Is My Pain Neuroplastic or a Mind-Body Concern?

 

By Alex Klassen MSW, RSW

Unfortunately, it’s not always easy to tell! After all, pain signals tell us (very convincingly) the body is in danger. It doesn’t feel like an easy thing to disagree with.

Let’s start with a quick definition of neuroplastic pain. Put concisely, neuroplastic pain occurs when your brain mistakes safe nerve signals from the body as dangerous, generating pain1. It’s a habitual mistake the brain can develop over time, which is why it’s called “neuroplastic”. You can think of it like an over-protective guard dog. A knock at the door may be a friendly visitor, but the reactive dog becomes too alarmed and starts barking. Research shows us that when the brain receives nerve signals from the body, “cognitive and emotional factors have a critically important influence on pain perception”2, meaning an over-protective brain can generate too much pain.

We’ll use the term “structural pain” in contrast to neuroplastic pain. Structural pain occurs when there’s an injury/physical problem in the body, and the brain accurately perceives these danger signals. The brain generates pain to tell us something is wrong, which needs our care and attention. This helps us stop, diagnose, and treat the structural problem.

If you’ve been experiencing chronic pain, we’re not suggesting you start viewing all the pain in your body as neuroplastic. We don’t want to jump too quickly to mind-body conclusions about the nature of the pain you’re feeling. The purpose of this post is to help you understand the signs of neuroplastic pain, so you can reflect on your experiences, engage in self-assessment, and get an idea if the pain you’re experiencing is treatable with a mind-body therapeutic approach3.

An important note: You don’t need to check off every point below for your pain to be neuroplastic. Some of my clients find nearly every one of these factors applies to their pain, while others only align with a few items, yet their pain is neuroplastic and reduced by therapy.


Sign 1: The Pain Isn’t Behaving Like Structural Pain

  1. Inconsistency

    Injuries and structural problems in the body typically hurt quite consistently. In contrast, when experiencing neuroplastic pain, my clients will often notice their pain changes day-to-day. Sometimes it’s quite confusing, as there’s no clear sense of why it feels better or worse. Because structural pain is caused by physical conditions that change slowly over time, quicker or more spontaneous shifts in sensation and intensity can suggest our pain is caused by the brain1.

  2. Spread and Movement

    The spread of pain symptoms often causes fear, confusion, and frustration, but on the bright side, it can suggest your pain is neuroplastic and curable. Structural pain is typically consistent and localized to injury sites or structural problems in the body. If your pain symptoms migrate around the body, move up and down, or become symmetrical, this suggests they may be neuroplastic rather than structural1.

  3. Multiple Symptoms

    If there are multiple pain spots occurring in your body that are difficult to explain, the brain may be the common denominator. While multiple chronic pain symptoms could be coming from multiple injuries or systemic disorders, it’s quite possible an over-protective brain is the central cause1.

  4. Pain is Triggered by Things that Shouldn’t Physically Hurt

    Stimuli and activities like weather, smells, foods, workplaces, crowded places or the time of day can become associated with pain. If the brain believes a certain stimuli/activity causes pain, we’ll feel in danger the next time we’re doing it. To protect us from the danger, our brain then triggers neuroplastic pain, reinforcing the connection between that stimuli/activity and pain. This is called a conditioned response. If you’re noticing triggers you wouldn’t expect to hurt are causing physical pain, be aware this pain could be neuroplastic1.

  5. Delayed Onset

    Sometimes we engage in a certain physical activity or task, and it feels ok in the moment, only for pain to emerge later. Structural pain doesn’t typically behave this way. Injuries should hurt when they happen, and structural problems should generate pain when they are aggravated by movement. Pain emerging following a physical activity may be neuroplastic, not structural1.

  6. Lacking Physical Diagnosis

    If you’ve had various scans, tests and assessments, and physicians and specialists are unable to find a structural problem to accurately explain your pain, it can suggest your pain is neuroplastic. Furthermore, many of our clients have been given a structural diagnosis, but their pain is neuroplastic. If you’ve received a diagnosis and tried many different physical treatments and medications, with little success, it can suggest that you’re trying to fix or heal problems in the wrong place. We always recommend extensive physical assessment from specialized medical providers. However, if no accurate structural problems can be found and treated, it may be time to shift your treatment focus from the body to the brain and nervous system1.


Sign 2: The Pain Is Connected to Emotion

  1. Pain Emerged During a Stressful Time or Life Transition

    During periods of stress and change, our brain may be functioning on high alert much of the time. This can make our environment, emotions, and body feel more dangerous. It’s in this unsafe, reactive brain-state that neuroplastic pain is more likely to develop1.

  2. Symptoms are Influenced by our Emotional State

    Problems in relationships, difficulties at work, and systemic stressors like loneliness, poverty, racism, gender-based oppression or sexual oppression can cause flare-ups and increases of pain. It is common for human beings to experience physical pain or symptoms during stressful or emotionally difficult times. If your pain is worse during stress and emotionally difficulty, and reduced when you feel safe and calm, it suggests the pain is neuroplastic1.

  3. High-Intensity Living

    Living our lives on-edge due to perfectionism, people-pleasing, worrying, controlling, and self-criticizing makes us more likely to develop chronic pain. While we all experience stress, maladaptive thinking habits and ways of navigating the world can make us feel chronically unsafe, resulting in neuroplastic pain symptoms1.


Sign 3: Predisposing Factors and Life Events

  1. Childhood Adversity

    Experiences of neglect, trauma, bullying, and accidents in childhood can lead to feeling unsafe in the world. Research shows strong connections between childhood adversity and chronic pain4,5. A brain that feels chronically unsafe is more at risk of developing neuroplastic pain and symptoms.

  2. Trauma

    Survivors of physical, sexual, and psychological trauma are much more likely to develop chronic pain. In fact, research shows between 10% and 50% of individuals diagnosed PTSD report chronic pain7. If the impacts of trauma are not processed and healed, a persistent sense of chronic danger and dysregulation in the nervous system can lead to the generation and amplification of neuroplastic pain symptoms8.

  3. Chronic Nervous System States of Fight/Flight/Freeze/Shutdown

    Pain is designed to protect us. So is entering a nervous system state of fight, flight, freeze, or shutdown. While our bodies are meant to move in and out of these danger responses, becoming stuck in states of dysregulation can trigger and perpetuate neuroplastic pain9. If you are experiencing chronic symptoms of fatigue, depression, dissociation, insomnia, anxiety, and/or anger, these are signs of nervous system dysregulation that can generate pain symptoms9, 10.

  4. Pathological Views of the Body

    In attempts to understand and fix the problem, chronic pain sufferers often collect a set of pathological beliefs about their bodies. Through interactions with various health professionals, forums, and online research, many unhelpful labels may be gathered. While structural diagnosis is meant to help with treatment, if the pain is neuroplastic, pathological labels can create confusion and increase fear, despair, and frustration. Viewing the body as broken, abnormal, or unable to heal increases emotional danger and avoidance behaviours, amplifying neuroplastic pain3.


Book a free 20-minute consultation with one of our therapists and begin your journey out of chronic pain today.

 

  1. Gordon, A., Ziv, A. (2021). The way out: A revolutionary, scientifically proven approach to healing chronic pain. Sony/ATV Music Publishing LLC.

  2. Crofford LJ. Chronic Pain: Where the Body Meets the Brain. Trans Am Clin Climatol Assoc. 2015;126:167-83. PMID: 26330672; PMCID: PMC4530716.

  3. Pain Reprocessing Therapy Center (2021). Pain reprocessing therapy training.

  4. Schubiner, H. & Kleckner, I. (2019). The neurophysiology and psychology of pain in psychophysiologic disorders. In D. Clarke, H. Schubiner, M. Clarke-Smith, & A. Abbass (Eds.), Psychophysiologic disorders: Trauma informed, interprofessioal diagnosis and treatment (pp. 45-68). Psychophysiologic Disorders Association.

  5. Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(36):1001-1006.

  6. Stickley A, Koyanagi A, Kawakami N. Childhood adversities and adult-onset chronic pain: results from the World Mental Health Survey, Japan. Eur J Pain. 2015;19(10):1418-1427.

  7. Gasperi, M., Afari, N., Goldberg, J., Suri, P., & Panizzon, M. S. (2021). Pain and Trauma: The Role of Criterion A Trauma and Stressful Life Events in the Pain and PTSD Relationship. The journal of pain, 22(11)

  8. Sharp TJ, Harvey AG: Chronic pain and posttraumatic stress disorder: Mutual maintenance? Clin Psychol Rev. 21:857–877, 2001

  9. Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. WW Norton & Co.

  10. Kolacz, J., & Porges, S. W. (2018). Chronic Diffuse Pain and Functional Gastrointestinal Disorders After Traumatic Stress: Pathophysiology Through a Polyvagal Perspective. Frontiers in medicine, 5, 145. https://doi.org/10.3389/fmed.2018.00145

 

Tanner Murtagh