What is central sensitization syndrome? Causes, symptoms, and treatments

Do everyday activities — ‌like sitting down in a chair or taking a walk‌ — ‌feel uncomfortable or even painful, even when there’s no obvious injury or reason? Or perhaps you’ve experienced aches and pains that seem to stick around, or even show up in new places, long after an initial injury or flare-up has settled.

This increased sensitivity to pain and discomfort could be due to a condition called central sensitization syndrome (CSS). “Think of CSS as your body’s alarm system becoming a bit overprotective. Instead of just responding to clear threats, it sometimes starts reacting to safe or familiar sensations as if they’re dangerous, which can make you feel pain more easily,” says Laura Plankis, a physical therapist at Hinge Health certified in pain reprocessing therapy (PRT), a therapeutic approach to help people with ongoing pain retrain their brain to see pain as less of a threat.

CSS may help explain why some people experience ongoing discomfort, even in the absence of an active injury or structural issue. It’s a well-researched phenomenon that underscores how pain isn’t just related to an issue in your tissues, like knee cartilage or discs in your spine. Rather, pain is also shaped by your nervous system, life experiences, and thoughts and emotions. Often, the exact causes of CSS aren’t clear, but several factors like chronic stress or psychological trauma are believed to be major risk factors.

The first step to managing central sensitization syndrome is understanding why it happens and how your nervous system plays a role in processing pain. This will teach you that CSS is treatable because your nervous system can be retrained to be less sensitive to pain. When you understand how pain works, you may feel less afraid to move your body. Additional approaches like gentle movement, mindfulness, and grounding techniques can help calm the nervous system and gradually restore comfort in daily activities.

Here, Hinge Health physical therapists share what factors contribute to CSS, signs and symptoms that your pain could be related to central sensitization, and practical steps you can take to retrain your pain system and improve your pain and well-being.

What is central sensitization syndrome?

CSS happens when the central nervous system stays on high alert, making you more sensitive to pain and other sensations. We feel pain in our bodies, but how we react to that pain comes from the nervous system, which includes the brain and spinal cord. This system is what tells you to quickly pull your hand away from a hot pan to avoid getting burned.

If you have chronic pain, it’s possible that central sensitization syndrome (CSS) plays a role — in fact, research shows that pain lasting more than three months can involve changes in how your nerves process pain, which is a hallmark of CSS. 

Usually, pain is your body’s way of alerting you to something that needs attention, like an injury or real threat. These signals are known ‌as noxious stimuli, Dr. Plankis says. “With CSS, the nervous system starts to ‘turn up the volume’ on pain signals, so your body can respond to normal or safe experiences, like touch, temperature, or gentle pressure, as dangerous or harmful.” 

You can think of CSS as an overactive smoke alarm in your kitchen. Sometimes, it may go off just because you’re cooking, even when there’s no fire. In a similar way, CSS turns up your body’s alarm system, causing you to feel pain even when nothing is happening. “The brain’s job is to keep you safe, so if it thinks there’s a threat, even small or harmless triggers can create strong pain signals,” Dr. Plankis says.

Does CSS mean pain is ‘all in your head’?

No. While CSS involves changes in how your nervous system processes pain, the discomfort you feel is very real — not imagined, exaggerated, or all in your head. In CSS, the central nervous system (including the spinal cord and brain) can mistakenly send pain signals even when there’s no physical injury or threat. This means your experience of pain comes from real changes in nerve signaling, not from “making it up.” The encouraging news is that many strategies can help calm your nervous system and reduce symptoms over time.

Causes and risk factors of central sensitization syndrome

There isn’t just one known cause of CSS — it’s likely the result of a combination of physical and emotional factors. (Sometimes it’s just bad luck and we don’t know why it happened.) Some of the most common risk factors include:

• Repeated or prolonged injury or inflammation. “The longer pain sticks around, the more likely it is for your central nervous system to become extra sensitive,” Dr. Plankis says. This is a normal protective response from your body. “In time, pain signals can start to spread to nearby areas, something I like to call ‘nosy neighbors,’ even if there’s nothing wrong with those regions of the body,” Dr. Plankis says. This is how pain from CSS can become widespread.

• Chronic stress or psychological trauma. Stress or trauma doesn’t have to come from big, dramatic events to affect your central nervous system. Everyday stressors can have an impact, too. Stress from work deadlines, relationship challenges, financial worries, or caregiving responsibilities, can increase your risk of CSS. These experiences can prime the nervous system in some people, making it more reactive to pain. 

• Emotional and psychological responses. “Psychological factors, including negative thoughts or catastrophic thinking, are also contributors,” Dr. Plankis says. Reacting to pain with fear, worry, or beliefs like “this will never get better” can heighten the brain’s perception of threat, making pain feel more intense or persistent, Dr. Plankis explains.

