Ep. 37 Sensory Sensitization - Conservative Management Strategies

Episode Summary:

Join co-hosts Dr. Dan Bates and Justine Feitelson on 'It's Not In Your Head' as they tackle the complex world of sensory sensitization. In this episode, they delve into the science behind sensory sensitization, its connection to nociplastic pain, and how they lead to increasing pain and other issues. From light and sound, to touch, temperature, and more, learn about the various conservative management strategies you can implement to alleviate and cope with more intrusive symptoms through methods like desensitization, graded exposure, and useful gadgets that can make all the difference. Whether you're dealing with fibromyalgia, migraines, or other conditions related to sensory amplifications, this episode is packed with real-life experiences, case studies, and practical advice and techniques to help improve your quality of life. Don't miss Justine and Dan's key insights for both patients and healthcare providers alike.

Episode Overview:

This episode dives into sensory sensitization—a type of central sensitization—explaining what it is, how it develops, and why it can be so challenging. The focus is on conservative strategies for managing symptoms and specific sensory triggers.

What is Sensory Sensitization?

• Sensory sensitization occurs when the nervous system becomes hyperresponsive, amplifying sensations such as pain, light, sound, smell, taste, temperature, and touch.

• They become “positive feedback loop,” where triggers escalate and amplify sensitivity, affecting movement, mood, and quality of life.

• They are often linked to conditions such as fibromyalgia and other nociplastic pain syndromes, which is persistent pain from altered nociception without clear injury.

Common Symptoms and Triggers

• Amplified sensations: light, sound, smell, touch, taste, heat, cold, food intolerances, and balance issues.

• Sensitivities can also result from old injuries, scars, surgeries, neurodivergence, hypermobility, and diseases like complex regional pain syndrome.

• Are often accompanied by fatigue, cognitive dysfunction, mood issues, anxiety, depression, migraines, and gastrointestinal (GI) symptoms.

Conservative Management Strategies

Touch Sensitivity

• Strategies include compression garments, graded exposure to bothersome textures or sensations, and desensitization tools (toe spacers, special insoles)

• Graded exposure: Brief tolerable exposure, increasing over time.

• Position sense and movement can improve with compression, and added sensory input like kinesiology tape.

Light Sensitivity

• Use FL-41 or blue light glasses; automate lighting for comfort.

• Mindful exposure to light and visual field exercises help reduce hypersensitivity and associated anxiety.

Vestibular and Proprioception

• Sensory input affecting balance and movement; refer to specialists for underlying balance disorders.

• Vestibular techniques like the Apley maneuver for benign positional vertigo are discussed.

Sound Sensitivity

• Use earplugs or noise-dampening devices (Loop, Calmer, Vibes, Curvd).

• Sound therapy, gradual exposure, white noise machines, and conscious breaks recommended.

• Central gain: Avoid total silence to prevent increased brain sensitivity to noise.

• Audio Cardio app for tinnitus management

Temperature Sensitivity

• Graded exposure to hot or cold, adaptive clothing, fans, heated gloves/socks for comfort.

• Medication options for cold hyperalgesia include duloxetine; spinal cord stimulation may help some.

Smell and Taste Sensitivity

• Strategies: controlling environment, using HEPA filters, ventilating spaces, and gradual exposure.

• For taste and food intolerances, avoid restrictive elimination diets unless true allergies; rotate foods for neurodivergent profiles, work with dieticians if needed.

Gastrointestinal Issues

• Sensitization often correlates with digestive symptoms.

• Identify if more pathology exists and refer to gastroenterology when needed.

Overarching Strategies

• “3D concepts”: Desensitize, distract, and downregulate.

• Prioritize triggers, match management strategies, and increase exposure tolerances gradually.

• Progress is gradual—patience and persistence are important.

Practical Tools and Resources

• Glasses, earplugs, white noise machines, masks, timers, desensitization tools.

• Justine’s Base Camp program to work through the different buckets and implement these strategies

• Seek additional professional/specialist help and therapy when appropriate.