Central Sensitization in Older Adults: Why Pain Feels Stronger With Age

What Is Central Sensitization?

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Central sensitization occurs when the nervous system becomes hypersensitive. Normally, pain signals are triggered by injury or inflammation. Once healing occurs, the nervous system calms.

With central sensitization, the nervous system remains in a heightened state. Pain pathways become overactive, sending stronger signals even when there is minimal or no tissue damage.

In simple terms, the “volume” of pain is turned up.

Why It Can Become More Common With Age

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Ageing affects both the peripheral nerves and the central nervous system. Chronic inflammation, repeated injuries and long-standing pain conditions can gradually sensitise neural circuits.

Older adults who have lived with arthritis, spinal degeneration or neuropathic pain for years may be more vulnerable to developing persistent sensitivity.

Changes in sleep quality, stress levels and overall health also contribute to this neurological amplification.

Symptoms of Central Sensitization in Seniors

Central sensitization does not always present as sharp pain. It often appears as widespread sensitivity, fatigue and discomfort disproportionate to physical findings.

The table below outlines common features.

These symptoms can be confusing because medical imaging may not show significant new damage.

The Role of Chronic Inflammation and Stress

Inflammatory processes associated with arthritis and other chronic conditions may continuously stimulate the nervous system. Over time, this stimulation changes how pain signals are processed.

Stress hormones also amplify neural sensitivity. Persistent discomfort increases stress, which in turn intensifies pain perception. The cycle becomes self-perpetuating.

Sleep deprivation further lowers pain thresholds, worsening sensitivity.

Why Pain May Feel Stronger Even Without New Injury

Central sensitization explains why older adults may report severe discomfort despite stable medical findings. The nervous system itself has changed.

Pain becomes less about tissue damage and more about altered signal processing.

This does not mean the pain is psychological or imagined. It is neurologically real and requires targeted management strategies.

Managing Central Sensitization in Older Adults

Traditional high-dose pain medication is often ineffective for centrally sensitised pain. Instead, a multidisciplinary approach is recommended.

Gradual physical therapy can retrain movement patterns without overwhelming the nervous system. Cognitive behavioural strategies may reduce fear and stress associated with pain. Optimising sleep and reducing inflammation are equally important.

Medication adjustments should focus on supporting nerve modulation rather than simply suppressing symptoms. Early recognition prevents escalation.

When Additional Support May Be Needed

If amplified pain significantly reduces mobility, disrupts sleep or leads to social withdrawal, broader supportive measures may be required.

Unmanaged central sensitization can accelerate functional decline. Addressing it proactively helps preserve independence and emotional wellbeing.

When daily life becomes limited by hypersensitivity, reassessment is essential.

FAQ: Central Sensitization in Older Adults

Is central sensitization common in seniors?

It becomes more likely in individuals with long-standing chronic pain.

Does central sensitization mean the pain is not real?

No. The pain is neurologically real, even if tissue damage is minimal.

Why does pain feel worse at night?

Fatigue and reduced distraction can amplify sensitivity.

Can medication alone solve it?

Often not. A combined physical and psychological approach is more effective.

When should families seek medical advice?

If pain seems disproportionate to injury or continues despite treatment.

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