• Poor sleep quality. Research suggests that 50-80% of people with chronic pain have trouble sleeping, which can create a cycle where pain worsens sleep, and poor sleep increases pain. The less sleep you get, the more likely you are to experience pain, studies show. “Not getting enough restful sleep each night can lower your pain threshold and make your nervous system more sensitive,” says Dr. Plankis.

• Nerve damage or neuropathy. Sometimes, nerves don’t work as well as they should due to conditions like diabetes, which can lead to diabetic neuropathy, infections (like Lyme disease), autoimmune diseases like rheumatoid arthritis, injuries, or certain medications (like chemotherapy). Such nerve changes can affect how your body processes pain and increase the risk of developing CSS.

• Bad luck. Sometimes, things happen in ways we don’t fully understand. During the healing process, the body can occasionally make mistakes, which might lead to altered sensations or changes in how nerves function. For example, in conditions like complex regional pain syndrome (CRPS), even a minor injury can sometimes result in severe nerve sensitivity for no clear reason.

Symptoms of central sensitization syndrome

CSS can show up in different ways. Many people notice changes in how their body feels when sitting down in a hard chair or wearing tight clothing, for example. Others may feel overly fatigued for no apparent reason. Common symptoms of central sensitization can include: 

• Feeling extra sensitive to touch, pressure, or temperature (even gentle sensations may feel painful)

• Pain that seems more intense than you’d expect based on the injury or condition

• Ongoing pain that spreads beyond the original area to other parts of your body

• Feeling tired or having trouble sleeping, even if you think you’re getting enough rest

• Difficulty concentrating or experiencing brain fog

Conditions linked to central sensitization syndrome

CSS is often associated with other chronic pain conditions. “With these conditions, your body’s ‘pain map’ becomes smudged. The brain becomes less certain about where pain is coming from and starts to generalize these signals, which can make pain feel more widespread and harder to pinpoint,” Dr. Plankis says. 

Common conditions linked with CSS can include anything from temporomandibular joint (TMJ) disorder to chronic fatigue syndrome. These include: 

• Fibromyalgia. Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain and tenderness throughout the body, mainly affecting muscles and soft tissues. 

• Chronic migraine and tension headaches. “Migraines can be triggered by things like light or sound. These aren’t dangerous but are perceived as threats by the nervous system, and can lead to intense pain,” Dr. Plankis says.

• Irritable bowel syndrome (IBS). People with IBS often experience digestive discomfort or pain, even when tests and imaging don’t show anything out of the ordinary. 

• Temporomandibular joint (TMJ) disorder. Temporomandibular joint disorders (TMDs) include a variety of conditions that affect the TMJ and surrounding muscles. The TMJ itself acts as a hinge, enabling your jaw to open and close smoothly. When it becomes irritated, it can lead to symptoms such as jaw pain, stiffness, and difficulty with movement. 

• Chronic fatigue syndrome (CFS). Those with CFS, also called myalgic encephalomyelitis, experience ongoing tiredness that isn’t fully relieved by rest, often alongside pain or other symptoms.

• Vulvodynia and interstitial cystitis. Vulvodynia refers to ongoing pelvic pain, while interstitial cystitis describes persistent bladder pain and other symptoms. Both conditions can occur even when there’s no clear cause.

• Complex regional pain syndrome (CRPS). CRPS is a neuropathic pain disorder, or a type of pain problem that affects the nerves. It can occur after injury or surgery or for no reason at all. It can cause extra sensitivity to touch, increased pain, changes in sweating and skin color, and changes in how your skin and nails look and feel.

• Non-specific low back pain or myofascial pain syndrome. Both of these conditions involve ongoing pain without a clear structural cause; the discomfort can last for a long time.

These gentle, dynamic stretches and breathing exercises can help restore a sense of calm and balance. Breathing deeply and moving slowly and intentionally through these movements can calm your nervous system and signal to your body that it’s safe to move.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

How to retrain your pain system

CSS occurs when your pain system becomes overly sensitive — but the good news is your brain and body can learn new patterns. The process is called desensitization and involves helping your nervous system recognize that movement and activity are safe — even if you feel some pain. Over time, continuing to move (even if it’s uncomfortable) can “turn down the volume” of your pain signals.

Retraining your pain system isn’t one-size-fits-all. Many people benefit from working alongside a professional, such as a physical therapist with experience in pain neuroscience as well as a mental health provider, such as a therapist who’s trained in cognitive behavioral approaches. Together, these experts can tailor approaches like gentle stretching, targeted exercise, and relaxation techniques to your needs. The key is finding movements and strategies you can tolerate and enjoy, with a plan that meets you where you are. Some people with CSS may be able to tolerate high-intensity exercises without much pain. 

