When a patient has diffuse, burning, unrelenting pain that does not match a clean line on an MRI, the pain is often misunderstood. Some patients are told they have fibromyalgia, anxiety, or pain that is “psychological.”
One important piece that is often missed is sympathetically maintained pain.
The sympathetic nervous system is best known for the fight-or-flight response. It also helps regulate heart rate, blood pressure, sweating, temperature, bowel and bladder function, and internal organ signaling. When the body has been exposed to chronic pain, trauma, inflammation, or conditions such as endometriosis, this system can become hyper-reactive.
Somatic Pain vs. Sympathetic Pain
Most clinicians are trained to look for somatic pain. This is the more familiar kind of pain: a broken bone, torn tendon, irritated joint, or focal injury. It is often sharp, localized, and easier to point to.
Sympathetic pain can feel very different. It may be burning, prickling, deep, heavy, throbbing, or difficult to describe. Patients may also experience allodynia, where light touch or clothing feels painful. Other clues can include sweating changes, temperature changes, skin color changes, and a constant sense of internal alarm.
How Pain Can Spread Like Wildfire
We often think of sympathetic sensitization like a wildfire. The flames become so large that it is hard to see what originally started the fire.
Sensitization can involve major sympathetic “hubs” in the body. The stellate ganglion influences the head, neck, arms, heart, and upper body. The celiac plexus affects the upper abdomen. The lumbar sympathetic plexus affects the legs. The superior hypogastric plexus is a major pelvic hub, including the bladder, uterus, colon, and deep pelvic structures. The ganglion impar affects the tailbone, rectal, and external genital region.
This is why pain that begins in one region may eventually feel much broader, more reactive, and harder to explain.
What a Proper Workup Requires
A proper workup has to ask whether the nervous system is amplifying the pain.
Targeted sympathetic nerve blocks can temporarily quiet one of these hubs. This may help “reset” an overactive alarm system and, just as importantly, clear the diagnostic fog.
When the sympathetic fire is quieted, the underlying drivers may become easier to identify: a hypermobile sacroiliac joint, irritated disc, pelvic inflammatory source, hidden hernia, nerve compression, or another mechanical pain generator.
Our Approach at MPM
At Manhattan Pain Medicine, we evaluate sympathetically maintained pain as part of a broader diagnostic picture, helping patients identify both the overactive alarm system and the underlying source that may have triggered it.
