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 Send us Fan Mail This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms. About Dr. Nevo Read what patients are saying... LINKS: Body and Mind Pain CenterMind Body RehabilitationSubstack