Central pain gets stuck because the glial cells around the nerves in your brain and spinal cord flip into a Warburg-like emergency energy mode and fail to stand down. In that state they send out chemical byproducts that act as signals. Those signals keep your central nervous system on edge and locked in a pro-pain state.
Has your pain become constant and spread out? Does it seem to live in your nervous system instead of at the first injury? There may be a reason inside your cells. Around the nerves in your brain and spinal cord are support cells called glia . They can flip into a kind of emergency energy mode. In chronic pain, they can get stuck there. Then they keep sending signals that lock your central nervous system in a pro-pain state. This article is part of our Hidden Drivers of Chronic Pain series. It explains that switch and why it can be treated.
What are glial cells, and how do they change in chronic pain?
Your neurons do not work alone. They are surrounded and supported by glial cells. These include microglia, which act as the immune cells of the nervous system, and astrocytes, which give support and keep things in balance. When all is well, these glia keep a calm, steady setting for your neurons. But after nerve injury or long-term inflammation, the glia switch on. They shift into a defensive, reactive state. Part of that shift is a big change in how they make energy.
The Warburg-like metabolic switch
When glia switch on, they often go through a metabolic reprogramming similar to something called the Warburg effect . That is the same energy switch famously seen in cancer cells. They move away from slow, efficient energy making in the mitochondria (oxidative phosphorylation). They move toward fast, wasteful sugar burning (aerobic glycolysis). Why? Because this faster mode burns more fuel but gives the quick burst of energy needed for a fast immune and inflammation response. For a sudden threat, that makes sense. But this wasteful mode makes a lot of byproducts, especially lactate and other chemicals.
Why does central sensitization keep you hurting?
Those chemicals are not just waste. They act as signals that keep the central nervous system in a pro-pain state. The glia in emergency mode are, in effect, sending a chemical message: stay alert, stay on edge, and keep hurting. The switch is supposed to be short-lived. But in chronic pain, the glia can get stuck in this Warburg-like state and fail to stand down. As long as they stay switched on, they keep making the signal chemicals that maintain central sensitization . In that state the central nervous system itself turns the volume up. Pain is made and kept going in the brain and spinal cord, partly apart from the first site.
Is centralized pain “all in your head”?
Glial activation is one of the biggest advances in modern pain research. A large body of evidence shows that switched-on microglia and astrocytes drive and maintain central sensitization. The shift of these cells toward fast sugar burning is well documented. The role of chemicals like lactate as signals is better understood every year. So if you have been told, with a wave of the hand, that your pain is “in your head,” there is a deep irony. Centralized pain truly does involve real, physical changes in how the cells of your nervous system make energy. That does not mean it is imaginary. It means there is a cause, and a path.
How the Padda Institute approaches centralized pain
The aim is to calm the glia and the central sensitization they drive. The way in is to cut the inputs that keep the glia switched on. That means lowering the systemic inflammation and the metabolic dysfunction, and quieting the pain signals from the body that switch these cells on again and again. We use the full toolkit of this series. This means treating the energy and inflammation setting of the nervous system itself. As those drivers drop, the glia get the chance to power down out of their pro-pain emergency mode. The central sensitization can begin to unwind. Pain that had become self-sustaining can loosen its grip. This is a practice-based approach to a real, biological process; individual results vary.
Frequently asked questions
What does it mean when pain becomes "centralized"?
Centralized pain means the central nervous system itself has turned the volume up. It now makes and sustains pain partly apart from the first injury site. In the process described in this video, switched-on glial cells stuck in a pro-pain energy state help keep the nervous system on edge. It is a real, physical process, not something imaginary.
Is centralized pain permanent?
Not always. The glial switch that maintains central sensitization is meant to be short-lived. The approach described here works to cut the inputs that keep glia switched on. Then they can power down and the sensitization can begin to unwind. This is a practice-based approach to a documented biological process. Individual results vary.
Why Your Scan Doesn’t Match Your Pain: Central Sensitization Explained shows how central sensitization is turned down.
Can medication or supplements calm glial activation on their own?
The approach described focuses on lowering the body-wide inflammation, broken metabolism, and pain signals from the body that keep glia switched on. It does not rely on any single drug. Do not start, stop, or change any medication without consulting your physician. Individual results vary.
What causes central sensitization?
Nerve injury or long-term inflammation switches on the glial cells around the nerves in your brain and spinal cord. Once on, they flip into a Warburg-like emergency energy mode that pumps out lactate and other chemicals. Those chemicals act as signals that keep the central nervous system alert and on edge. The switch is meant to be short-lived; in chronic pain the glia get stuck in it.
How do you tell if you have central sensitization?
The telltale pattern is pain that has become constant and spread out. It seems to live in your nervous system instead of at the first injury. In central sensitization the brain and spinal cord themselves turn the volume up. So pain is made and kept going partly apart from where it started. A full exam sorts out how much of your pain is central and how much still comes from the body.
How do you fix central sensitization?
You take away what keeps the glia switched on. That means lowering body-wide inflammation, fixing broken metabolism, and quieting the pain signals from the body that switch these cells on again and again. That treats the energy and inflammation setting of the nervous system itself. As those drivers come down, the glia can power out of emergency mode. Then the sensitization can begin to unwind. Individual results vary.
Where are you located and how do I book?
Padda Institute Center for Interventional Pain Management, 4477 Woodson Rd, Suite 100, St. Louis, MO 63134. Book at painmd.tv/appointment/ or call (314) 481-5000.
Key takeaways
- Glial cells (microglia and astrocytes) can shift into a Warburg-like energy mode that drives pain.
- This process is well documented. Switched-on glia are known to maintain central sensitization.
- The switch is meant to be short-lived, so the goal is to calm the inputs that keep glia active.
- If your pain feels centralized, there is a mechanism and a path — start at painmd.tv/appointment/.
This article is educational and is not a substitute for evaluation, diagnosis, or treatment by a physician. Individual results vary. Do not start, stop, or change any medication without consulting your physician.
Find the source of your pain — not just the signal
Padda Institute Center for Interventional Pain Management builds a customized, root-cause plan for each patient. Interventional care and metabolic medicine, under one roof in St. Louis.
Or call or text us — 4477 Woodson Rd, Suite 100, St. Louis, MO 63134.
Msg & data rates may apply. Reply STOP to opt out, HELP for help. Text is not a secure channel — please don’t send medical or personal health information by text, and don’t use text for emergencies.
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP — Board Certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine, and Obesity Medicine. Last reviewed July 2026.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
