Structural, functional, and neurochemical changes associated with central sensitization

Structural and functional changes in the thalamus, hypothalamus, and amygdala
Hyperexcitability of the cell membrane of central neurons, decreased action potential threshold, increased synaptic strength, decreased descending inhibitory transmission, reduced activation threshold, and enlarged receptive fields
Loss of gray matter volume in the anterior and posterior cingulate cortex and prefrontal cortex
Heightened functional activity within the somatosensory cortex (sensory processing), insula (emotional context of sensation, sensory appraisal), and amygdala (mood processing)
Increased temporal summation (leading to increasing ascending sensory amplification) and reduced conditioned pain modulation (reduction in descending inhibitory signals)
Maladaptive central and peripheral neuroplasticity
Hypothalamic-pituitary-adrenal axis changes
Hyperactive sympathetic nervous system and endogenous opioid system
Changes in neurotransmitter concentrations in the cerebrospinal fluid
  • Adapted from information in reference 1.