Central sensitization syndrome may be associated with chronic autonomic concerns

1. Central sensitization syndrome is present in most patients with chronic autonomic concerns

2. Patients with central sensitization syndrome reported worse autonomic symptoms despite showing less severe objective autonomic dysfunction

Evidence Rating Level: 2 (Good)

This study investigated the role of central sensitization syndrome (CSS) in patients with chronic autonomic symptoms unexplained by objective testing, hypothesizing that CSS amplifies symptoms through disrupted interoceptive processing. Researchers conducted a retrospective case-control analysis of 555 patients with orthostatic intolerance, assessing autonomic function (Valsalva maneuver, tilt testing, sudomotor evaluation) and patient-reported outcomes (Central Sensitization Inventory [CSI], Compass-31, Neuropathy Total Symptom Score-6). CSS (CSI≥40) was present in 78% of participants, who were predominantly younger females with longer symptom duration and higher rates of comorbidities like fibromyalgia and anxiety compared to non-CSS patients. While both groups showed autonomic failure (AF), CSS patients reported significantly worse symptoms (higher Compass-31 and NTSS-6 scores, strongly correlated with CSI) despite less severe objective AF (mean AF scores 4.21 vs. 5.23, p=0.021). Notably, CSS patients demonstrated greater orthostatic cerebral blood flow decline (p<0.001) and hypocapnia (p=0.004), suggesting central dysregulation contributes to symptom amplification. These findings indicate CSS is prevalent in autonomic dysfunction and may explain symptom-sign discordance, emphasizing the need for dual treatment targeting both CSS and AF. For clinicians, recognizing CSS in patients with disproportionate symptoms can guide more comprehensive management strategies.

Click to read the study in Neurology

Image: PD

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