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Living Dangerously: Education Tool for Patients With Central Sensitization
By: Nataliya Zlotnikov, HBSC, MSc

What Is Central Sensitization in 15 Seconds

Watch this brief snippet from our online healthcare course, Management Strategies for Central Sensitization: An Introduction to the Pain Truth Certification Program by APTEI (Advanced Physical Therapy Education Institute), to learn what is central sensitization. 

Learn About How to Manage Central Sensitization with Bahram Jam

Interlude: It's All an Illusion...

The famous Checker Shadow Illusion.

Which square is darker, A or B?

If you haven't seen this optical illusion before, take a second and decide before scrolling down.




The Answer

The answer is that they are both the same colour!

These illusions work because of the way the brain understands contrast and shadows. 

The cylinder appears to be casting a shadow onto B though there really isn’t a shadow there. Our brain makes the assumption that block B must be lighter than it actually is had the shade not been there.

This illusion however interesting, can get quite technical and is not exactly the topic of today's blog, so if you'd like to learn more about how it works, you can do so here.

What we do need to keep in mind for today is that our visual perception system and our brain work together to create a meaningful representation of the world around us to help us survive

Checker Shadow & Central Sensitization

To keep you alive, your brain is subconsciously and constantly judging if you are in safety or in danger, by calculating how much physical and emotional pleasure or stress you are experiencing.

Safety Side

If the scale tips more towards the “safety” side, the brain and the nervous system calm down, remain relaxed and become less sensitive to pain or to stress (odours, loud noises, they don’t bother you).

When the scale favours this safety side, the brain produces powerful chemicals that help reduce pain such as morphine and serotonin.

Danger Side

If the scale tips more towards the “danger” side, the brain and the nervous system become more hyper-vigilant and sensitive to pain. And sensitive in fact to all stimuli, e.g. you have a migraine? You'll be more sensitive to loud noises, to light, to smells, etc. - your nervous system wants to protect you.

When the scale leans more towards the danger side, the brain stops producing the powerful pain-reducing chemicals mentioned above such as morphine and serotonin. Why? Because it's in a fight or flight mode.

Is It Safe or Dangerous? Introduction to the Nervous System Sensitivity Scale

Allow us to present you to the Nervous System Sensitivity Scale (NSSS), developed by Bahram Jam.

A few points about the NSSS:

  1. NSSS is a novel outcome measure/educational tool for patients with persistent pain.
  2. There are currently no studies on the reliability and validity of the NSSS.
    • Nothing in the NSSS is new, Bahram has based it on the work of others and has simply compiled it. 
  3. Bahram doesn’t intend for it to be an outcome measure to measure people's recovery (even though that is what he uses it for). He wants it to be used more as an educational tool.

NSSS Basics 

  • NSSS scoring system has a safety (S) score out of 100 and a danger (D) score out of 100.
  • The goal is to have the S score as close to 100 as possible, and the D score as close to zero as possible.
  • However, the majority of patients that Bahram sees that are centrally sensitized demonstrate scores closer to this 10/100 (S) and a ~90/100 (D) score; their scale is severely shifted.

In This Online Healthcare Course

Bahram will thoroughly discuss the NSSS using scientific literature to explain the importance of the questions in this scale as well as address the application of his Pain Truth Program as a tool to assist with the recovery of patients presenting with central sensitization.   

The purpose of the 1-hour webinar on which today's blog is based is to introduce healthcare practitioners to what the Pain Truth Certification Program (PTC) is all about. 

All the information is readily available on his website

Learn About The NSSS and The Pain Truth Here

Get Your NSSS Here

The NSSS and other relevant pain education documents, information and videos are all available free of charge on the Pain Education section of APTEI's site

Here is a direct link to the NSSS in English and French:
Nervous System Sensitivity Scale (NSSS) - English
Nervous System Sensitivity Scale (NSSS) - French

Learn About Clinical Application of the NSSS 


The Opposite of Pain

The opposite of pain is not pain-free, it is pleasure and being in control of experiencing it.

We know that trying to eradicate the pain often does not work. 

That is basically the essence of the 6-week Pain Truth program. Maximizing people's pleasures. 

And pleasure doesn't mean a cruise ship trip, it's not about those big things, it's about the little things, enjoying your cup of coffee, hanging out with a friend, etc., and when people understand that, their life actually changes.


"Persistent pain can eradicate pleasure
and persistent pleasure can eradicate pain"


More With Bahram

Get to know some of Bahram's newest courses on Embodia on our blog, Fascial Release, Male Pattern Baldness & Therapeutic Alliance: Dr. Bahram Jam’s New Courses

Or, click below to go to the courses directly: 

Bahram Jam

Bahram is a physiotherapist and founder of the Advanced Physical Therapy Education Institute (APTEI). He's taught 1000+ continuing education courses to healthcare professionals across Canada & internationally.

He has instructed over one thousand post-graduate orthopaedic and pain science courses and has been a guest presenter at several physiotherapy and medical conferences across Canada and internationally.

His primary clinical approach is to identify relevant functional impairments and determine the best self-management strategy to maximize patient independence.

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