Central pain syndromes can cause burning, electric, hypersensitive, widespread, or persistent pain when the nervous system amplifies or maintains pain signals.
Learn how Dr. Siefferman diagnoses and treats central pain syndromes, helping patients better understand persistent pain and explore personalized options for long-term relief.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hi, I’m Dr. Jason Siefferman, medical director at 91视频. Central pain syndromes are some of the more complex conditions that we see and treat. What this means is that there’s a problem in the central nervous system causing a pain signal that is not arising from a peripheral structure.
There’s not a joint, muscle, bone, nerve, something signaling pain to the brain. The pain is already ingrained in the spinal cord or the brain itself. In this situation, we really do have to confirm that there isn’t an ongoing driving source peripherally because if there is and it was missed, that’s an easy treatment pathway. Once we’ve established that there are no ongoing peripheral stimulators of pain, then we focus on how we can modulate the central pain processing. This may include medications to downregulate the nervous system sensitivity.
It may include some injections of the sympathetic plexus or sympathetic ganglia. We often use neuromodulation in this situation with dorsal root ganglion stimulators, spinal cord stimulators, peripheral nerve stimulators and then of course there’s a range of psychological integrative therapies which we use for this which may include biofeedback, transcranial magnetic stimulation and EMDR. Regardless, we will strive to understand exactly what’s happening, why it’s persisting and find an avenue of approach that gives hopefully some relief.
Central pain syndromes are conditions in which the central nervous system plays a major role in generating, amplifying, or maintaining pain. Central pain syndrome may develop after damage to or dysfunction of the brain, brainstem, or spinal cord, such as after stroke, spinal cord injury, multiple sclerosis, or brain injury.
Centralized pain or central sensitization can also occur when the nervous system becomes more sensitive over time, making pain feel stronger, spread more widely, or persist after tissues have healed.
Symptoms may include burning, tingling, stabbing, cold pain, pins and needles, touch sensitivity, movement sensitivity, or pain that feels out of proportion to imaging findings.
At 91视频, evaluation begins by identifying whether pain appears central, peripheral, musculoskeletal, inflammatory, autonomic, pelvic, headache-related, or mixed.
For patients looking for central pain syndrome treatment in Manhattan, MPM uses a diagnosis-first approach to understand the nervous system pattern, prior neurologic history, pain distribution, sensitivity, triggers, function, sleep, and emotional burden.
Care may include medication management, pain psychology, biofeedback, acupuncture, Feldenkrais, botulinum toxin injections for selected headache or muscle-related patterns, and coordination with neurology, rehabilitation, psychology, or other specialists when needed.
Central pain can be difficult for patients because imaging or local tissue findings may not fully explain the intensity, spread, or persistence of symptoms. This does not mean the pain is imagined or exaggerated. It may mean that the brain, spinal cord, and nervous system have become more involved in how pain is processed.
A diagnosis-first approach helps separate central nervous system injury, central sensitization, peripheral neuropathy, CRPS, headache disorders, pelvic pain, musculoskeletal pain, inflammatory pain, autonomic dysfunction, and emotional threat processing.
MPM evaluates these layers carefully so the care plan is not based on one assumption. The goal is to understand whether pain is driven mainly by a neurologic condition, a persistent peripheral pain generator, nervous system amplification, or a combination of contributors.
Central pain syndromes fit across several MPM Zones of Expertise, including Complex Chronic Pain, Headache, Psychology of Pain, Autonomic Dysfunction, and Pelvic Pain. This matters because central pain can appear in many forms. A patient may have widespread pain, burning nerve pain, chronic headache, pelvic pain, CRPS overlap, autonomic symptoms, or pain that persists after an injury has healed.
MPM uses the Zones of Expertise framework to evaluate whether symptoms appear centrally mediated, neuropathic, headache-related, pelvic, autonomic, musculoskeletal, inflammatory, or mixed. For some patients, the priority is neurologic coordination. For others, the focus is nervous system regulation, medication management, movement, pain psychology, and rebuilding function over time.
I cannot say enough good things about 91视频. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional 鈥� knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit 91视频 because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I鈥檝e suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I鈥檓 feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor鈥檚 office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at 91视频. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I鈥檓 finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Central pain syndrome is a neurologic pain condition caused by damage to or dysfunction of the central nervous system, which includes the brain, brainstem, and spinal cord. It may occur after stroke, spinal cord injury, multiple sclerosis, brain injury, or other neurologic conditions. Pain may continue even when there is no active injury in the painful body part itself because the nervous system is generating or amplifying pain signals. Central pain is real and biologic, but it should be evaluated carefully because similar symptoms can occur with neuropathy, CRPS, musculoskeletal pain, infection, inflammatory disease, or other conditions.
