Central Sensitization Syndrome Worsens Lyme Disease Symptoms?

Central sensitization syndrome (CSS) involves changes in the central nervous system, particularly the brain and spinal cord. This syndrome “is thought to involve hyperactivation of central neurons, leading to various synaptic and neurotransmitter/neuromodulator changes,” writes Batheja.

Central sensitization syndrome can lead to widespread pain, fatigue, and sensory hypersensitivity due to increased sensitivity of the nervous system.

There are several potential causes of central sensitization, which include:

Genetic factors
Increase in neurotransmitters that facilitate pain
Decrease in neurotransmitters that inhibit pain pathways

“The appropriate balance of these neurotransmitters is essential because they serve as a ‘volume control’ for pain and sensory processing.”

Changes in the brain from repetitive nociceptive signals and infections

“Notably, in relation to Lyme disease, infections in general are known to activate central sensitization in some patients, possibly through the release of inflammatory cytokines,” Batheja points out.

In fact, patients with persistent Lyme disease symptoms “have many of the same symptoms experienced by other patients thought to have central sensitivity syndrome.”

And since post-treatment Lyme disease syndrome (PTLS) patients typically experience pain to non-noxious stimuli, such as light and sound, they would meet the criteria for central sensitization syndrome, explains Yunus. [2]

Symptoms of Central Sensitization Syndrome

Central sensitization syndrome is characterized by heightened sensitivity of the nervous system. Common symptoms include:

Widespread pain
Fatigue
Sensitivity to light or sound
Cognitive problems such as memory or concentration difficulties
Sleep disturbances
Hypersensitivity to touch or pressure

Many Lyme disease patients with persistent symptoms report a similar pattern of pain, fatigue, and sensory hypersensitivity.

The Primary Symptoms of Central Sensitization

Pain

There are three types of pain:

Peripheral (nociceptive) pain caused by inflammation or tissue damage in the periphery.
Neuropathic pain resulting from dysfunction or injury of peripheral nerves.
Central (non-nociceptive) pain characterized by altered central nervous system sensory processing of pain, as seen in conditions like fibromyalgia.

According to Batheja, central pain due to “central sensitization or the augmentation of CNS pain-processing may account for the persistent experience of widespread pain.”

Central pain leads to diffuse hyperalgesia and allodynia.

“Allodynia (pain due to a stimulus that does not usually provoke pain) and hyperalgesia (increased pain from a stimulus that usually provokes pain) are prominent symptoms in patients with neuropathic pain,” writes Jensen. [3]

“In the case of Lyme disease, it is likely that all three types of pain are involved to a different extent in any particular patient,” Batheja writes.

Fatigue and Cognitive Impairment

Fatigue and cognitive impairments are prominent features of central sensitization syndrome. Patients with post-treatment Lyme disease syndrome or chronic Lyme disease often report persistent insomnia and fatigue.

While fatigue can have both central and peripheral origins, the authors explain that “central fatigue often has the significant correlate of cognitive impairment.”

Studies of patients with post-treatment Lyme disease syndrome have shown problems with memory, working memory, processing speed, and verbal fluency.

Central sensitization syndrome has been described in several illnesses with similar symptoms including fibromyalgia and chronic fatigue syndrome.

Sensory Hyperarousal

Sensory hyperarousal to lights and sound is a defining feature of central sensitization.

The hypersensitivity can significantly affect daily life. Some individuals may avoid daylight or wear sunglasses indoors due to extreme sensitivity to light.

In patients with post-treatment Lyme disease syndrome, “sensory hyperarousal was reported by a majority of patients after acquiring Lyme disease, most often affecting hearing and/or vision,” the authors write.

One study found that among 85 Lyme disease patients:

70% reported hypersensitivity to light
48% reported hypersensitivity to sound

“The auditory hyperacusis seen in Lyme disease patients can be intense and incapacitating,” the authors report.

[bctt tweet=”Do some Lyme disease patients with persistent pain, fatigue and sensory issues suffer from central sensitization syndrome?” username=”DrDanielCameron”]

Conclusion

“Because many individuals with post-treatment Lyme syndrome (PTLS) or chronic Lyme disease have a similar symptom cluster, central sensitization may be a process mediating or exacerbating their sensory processing,” the authors conclude.

Further research is needed to determine whether patients with PTLS have neural activation patterns similar to those seen in other central sensitization disorders.

Editor’s note: Many of my patients appear to suffer from central sensitization syndrome. For transparency, I am an author of the International Lyme and Associated Diseases Society (ILADS) guidelines which do not dismiss the persistent infection hypothesis.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

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