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 proper treatment, symptoms can resolve.

Allodynia frequently overlaps with other forms of neuropathic pain, including burning or freezing sensations, pins and needles, and 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—making it an important Lyme disease symptom.

When Allodynia Comes with Autonomic Dysfunction

A patient 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 the initial consultation, what stood out 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, treatment was begun based on a clinical diagnosis.

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 is increasing recognition of Lyme-associated small fiber neuropathy, autonomic dysfunction including POTS and orthostatic hypotension, and 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

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.

Clinical Takeaway

Recovery from allodynia wasn’t instantaneous, but the trajectory changed after Lyme treatment began—once the underlying infection is addressed, the nervous system can begin to heal. Lyme disease can invade the nervous system and affect small unmyelinated fibers responsible for temperature sensation, pain perception, and autonomic functions, producing allodynia, POTS, and burning pain that are often misdiagnosed as fibromyalgia or unexplained chronic pain. When standard treatments don’t work and symptoms like allodynia or dysautonomia persist, Lyme disease must be considered, particularly in endemic areas or patients with unexplained multi-system symptoms.

Frequently Asked Questions

Can Lyme disease cause allodynia?
Yes. Lyme disease can trigger small fiber neuropathy and central sensitization, both of which can produce allodynia—pain from stimuli that normally don’t hurt.

Does allodynia from Lyme disease improve with treatment?
Yes. When allodynia is driven by Lyme-related neuroinflammation, antibiotic treatment targeting the infection can reduce sensitization and improve symptoms over time.

What is the connection between allodynia and POTS?
Both involve dysfunction of the small nerve fibers that regulate sensation and autonomic function. When Lyme disease damages these fibers, allodynia and POTS can develop together.

Related Reading

Lyme Disease Symptoms: What Patients Need to Know
Chronic Pain in Lyme Disease: Why It Moves and What Helps
Allodynia: When Normal Touch Becomes Painful
Burning Pain with a Normal EMG
Lyme Disease Neuropathy: Symptoms and What Causes It
Autonomic Dysfunction in Lyme Disease

References

1. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–S15.
2. Novak P, Felsenstein D, Mao C, et al. Association of small fiber neuropathy and post-treatment Lyme disease syndrome. PLoS One. 2019;14(2):e0212222.
3. Jensen TS, Finnerup NB. Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms. Lancet Neurol. 2014;13(9):924–935.