Central pain may feel burning, stabbing, electric, cold, aching, tingling, or like pins and needles. Some patients experience severe sensitivity to light touch, pressure, movement, temperature changes, stress, or fatigue. Pain may be localized to one area or spread more widely. Some people feel pain after stroke, spinal cord injury, multiple sclerosis, or brain injury. Others describe pain that feels stronger than expected based on imaging or tissue findings. The exact pattern depends on the nervous system pathways involved and whether other pain generators are also present.
Central sensitization describes increased sensitivity in the nervous system. When this occurs, pain may feel stronger, spread more widely, last longer, or continue after tissues have healed. A person may become more sensitive to touch, movement, pressure, temperature, sound, stress, or fatigue. Central sensitization is not the same as imagining pain. It reflects changes in how the nervous system processes signals. It can overlap with fibromyalgia-like pain, CRPS, headache, pelvic pain, post-COVID pain, neuropathy, and long-standing musculoskeletal pain.
Central pain syndromes may be caused by stroke, spinal cord injury, multiple sclerosis, brain injury, central nervous system disease, CRPS, or other neurologic conditions. Centralized pain can also develop when pain continues for a long time and the nervous system becomes more reactive. In some patients, central pain overlaps with peripheral nerve pain, musculoskeletal pain, headache disorders, pelvic pain, autonomic dysfunction, trauma physiology, or inflammatory conditions. The cause is not always one single event. A careful evaluation helps determine whether pain is central, peripheral, structural, inflammatory, autonomic, or mixed.
Central pain syndromes are diagnosed through medical history, neurologic review, physical examination, symptom pattern, prior imaging, and evaluation for other causes. Testing may be used to assess stroke, spinal cord injury, multiple sclerosis, brain injury, neuropathy, inflammatory disease, or other neurologic concerns. No single test explains every case of central pain. Clinicians must also consider peripheral neuropathy, CRPS, musculoskeletal pain, headache disorders, pelvic pain, infection, endocrine disorders, medication effects, and psychiatric distress. Diagnosis-first care helps avoid both dismissal and over-attribution to one cause.
Treatment depends on the cause and pain pattern. Options may include medication management, pain psychology, biofeedback, graded movement, acupuncture, Feldenkrais, sleep support, function-focused rehabilitation, and coordinated neurologic care when needed. Certain antidepressant or anticonvulsant medications may be used for nerve-related or centralized pain in selected patients. Botulinum toxin injections may be considered when central pain overlaps with selected headache or muscle-related patterns. Procedures are used only when a specific pain generator is identified. Treatment is usually multimodal because central pain often involves both pain signaling and function.
Yes. Pain psychology can help central pain by supporting nervous system regulation, coping, sleep, stress management, fear of movement, pacing, and emotional recovery from long-term pain. It does not mean the pain is imagined, exaggerated, or purely emotional. Central pain is a real nervous system condition. Pain psychology helps patients work with the brain and nervous system while medical care continues. It may also help patients communicate symptoms, reduce pain-related fear, rebuild activity gradually, and improve quality of life.
Seek urgent medical evaluation for new weakness, facial droop, speech difficulty, sudden severe headache, loss of bladder or bowel control, new numbness, rapidly worsening neurologic symptoms, fever, trauma, confusion, chest pain, shortness of breath, or sudden major change in function. These symptoms may suggest stroke, spinal cord compression, infection, vascular disease, neurologic injury, or another urgent condition. Central pain should not be assumed when new or rapidly changing neurologic symptoms are present.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Central pain syndromes are conditions in which the brain, brainstem, or spinal cord plays a major role in generating, amplifying, or maintaining pain. In true central pain syndrome, pain may follow damage to or dysfunction of the central nervous system, such as stroke, spinal cord injury, multiple sclerosis, brain injury, or another neurologic condition. In centralized pain or central sensitization, the nervous system becomes more sensitive over time, which can make pain feel stronger, more widespread, or more persistent than expected.
Central pain can be especially frustrating because the painful body part may not show obvious damage on imaging. A patient may be told that the scan looks stable or that the tissue has healed, yet the pain remains severe. This does not mean the pain is imagined. It may mean that the nervous system itself has become part of the pain generator.
Central pain can feel burning, electric, stabbing, cold, tingling, aching, or like pins and needles. Some patients experience severe sensitivity to touch, temperature, movement, pressure, or stress. Clothing, a bedsheet, a shower, light pressure, or normal movement may feel painful. Pain may be localized to one region or spread across a wider area.
Symptoms may worsen with fatigue, poor sleep, emotional stress, physical activity, weather changes, temperature changes, or sensory stimulation. Some patients also experience brain fog, dizziness, autonomic symptoms, headaches, pelvic pain, muscle guarding, or fear of movement. The symptom pattern can feel confusing because the nervous system is involved in many body functions.
