Central Sensitization in Chronic Pain and Eating Disorders: A Potential Shared Pathogenesis

Although less recognized than other disruptions in functioning, individuals with chronic pain frequently display disturbances in eating associated with pain, changes in appetite, medication side effects, and prescribed elimination diets. Not only may changes in nutritional status and weight increase the risk for the development of an eating disorder, there is evidence that individuals with chronic pain and those with eating disorders share similar vulnerabilities that place them at risk for both conditions, as well as their comorbidity. This review will describe the temperamental, behavioral, and neurobiological risk factors linking chronic pain and eating disorders. We propose that these risk factors may reflect central sensitization, a condition of over-activation of the central nervous system that increases sensitivity to internal and external conditions. To manage high levels of sensitivity, individuals may develop unique patterns of behavioral avoidance, pain behaviors and/or restrictive eating. Using the framework of central sensitization, this review will discuss relevant assessment and intervention strategies to address sensitivity in eating disorders and chronic pain.