La sensibilización central es una condición del sistema nervioso que está asociada con el desarrollo y mantenimiento del dolor crónico.Cuando ocurre la sensibilización central, el sistema
nervioso pasa por un proceso de agitación y se regula
en un estado persistente de alta actividad.
Este estado de reactividad persistente o regulado mantiene el dolor incluso después de que la lesión inicial pudo haberse curado.
La sensibilización central tiene dos características principales.Ambas implican una mayor sensibilidad al dolor y la sensación al tacto.Se llaman “alodinia” e “hiperalgesia”.
La alodinia se produce cuando una persona experimenta dolor, con cosas que normalmente no son dolorosas.
Por ejemplo, los pacientes con dolor crónico suelen experimentar dolor incluso con cosas tan simples como el tacto o el masaje.En tales casos, la sensación del tacto viaja, por supuesto, a través del sistema nervioso. Debido a que el sistema nervioso se encuentra en un estado persistente de actividad elevada, la sensación se registra en el cerebro como dolorosa o incómoda incluso cuando realmente no debería, dado que la sensación misma era la de un simple toque o masaje.
La hiperalgesia ocurre cuando un estímulo doloroso
real se percibe como más doloroso de lo que debería.
Un ejemplo podría ser cuando un golpe simple, que normalmente podría ser ligeramente doloroso, el paciente de dolor crónico, lo siente sumamente doloroso.Una vez más, la sensación de dolor viaja a través del sistema nervioso, que se encuentra en un estado persistente de alta reactividad, y el dolor se registra en el cerebro como un nivel elevado de dolor.
Los pacientes con dolor crónico a veces piensan que se
están volviendo locos porque saben que el tacto o los
golpes simples no deben ser tan incómodos o dolorosos
como los experimentan.
Otras veces, no son los propios pacientes quienes piensan que están locos, sino sus amigos y seres queridos.Pueden mirar al paciente de dolor crónico haciendo
muecas, al ver que el más mínimo toque le duele, y
piensan que el paciente debe ser realmente un
hipocondríaco, o algo así.
Después de todo, el contraste entre ellos y el paciente con dolor crónico es duro:Los amigos y seres queridos pueden ser tocados o recibir un golpe y no les duele.La diferencia, sin embargo, es que los amigos y seres queridos no tienen un sistema nervioso que está atrapado en un estado persistente de reactividad elevada, llamada sensibilización central.
Además de la alodinia y la hiperalgesia, la
sensibilización central tiene algunas otras
características, aunque pueden ocurrir menos
comúnmente.
La sensibilización central puede conducir a sensibilidades
aumentadas a través de todos los sentidos, no sólo el
sentido del tacto.
Los pacientes con dolor crónico a veces pueden reportar sensibilidad a la luz, los sonidos y los olores.
La sensibilización central se asocia con déficits cognitivos, como la concentración deficiente y la mala memoria a corto plazo.
La sensibilización central también se corresponde con el
aumento de los niveles de angustia emocional,
particularmente, ansiedad.
Después de todo, el sistema nervioso es responsable no sólo de las sensaciones, como el dolor, sino también de las emociones.Cuando el sistema nervioso está atascado en un estado persistente de reactividad, los pacientes van a estar literalmente “nerviosos” -en otras palabras, ansiosos-.
La sensibilización central se ha reconocido desde hace
mucho tiempo como una posible consecuencia del
accidente cerebrovascular, y también de una lesión de la
médula espinal.
Sin embargo, se ha vuelto cada vez más claro que desempeña un papel importante en muchos diferentes trastornos del dolor crónico.Puede presentarse con el dolor de espalda crónico, dolor de cuello crónico, lesiones por el efecto “latigazo cervical”, dolores de cabeza tensionales crónicos, jaquecas (migrañas), artritis reumatoidea, osteoartritis de la rodilla, endometriosis, lesiones sufridas en un accidente vehicular , después de las cirugías.
Fibromialgia, síndrome de intestino irritable, y síndrome de fatiga crónica, todos parecen tener como denominador común la sensibilización central.
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