A Clinician’s Guide to Widespread Pain and Sensitization

Let’s be honest: as clinicians, sometimes a patient walks in and their story just does not add up. You listen, you frown (maybe unconsciously), and somewhere in the back of your mind, you’re thinking, "None of this makes sense." I’ll let you in on a secret—if you, the provider, are confused, the patient’s probably sensitized.

You’re not alone. For years, I’d see patients with these complicated webs of symptoms: pain that jumped from foot to neck to ear, a foggy medical history, and a myriad of complaints that just didn’t line up with textbook medicine.

The frustration isn’t theirs alone; we share it. The turning point? Recognizing that the frustration itself is sometimes a diagnostic clue. When their story is confusing, it’s often not because the patient’s trying to mislead you—or that they’re exaggerating—but because central sensitization is the uninvited guest in the room.

Why Does It Feel So Complicated

Central sensitization is, at its core, nervous system dysfunction. Think of it like a broken amplifier—it takes a minor input and turns it into an overwhelming output: pain, hypersensitivity, brain fog, mood changes, and more. Patients accumulate diagnoses: fibromyalgia, CRPS, IBS, POTS, MCAS, migraines—the math on one person having all this by chance just doesn’t stack up. What’s far more likely? These are all offshoots of one underlying process affecting different parts of the body.

The key realization for Dan came from seeing patterns: patients who weren’t just hypermobile, but sensitive to light, sound, food, sometimes temperature—ticking boxes for multiple so-called "standalone" diagnoses. With time, it became clear we’re often not dealing with twenty different conditions in one body; instead, it’s one malfunctioning system—the nervous system—manifesting in myriad ways.

The 7 Buckets: Making Chaos Manageable

Let’s bring some order. If you’re dealing with widespread pain and central sensitization, here are the seven main categories to identify and focus on:

●     Sensory Hypersensitivity: Disproportionate pain, allodynia, migraines, TMJ pain, IBS, interstitial cystitis, vulvodynia, even dry eye syndrome.

●     Sleep Disturbances: Insomnia, unrefreshing sleep, hypersomnia, sleep apnea, narcolepsy.

●      Fatigue: Not just tiredness—think post-exertional malaise, chronic fatigue syndrome, brain-frying fatigue.

●      Cognitive Dysfunction ("Brain Fog"): Problems with thinking, concentration, even getting misdiagnosed as ADD or mild cognitive impairment.

●      Mood Disturbance: Anxiety, depression, irritability, sometimes PTSD.

●      Motor Dysfunction: Restless leg, tremors, jerks, non-epileptic seizures, motor weakness and inhibition

●      Dysautonomia: The autonomic system going haywire—POTS, PSWT, GI dysregulation, bladder pain/frequency, sweating abnormalities, sexual dysfunction.

Each of these doesn’t exist in isolation—they feed into one another, creating a tangled web. For patients, telling a coherent story is hard because they’re living in the mind-fog, burdened by multiple symptoms, all amplified. As clinicians, we must move from open-ended history to a guided process—run through each bucket, ask targeted questions, then let the patient tell you what you missed.

Framework for Understanding

●      Identify the dominant symptom: Is it pain, fatigue, cognitive or mood disturbance? Let this shape your work-up.

●      Count the buckets: The more categories the patient ticks, the more likely central sensitization plays a role.

●      Look for amplifiers and feedback loops: Poor sleep makes pain worse. Pain worsens mood. Mood disrupts sleep. Dig enough and the loops reveal themselves.

Takeaways for Patients and Providers

Patients: You aren’t crazy, and you’re definitely not making this up. Recognize symptom patterns and communicate them.

Providers: Be methodical. When confused, think sensitization first. Use the buckets to untangle the mess.

Widespread pain and bewilderingly complex presentations aren’t a diagnostic death sentence. Lean in, ask the right questions, and remember: sometimes, confusion is a symptom in itself.

For more insight and practical advice, tune in to episode 13 of It’s Not in Your Head Podcast.