Central pain syndrome usually refers to pain caused by central nervous system injury or disease. This may include pain after stroke, spinal cord injury, multiple sclerosis, or brain injury. Central sensitization refers to a state in which the nervous system becomes more reactive and amplifies pain signals. Central sensitization may occur with long-standing pain, CRPS, fibromyalgia-like symptoms, chronic headache, pelvic pain, post-COVID pain, peripheral neuropathy, or persistent musculoskeletal pain.
These terms are related but not identical. A patient can have central nervous system injury, peripheral nerve input, musculoskeletal pain, and central sensitization at the same time. This is why MPM evaluates the full pain picture rather than assuming one label explains everything.
Central pain may develop after stroke, spinal cord injury, multiple sclerosis, traumatic brain injury, or other neurologic conditions. It may also overlap with CRPS, peripheral neuropathy, headache disorders, pelvic pain, autonomic dysfunction, fibromyalgia-like pain, post-COVID pain, and long-standing musculoskeletal conditions.
In some patients, ongoing pain input from the body keeps the nervous system on high alert. Over time, pain pathways may become more sensitive. This can make normal sensations feel painful, cause pain to spread, or make symptoms persist after tissue healing. Emotional threat, trauma, sleep disruption, stress physiology, and fear of movement can further affect the nervous system, but they do not make the pain less real.
MPM begins with a detailed clinical history. This includes pain location, pain quality, neurologic history, stroke or spinal cord injury history, multiple sclerosis, brain injury, CRPS, neuropathy, headache, pelvic pain, autonomic symptoms, prior imaging, medications, procedures, physical therapy, sleep, function, and emotional burden.
The evaluation asks several questions. Is there evidence of central nervous system injury? Is there ongoing peripheral nerve input? Are there musculoskeletal or inflammatory pain generators? Is the pain pattern consistent with CRPS? Are headache, pelvic pain, autonomic dysfunction, or fibromyalgia-like symptoms contributing? Are fear of movement, sleep disruption, or trauma physiology amplifying the pain system?
Testing may be needed when neurologic disease, infection, inflammatory disease, vascular disease, endocrine disorders, medication effects, or other conditions are possible. MPM may coordinate with neurology, primary care, rehabilitation, psychology, or other specialists depending on the clinical picture.
Central pain treatment is usually multimodal. Medication management may include medications that target neuropathic or centralized pain pathways, such as selected antidepressant or anticonvulsant medications, when appropriate. Treatment choices depend on diagnosis, symptoms, side effects, medical history, and current medications.
Pain psychology can support nervous system regulation, coping, sleep, fear of movement, trauma response, pacing, and function. Biofeedback may help patients learn how stress physiology, breathing, muscle tension, and autonomic activation interact with symptoms. Acupuncture may be considered as part of a broader chronic pain plan. Feldenkrais or other movement-based approaches may help patients rebuild safer, less threatening movement patterns when the body has become guarded or sensitive.
Botulinum toxin injections may be considered only for selected symptom patterns, such as certain headache conditions or muscle overactivity, not as a general treatment for all central pain. Procedures may be considered when a specific peripheral pain generator is found, but central pain treatment should not rely on procedures alone.
Pain psychology is often misunderstood. It is not a statement that pain is emotional or imagined. It is a treatment approach that recognizes how pain, stress, attention, sleep, fear, trauma, movement, and nervous system sensitivity interact. For patients with central pain, these tools can be especially important because the central nervous system is already involved in amplifying or maintaining symptoms.
Pain psychology and biofeedback may help patients reduce fear of movement, pace activity, communicate symptoms, improve sleep habits, manage flare-related distress, and build strategies for daily function. These tools are most effective when they are integrated with medical evaluation and an appropriate physical care plan.
Central pain should not be assumed when symptoms are new, sudden, rapidly worsening, or neurologically concerning. Patients should seek urgent evaluation for new weakness, facial droop, speech difficulty, sudden severe headache, loss of bladder or bowel control, new numbness, rapidly worsening neurologic symptoms, fever, trauma, confusion, chest pain, shortness of breath, or sudden major change in function. These symptoms may require emergency, neurologic, or medical evaluation.
MPM approaches central pain syndromes through a diagnosis-first, coordinated model. The evaluation considers central nervous system injury, central sensitization, CRPS, peripheral neuropathy, headache pathways, pelvic pain, autonomic dysfunction, musculoskeletal pain, inflammatory contributors, sleep, stress physiology, and function.
For patients looking for central pain syndrome treatment in Manhattan, MPM offers a careful, patient-centered approach to nervous system-related pain. The goal is to clarify whether pain is central, peripheral, structural, inflammatory, autonomic, pelvic, headache-related, or mixed, then build a coordinated plan that supports symptom management, nervous system regulation, and function over time.
