Episode 24: High Definition Pain

Highly Sensitive Nervous Systems and Chronic Pain: Sensory Processing Sensitivity, Allostatic Load, and What Actually Helps

Dr. Zev Nevo explains how highly sensitive persons (HSPs)—a neurobiological trait affecting about 20–33% of people—may experience chronic pain differently due to heightened sensory processing and insula activity, leading to vivid pain descriptions often misread as catastrophizing. He describes “bidirectional sensitization,” where sensory sensitivity amplifies pain and chronic pain further sensitizes the nervous system, shaped by central sensitization, autonomic dysregulation, and allostatic load. The episode introduces the validated 27-item Highly Sensitive Person Scale (HSPS) and outlines six sensitivity patterns (introverted, extroverted, empathic, sensory, intuitive, creative). It addresses misconceptions and offers strategies: patience, titrated “microdosed” exposure, interoceptive reframing to reduce hypervigilance, addressing allostatic load, pivoting to regulation during stress, and using objective data like HRV. Guidance is included for self-advocacy, provider practice, and cultural, gender, and lifespan factors.

00:00 Vivid Pain Dismissal

01:43 HSP Pain Link

03:24 Two Patients Contrast

06:40 Bidirectional Sensitization

09:03 Allostatic Load Bucket

12:42 HSPS Assessment Tool

16:59 Interoception Trap

21:42 Six Sensitivity Faces

28:49 HSP Pain Myths

33:27 Six Core Strategies

37:19 Balanced Sensation Tracking

37:45 Reduce Allostatic Load

39:21 Pivot Toward Neutral

40:34 Objective Data Trust

42:15 Self Advocacy Scripts

47:09 Patient Recovery Story

49:57 HSP Pain Neuroscience

54:39 Provider Clinical Framework

01:00:30 Culture Gender Lifespan

01:04:35 Final Healing Roadmap

01:08:39 Closing Thanks Share

REFERENCES & RESOURCES:

Sensory Processing Sensitivity & High Sensitivity

Morese R, Palermo S, Defedele M, et al. Sensory processing sensitivity and social pain: a hypothesis and theory. Front Hum Neurosci. 2023;17:1122849. doi:10.3389/fnhum.2023.1122849 [PMC]

Lionetti F, Aron A, Aron EN, et al. Dandelions, tulips and orchids: evidence for the existence of low-sensitive, medium-sensitive and high-sensitive individuals. Transl Psychiatry. 2018;8(1):24. doi:10.1038/s41398-017-0090-6

Hochreuter J, Wehrli S, Locher C, et al. Painfully sensitive: how sensory processing sensitivity affects healthy adolescents' perception of pain. J Pain Res. 2025;18:719-733. doi:10.2147/JPR.S473575 [PubMed]

Aron EN, Aron A, Jagiellowicz J. Sensory processing sensitivity: a review in the light of the evolution of biological responsivity. Pers Soc Psychol Rev. 2012;16(3):262-282. doi:10.1177/1088868311434213 [PubMed]

Allostatic Load & Stress

Ruiz-Robledillo N, Costa-López B, Moreno O, et al. Sensory processing sensitivity as a predictor of health-related quality of

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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack