Persistent Pain & Central Sensitisation: Why “Sensitive” Doesn’t Mean What You Think

If you have ever been told your pelvic pain involves "central sensitisation," you may have wondered if this means you’re too sensitive or overreacting to pain. But this is not what it means. Central sensitisation describes a change in how the nervous system processes signals and is not an indication of someone's pain tolerance or how "real" their pain is.

What actually is central sensitisation?

Central sensitisation is defined as an amplification of neural signalling within the central nervous system (the brain and spinal cord) that results in pain hypersensitivity. It is as if the volume on the nervous system's pain signal has been turned up. This can mean pain is felt more intensely than expected, is felt beyond the original area of pain, or continues even after the original tissue has healed.

This is different to pain caused directly by tissue damage or inflammation, which is the kind of pain most people are familiar with, for example a cut or a broken bone. Pain, in its normal form, is protective. It tells you something is wrong, prompting you to avoid further harm to allow injured tissue to heal. But sometimes, the nervous system continues to amplify pain signals beyond the point of tissue healing, or in situations where tissue damage was never significant to begin with. With central sensitisation, the nervous system itself becomes part of the problem, amplifying or maintaining pain signals regardless of what is actually happening in the tissue.

What does this mean for pelvic pain?

Central sensitisation has been identified across a wide range of chronic pain conditions, such as osteoarthritis, chronic low back pain, headache, and importantly, chronic pelvic pain.

Central sensitisation is particularly relevant to chronic pelvic pain, including conditions such as endometriosis, vulvodynia, and persistent pain after pelvic floor dysfunction has been treated. This is one of the reasons pelvic pain does not always resolve in line with what is found on imaging or in surgery, and why pain can persist even after endometriosis lesions have been removed. This is also why two people with the same diagnosis can have very different pain experiences, and why an individual assessment is so important.

Pelvic floor physiotherapy for chronic pelvic pain is not only about treating the area of pain directly but addressing central sensitisation and incorporating pain science education alongside other treatment. Research focused on chronic pelvic pain has identified understanding a sensitised nervous system as one of the most important concepts for people living with this kind of pain. This helps people understand that their pain is real and reasonable, even when it doesn't correlate to visible tissue damage.

What does central sensitisation feel like?

People with significant central sensitisation often report a particular set of symptoms beyond the pain itself, including:

• Pain that spreads beyond the original site of pain

• Sensitivity to light touch, pressure, heat, or cold

• Sensitivity to light, noise, or smells

• Poor sleep

• Difficulty concentrating

• Pain that is worsened by stress

• Restless legs

These symptoms are features of a nervous system that has become more reactive overall, not just in the painful area.

Can it be treated?

The research is clear that central sensitisation can improve with the right approach over time and with a combination of strategies.

Helpful approaches can include:

1. Movement and exercise, which has a pain-relieving effect on the nervous system, however the right type, intensity, and pace matters.

2. Pain science education, which involves learning how pain works, including the concept of central sensitisation itself. Understanding that pain does not always equal tissue damage can reduce fear, improve coping, and has shown meaningful improvements in pain and disability.

3. Psychological approaches, such as strategies that address stress, sleep, and emotional wellbeing, which all influence how the nervous system processes pain.

4. Addressing the original source of pain, which means relevant treatment for the source of the pain alongside addressing the nervous system since ongoing input from injured or inflamed tissue can also drive and maintain central sensitisation.

It's important to know that no single treatment produces a dramatic effect on its own. The most meaningful results come from a combined approach over time, addressing both the body and the nervous system together.

What does this mean for me?

Central sensitisation is a real, evidence-based explanation for why pain can persist or feel more intense than visible tissue damage may suggest. Understanding this matters, because it shifts the focus to helping the nervous system to settle.

If you have been told your pelvic pain involves central sensitisation, a pelvic floor physiotherapist can help you better understand your pain and work with you on a treatment plan that addresses both the pelvis and the nervous system together to improve your pain and overall wellbeing.

References

1. Nijs J, George SZ, Clauw DJ, et al. Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine. Lancet Rheumatology. 2021;3(5):e383–92. https://doi.org/10.1016/S2665-9913(21)00032-1 

2. Mardon AK, Chalmers KJ, Heathcote LC, et al. "I wish I knew then what I know now" – pain science education concepts important for female persistent pelvic pain: a reflexive thematic analysis. Pain. 2024;165(9):1990–2001. https://doi.org/10.1097/j.pain.0000000000003205 

3. Voorham-van der Zalm PJ, et al. Pelvic floor physical therapy for pelvic floor hypertonicity: a systematic review of treatment efficacy. Sexual Medicine Reviews. 2022;10(2):209-221. https://academic.oup.com/smr/article/10/2/209/6880344