Allodynia is pain caused by something that normally wouldn’t hurt. It can happen with several neurological conditions and is a type of chronic pain. Something as simple as clothing brushing your skin or a breeze on your face can set it off. The pain may even be felt somewhere other than where you were touched. Allodynia can range from an odd, unexpected twinge to severe, disabling pain.
Because allodynia is usually caused by another condition, it’s important to have it evaluated by your physician. If you are struggling with thoughts of harming yourself, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or call 911.
How Common Is Allodynia?
The exact number of people with allodynia is hard to know, since it occurs with many different conditions. Neuropathic pain, a common cause of allodynia, affects an estimated 7% to 10% of people (1), and an estimated 15% to 50% of people with neuropathic pain have allodynia (2). Allodynia is also common in migraine, where about 6 in 10 people with migraine experience it during attacks (3).
What Are the Symptoms of Allodynia?
The main symptom of allodynia is pain from sensations that normally aren’t painful. Temperature changes, pressure on the skin or clothing moving against the skin can all cause pain (4).
Allodynia usually happens because of another neurological condition, so people often have symptoms of that condition too.
If allodynia comes with fibromyalgia, you may also have depression, anxiety, fatigue, sleep problems and trouble concentrating.
If it comes with migraine, you may also have headaches, sensitivity to light and sound, visual changes and nausea. Many people with migraine-related allodynia say that even their hair hurts during an attack (5).
What Causes Allodynia?
Allodynia is caused by changes in the way the central nervous system processes pain, called central sensitization. The pathways in the spinal cord, brainstem and brain that carry pain signals become overly sensitive, so almost any sensation can be felt as pain (6).
Allodynia usually results from another condition. The most common are fibromyalgia, migraine, peripheral neuropathy and postherpetic neuralgia.
Fibromyalgia. Fibromyalgia causes widespread pain in the muscles and joints. It sometimes begins after an injury, but it can continue and spread long after the injury heals. It appears to involve changes in how the spinal cord, brainstem and brain process pain, and it may be triggered by stress, viral infections or immune system changes (7).
Migraine. Migraine is a brain disorder that causes severe, recurring headaches and involves changes in brain activity, brain chemistry and inflammation. When migraines are frequent or long-lasting, they can lead to allodynia, usually across the head and face.
Peripheral neuropathy. Peripheral neuropathy is damage to the nerves outside the brain and spinal cord. It can be caused by injury, chemical or toxic exposures, and metabolic conditions such as diabetes. Depending on which nerve fibers are damaged, it can cause allodynia in the area served by those nerves.
Postherpetic neuralgia. Shingles is caused by the varicella zoster virus, the same virus that causes chickenpox. The virus can reactivate in nerve clusters and cause a painful rash along a nerve. Allodynia is very common after a shingles outbreak.
What Happens in the Nervous System With Allodynia?
The exact cause of allodynia isn’t fully understood. One theory is that touch-sensing nerve fibers form new connections in the spinal cord and begin to activate pain pathways (8). Other research suggests that nerves near the surface of the skin are involved. Parts of the brain’s emotional system, the limbic system, also seem to play a role, since emotional states can change how strongly allodynia is felt (2).
How Is Allodynia Diagnosed?
Because allodynia is so distinctive, it is usually fairly easy to recognize on exam. A diagnosis of allodynia usually leads to a closer look for the underlying condition causing it, so that condition can be treated too.
How Is Allodynia Usually Treated?
Treatment depends on the underlying condition. Nerve pain is often treated by a physician with medications such as certain antidepressants and anti-seizure medications, which can calm overactive pain pathways (9). Other pain relievers, topical treatments and, less often, stronger medications may also be used. Your physician can help weigh the benefits and side effects of each option. Counseling and approaches such as cognitive behavioral therapy can also help people cope with chronic pain.
How Does Allodynia Affect Your Life?
Allodynia can get worse over time as the overactive pain pathways become stronger and more efficient. It can make school and work harder, limit social activities and relationships, and take a toll on mental and emotional health.
How the NeuroRescue Program Can Help
Our care is designed to work alongside your physician and other providers, never in place of them. Please don’t change or stop any medication without talking with your prescriber.
Managing allodynia often takes more than treating the original condition or trying to block pain signals. We take a broad approach that looks at the many parts of the nervous system involved in pain, from the sensors in your skin and the nerves of your body, to the spinal cord and brainstem, to the cerebellum and basal ganglia, and to the frontal and parietal lobes and the brain’s emotional centers. This is the foundation of the NeuroRescue Program.
Research suggests spinal adjustments may do more than move a joint. Studies using EEG, brain stimulation and brain imaging have found that adjustments can produce short-term changes in how the brain processes sensory and movement information, including in the prefrontal cortex and the areas that plan and control movement (10, 11, 12, 13). Research also suggests spinal manipulation can reduce pain sensitivity, likely in part through effects on how the spinal cord processes pain signals (14). Researchers are still working to understand how long these changes last and how they relate to symptoms, but they help explain why we look at how your whole nervous system is working, not just the painful area.
Depending on your needs and test results, your program may include chiropractic adjustments and other manual therapies, used gently and only when appropriate and safe for you; electrical stimulation (15), low-level laser therapy (16) and exercises in a virtual reality environment (17), which have been studied for pain related to central sensitization, along with targeted neurological rehabilitation exercises. Transcranial magnetic stimulation (TMS) has also been studied for this type of pain (18). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it may be appropriate for you. The therapies we recommend are always chosen based on your testing and exam findings, and we pace your program carefully so it challenges your nervous system without flaring your pain.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function in the systems that need support and helping them work together. Our testing also helps us decide when to push and when to let you rest.
Our goal is to help turn the volume down on your pain, so everyday touch, clothing and movement can feel more comfortable again.
Your Next Step
Living with pain from things that shouldn’t hurt can be exhausting and isolating, especially when others don’t understand. You don’t have to face it alone. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
