disease caused by Borrelia burgdorferi can invade the nervous system, leading to neuroborreliosis—a well-documented but often underrecognized manifestation. In some cases, the infection affects small unmyelinated fibers, which are responsible for temperature sensation, pain perception, and autonomic functions like heart rate and digestion.

There’s increasing recognition of Lyme-associated:

• Small fiber neuropathy

• Autonomic dysfunction (POTS, orthostatic hypotension)

• Central sensitization syndromes (including allodynia)

These are often misdiagnosed as fibromyalgia, anxiety, or unexplained chronic pain syndromes, particularly when the Lyme diagnosis is missed or dismissed early on.

Why This Matters for Patients and Clinicians

This case illustrates a critical point: chronic nerve pain syndromes deserve a broad differential diagnosis—and Lyme disease should be on that list, particularly in endemic areas or in patients with unexplained multi-system symptoms.

When standard treatments don’t work, and symptoms like allodynia, burning pain, or dysautonomia persist, Lyme disease must be considered, even if standard lab tests are inconclusive.

Hope Through Accurate Diagnosis and Treatment

My patient’s recovery from allodynia wasn’t instantaneous, but the trajectory changed after Lyme treatment began. This reinforces what I’ve seen in many patients over the years: once the underlying infection is addressed, the nervous system can begin to heal.

While not every case of allodynia or small fiber neuropathy is caused by Lyme disease, the possibility should not be overlooked—especially when patients are suffering without answers.

Conclusion

Lyme disease is a master of disguise. It can present subtly or severely, and it often affects systems far beyond the joints. When the nervous system is involved, the symptoms can mimic autoimmune, neurological, and psychiatric conditions.

As clinicians and advocates, we must stay alert to these patterns and keep Lyme disease on the radar. And for patients experiencing pain that no one can explain—there is hope.

Because sometimes, the road to relief starts with looking in the right direction.