Treatments for central sensitization syndrome

Because of neuroplasticity — the brain’s remarkable ability to rewire itself and adapt — your nervous system isn’t fixed in a “sensitized” state forever. Neuroplasticity means that your brain and nerves can form new connections and patterns in response to new experiences, learning, and practice. For people with CSS, this means that over time, your nervous system can learn to become less sensitive to pain signals.

“Healing often begins with understanding what’s going on in your body and mind,” Dr. Plankis says. “Building this awareness is the first step toward feeling better.” Strategies such as exercise therapy, retraining your brain to handle certain movements and sensations, and prioritizing sleep can all help you “reverse” CSS and reduce pain. These approaches include: 

• Learn more about pain. The more you understand and familiarize yourself with pain, the more comfortable you’ll likely feel managing it. Long-lasting pain behaves differently than new pain — knowing the differences can help you feel more confident and less worried.

• Try physical therapy and targeted exercises. Doing specific exercises can help build strength, desensitize sensitive areas, and gradually reduce pain. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Perform rhythmic movement. Any movement is beneficial, but research suggests that aerobic rhythmic movement (or exercises that involve alternating left-right motion) can help regulate your nervous system and promote full-body calmness. Activities like walking, freestyle swimming, alternating lunges, cycling, dancing, or even gentle head turns (including head tilts) activate both sides of your brain and can support brain repatterning.

• Practice graded exposure. Graded exposure is a powerful desensitization technique, helping to retrain your nervous system to turn down the alarm for your hypersensitive area. “Slowly and repeatedly doing things that have become uncomfortable, like sitting in a chair or wearing certain clothes, while assuring yourself it’s safe, helps teach your brain those sensations are not dangerous,” Dr. Plankis says.

• Engage in mindfulness. Mindfulness means being fully present and aware of your thoughts, feelings, and surroundings. It can help you feel calmer, reduce stress, and appreciate life more. Taking a mindful walk — where you take note of what you smell, hear, and see — can help you relax and ease tension in your body. Or, when journaling your thoughts and feelings, notice how your hand feels as it moves with the pen or pencil.

• Consider cognitive behavioral therapy (CBT). Research shows that CBT — a form of psychological therapy — can help reframe unhelpful thought patterns, promote relaxation, and reduce chronic pain.

• Manage stress levels. Research shows that stress can amplify pain sensitivity. Practicing relaxation techniques daily, such as deep breathing exercises like diaphragmatic breathing and doing progressive muscle relaxation exercises can help lower stress and subsequent discomfort. Progressive muscle relaxation means tensing and then relaxing muscle groups in different areas of your body, one by one. This can help release tension, calm your body, and strengthen your mind-body connection.

• Adopt sleep hygiene habits. Practicing good sleep hygiene — like wearing a sleeping mask to block out light and listening to calming music before bed — can help ease you into more restful sleep. These habits can improve your sleep quality and reduce pain.

• Prioritize nutrition. Eating a balanced, nutrient-rich diet supports your body’s natural healing processes and emotional well-being. Focus on foods like fruits, vegetables, fatty fish, nuts, seeds, and whole grains. For individualized guidance, consider working with a registered dietitian.

Is central sensitization system reversible? 

Central sensitization syndrome can be reversible, thanks to science-backed techniques that retrain your pain system. We can acknowledge that these may seem complex, but many are actually quite simple. Teaching your body that movement is safe and using techniques to restore calm are all important in this pain system retraining.

“Think of reversing CSS as establishing new hiking trails in your brain,” Dr. Plankis says. The more you use a certain path, the more worn and familiar it becomes. Old pain pathways are like well-trodden trails, while new, healthier habits build fresh trails. “As you practice new ways of moving, thinking, and responding, those healthier trails in your nervous system get stronger, and the old pain pathways can fade and ‘revegetate.’” 

Change takes time, but with consistent steps, you can rewire your brain and body for greater comfort and ease.

Note: In some challenging cases of CSS, pain flares can occur even after the condition was believed to be resolved. That’s okay — the treatments above (especially CBT) can still help manage your symptoms.

PT tip: Be a gentle detective

When you notice pain or unusual sensations, take a moment to pause and observe what’s happening in your body. Is the pain predictable, like after an obvious injury, or is it more unpredictable and moving around your body? “Ask yourself, ‘Is this coming from a tissue injury, or could it be my brain’s way of trying to keep me safe,’” says Dr. Plankis. 

You can test this out by engaging in gentle movement. By exploring your pain, you can learn to understand it better and become more comfortable with it. “Approaching your body with curiosity instead of fear can help you choose the best healing path — whether that’s calming your nervous system or focusing on strengthening and caring for your body,” Dr. Plankis says.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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