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Virtual rehabilitation of central sensitization syndromes

Modern medicine often fails to effectively manage complex chronic conditions. Physicians are often constrained by tightly packed clinic schedules, leaving only brief windows of time for each patient encounter. While this setup may allow for basic diagnosis and treatment planning, there is scarcely enough time for comprehensive patient education, let alone providing the necessary support, guidance, and empowerment that complex patients need.

Fortunately, the post-pandemic surge in telemedicine has brought fresh opportunities to address this deficiency. We now can offer virtual rehabilitation programs that were previously unfeasible in a standard clinic patient flow model. Here, I address how virtual rehabilitation can help a particularly difficult group of patients—those struggling with central sensitization syndromes (CSSs).

What are central sensitization syndromes?

Central sensitization syndromes (CSSs) are characterized by heightened sensitivity of the central nervous system (CNS), leading to increased perception of pain and other sensory stimuli. These syndromes stem from alterations in the way the CNS processes and interprets noxious signals, leading to exaggerated responses to various stimuli. They also often encompass a wide range of overlapping symptoms, including pain, fatigue, sleep disturbances, cognitive difficulties, and mood disorders. Examples of CSS conditions include:

  • Chronic pain
  • Temporomandibular myalgia
  • Fibromyalgia
  • Post-concussion syndrome
  • CNS symptoms of long COVID
  • Migraine
  • Chronic fatigue syndrome
  • Chronic or recurrent vertigo
  • Chronic tinnitus

The pathology and clinical management of CSSs are incompatible with the structure of most standard practices. Because conditions arise from aberrant neuroplastic changes in the CNS, patients need to engage in regular rehabilitative activities that help pathological neural networks heal. This requires active patient participation in lifestyle modifications, self-care practices, and psychological interventions, a level of care that is nearly impossible to implement in a standard clinic patient flow model.

Virtual rehabilitation in telemedicine

Several features of telemedicine make it compatible with structured rehabilitation. This allows intense patient interaction and support, taking complex patients out of the standard clinic model and into a virtual environment where they can get the level of care they need.

Here is a partial list of features that can be incorporated into virtual rehabilitation programs for CSS patients:

Asynchronous patient education. Telemedicine allows for the delivery of educational materials asynchronously, meaning patients can access and review information at their convenience. This flexibility accommodates patients’ schedules and ensures they have ample time to absorb and understand the material provided. In our model, we use a recorded hour-long “clinic visit” to initiate treatment. This is the time we wish we could spend with new CSS patients, but simply cannot.

High clinical touch points. Telemedicine facilitates frequent and regular interactions between health care providers and patients, leading to high clinical touch points. This allows our advanced practice nursing providers to engage in regular supportive care. In our clinic, we have integrated motivational interviewing techniques borrowed from health coaching into the clinical encounter.

Mixed platforms. Telemedicine platforms integrate with mobile apps for patient education and engagement. Patients access educational materials, track symptoms, and monitor progress. Online learning complements traditional services, offering continuous support beyond appointments. For instance, we use an online cognitive behavioral therapy (CBT) app that parallels our program.

E-journaling, Telemedicine platforms may include features for electronic journaling or tracking of symptoms, progress, and activities. Patients can conveniently record their daily experiences, exercise routines, or medication adherence, providing valuable data for health care providers to asynchronously assess and adjust the rehabilitation plan as needed. Our electronic health record (EHR) system allows for this.

M-health. Telemedicine integrates with mobile health (m-health) technologies, such as wearable devices or smartphone apps, to facilitate remote monitoring and management of patients’ health. For instance, in one of our programs, we use an m-health platform to provide customized and adjustable tinnitus masking sound files for our patients.

Remote exercise monitoring. Telemedicine platforms can incorporate tools for remote monitoring of patients’ exercise sessions. This may include video demonstrations of exercises, wearable technology for tracking movement and intensity, and feedback mechanisms to ensure proper form and adherence to prescribed exercises. For instance, our EHR system integrates with FitBit wearables.

Patient convenience. One obstacle to rehabilitation is the time it requires on the part of the patient. Telemedicine provides convenient access to health care for working professionals, allowing virtual appointments to seamlessly fit into their busy schedules without the need for time off or travel to a physical clinic.


The post-pandemic era has seen a revolution in telemedicine, with its applications now beginning to be fully realized. Here, we demonstrate how telemedicine enables an efficient model for treating complex CSS patients, providing a transformative solution to the challenges posed by these conditions within traditional clinic structures. This comprehensive approach fosters patient engagement, adherence, and long-term recovery, marking a significant advancement in CSS management.

Hamid Djalilian is an otolaryngologist. 


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