This topic contains 7 replies, has 5 voices, and was last updated by 
Carl Nottoli, DC September 1, 2019 at 9:29 pm.
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Doc Nina
Good morning lovely ID practitioners. I recently posted regarding a complicated case that both myself and Dr. Joe here at Barefoot Rehab are treating. Today I gave her the Central Sensitization Inventory which is used to determine how much a patients pain is related to changes in the central nervous system rather than peripherally related pain. Sensitized patients will be more sensitive to the effect that they may even appear to be dramatizing their symptoms. These patients often experience significantly increased pain with light touch or pressure that would not affect someone who was not suffering with CS. In effect, their pain is grossly amplified. There is a index questionnaire which is considered to be close to 90% accurate in grading CS. Our patient graded a 53, which is considered severe CS.
Given this additional information, if this was your patient, what would you do?
Thanks!
Doc Nina
Seth Schultz, DC
Can you post some of the case details as well Nina? Thank you
Doc Nina
Hi Seth, they are in a previous post of mine from last week, its a lot of information, I could copy and paste it here if you like.
William Brady, DC
If a problem is outside my scope (legal practice area) or area of core competence (my own determination of my skills and preferences) then I would survey and refer.
Tonight at 6:00 pm we are launching the Fast Map assessment (on the ID facebook page). This should help you determine the cause of her central sensitization (as that is a finding not a detailed diagnosis). She may have other medical conditions, stress, diet issues, lack of exercise etc.
Lots of providers wrestle with the idea that I can’t help everyone and there are lots of other healthcare professionals that make work this case better.
Keep us posted.
Carl Nottoli, DC
Nina, have you run this patient through Fast Map? What did it show and what is your plan moving forward?
Doc Nina
Hey Dr. Carl and Dr. Bill! I watched the Fastmap video! Great stuff, and then I ran the questions for this patient, and it came out as 100% psychological, and 60% metabolic with 0% functional or structural. She WAS in a car accident, she DOES have demonstrated structural changes on MRI, but they ARE NOT in line with her symptom presentation at all. Interestingly there is no indication of any metabolic component, and I did not answer yes to the environment question. I fully believe the excessive nature of her symptom presentation is 100% psychological, but she does have known structural pathology as well. This is why her case is also 100% complicated. She is not convinced – by fear- that she needs surgery. The surgeon actually told her he would clear out the IVF on the WRONG SIDE in order to decompress the nerve root. I don’t know if this surgeon just didn’t look at the MRI, or maybe simply miss-spoke, but its a bit scary non the less to think a surgeon would do surgery on the wrong side, or at all in this case since the nerve compression is minimal at best. How do we keep from losing this patient to an inevitable failed neck surgery outcome? Just based on her psychological profile alone its likely that any intervention will fail, and this surgery she is being convinced into getting does not seem medically necessary.
Christopher Stepien
Correct me if I’m wrong Nina, but the question seems to be, “What are the causes and solutions to central sensitization?” Is that right?
I don’t know much about CS except that it can happen when there’s been severe trauma or where there are metabolic/psychosocial issues.
Maybe we can see if there are any papers on CS unless anyone knows of them?
What I’d be most interested in is how much CS can recede when structural/functional causes are addressed.
Carl Nottoli, DC
I would say if her problem is showing up via Fast Map as primarily psychological then her central sensitization is due to this pathology. It’s not to say she doesn’t also have structural/functional problems, but it rather says that treating these problems is barking up the wrong tree and will be ineffective until psychological pathology is treated.
CS is very non-specific from my understanding and so papers with any information might prove as useful as looking for “best lower back pain treatment.” No diagnosis of the specifics so results are basically not helpful.
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