Memory pain in the pelvis (central sensitisation)

In many medical conditions, long-term irritation of nerve endings may lead to a memory of pain in the brain. This is particularly well-known in urology where a constant persistent debilitating pain in the pelvis or external genitalia may lead to a condition called central sensitisation. To learn more, we hear from esteemed consultant urological surgeon Mr Keng Jin Ng. 

What is central sensitisation?

Patients, like ladies who suffer from interstitial cystitis or men with prostatitis and scrotal pain, may develop a memory of pain over the weeks and months. This is due to the nerve endings in the pelvis being aggravated by constant infection or inflammation.

During treatment for their specific conditions, even though the infection and inflammation may be settling, patients often describe aggravation of the pelvic pain with emotional stress. It is believed that in memory of pain, the brain would reduce the threshold in sensing pain and therefore resulting in heightened sensitivity to the nerve signals. With such memory of pain, patients often describe “part of the brain telling them they are in pain all the time”.

What connection does central sensitisation have with the brain?

Research has shown that in central sensitisation, the bombardment of the brain with painful signals from the nerve endings, may lead to tilting of the brain “hormones”. The calming brain “hormone” (proteins known as neuropeptides) called GABA would drop while the excitatory brain “hormone” called glutamate would rise. Such imbalance of the brain proteins would typically lead to anxiety and depression.
 

How is central sensitisation treated?

The treatment strategy would be to eradicate the infection and inflammation in the first instance. In turn, patients who are left with the memory of pain would be offered treatment to reduce the sensitivity of the nerve endings as well as resetting the pain threshold in the brain. This can be achieved through a combination of tablets and neuromodulation (such as PTNS).

Once the memory of pain has been wiped off, the patient will return to normal functioning without any further requirement for treatment. Once cured, patients often describe themselves as having been energised, no longer being dragged down by pain.

If you're suffering from chronic pelvic pain and wish to schedule a consultation with Mr Ng, you can do so by visiting his Top Doctors profile.