WHAT IS NEUROPLASTIC PAIN/PSYCHOPHYSIOLOGIC DISORDER/MIND-BODY SYNDROME?

All of these terms are basically equivalents, and mean that the pain or other symptoms one is experiencing are caused and amplified by psychological processes and are not due to disease or structural damage in the body1. What occurs is the brain misinterprets safe signals from the body as if they are dangerous, due to a person being stuck in a state of survival, and as a result produces pain or other symptoms2. The factor that drives the pain to be created, amplified, and maintained is when our brain and nervous system are in a prolonged state of danger or survival. It is important to note that the pain or other symptoms are real and occur in the brain3.


WHAT CAUSES NEUROPLASTIC PAIN/PSYCHOPHYSIOLOGIC DISORDER/MIND-BODY SYNDROME?

There are several contributing factors that can cause neuroplastic pain or symptoms to occur. These include2,3,4,5,6,7,8,9,10:

  • Belief the body is permanently damaged or flawed
  • Responding to our pain or symptoms with fear, worry, frustration, despair, grief, or anger
  • Anxious and depressive symptoms
  • Unprocessed trauma impacting nervous system functioning
  • Nervous system dysregulation, meaning being stuck in a fight, flight, freeze, or shutdown state for prolonged periods of time
  • High-alert behaviours such as perfectionism, people-pleasing, placing pressure on ourselves, excessive control, self-criticism, worrying, and/or obsessive thinking
  • Social and environmental factors that create a sense of danger


WHAT MEDICAL CONDITIONS COULD POTENTIALLY BE NEUROPLASTIC PAIN/PSYCHOPHYSIOLOGIC DISORDER/MIND-BODY SYNDROME?

Many conditions are neuroplastic or have a neuroplastic component, including the following1,2:

  • Fibromyalgia
  • Chronic neck and back pain
  • Abdominal and pelvic pain
  • Irritable bowel syndrome
  • Non-ulcer dyspepsia
  • Headaches
  • Complex regional pain syndrome (CRPS)
  • Vestibular concerns and dizziness
  • Tinnitus
  • Chronic fatigue syndrome (CFS)
  • Postural orthostatic tachycardia syndrome (POTS)
  • Myofascial pain syndrome
  • Chemical sensitivities
  • Irritable bladder syndrome (interstitial cystitis)

*It is always important to meet with a physician in order for structural damage and disease to be ruled out.


HOW IS NEUROPLASTIC PAIN/PSYCHOPHYSIOLOGIC DISORDER/MIND-BODY SYNDROME ASSESSED FOR IN THERAPY?

Our therapist supports clients in looking for likeliness that there pain or physical symptoms are neuroplastic in nature. Here are the criteria we utilize:


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

  1. Inconsistency

    2. 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 brain2.

  2. Spread and Movement

    3. 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 structural2.

  3. Multiple Symptoms

    4. 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 cause2.

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

    5. 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 neuroplastic2.

  5. Delayed Onset

    6. 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 structural2.

  6. Lacking Physical Diagnosis

    7. 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 system2.


Sign 2: The Pain is Connected to Emotion

  1. Pain Emerged During a Stressful Time or Life Transition

    2. 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 in danger. It’s in this unsafe, reactive brain-state that neuroplastic pain is more likely to develop2.

  2. Symptoms are Influenced by our Emotional State

    3. 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 in 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 neuroplastic2.

  3. High-Intensity Living

    4. 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 symptoms2.


Sign 3: Predisposing Factors and Life Events

  1. Childhood Adversity

    2. 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 pain12,13,14. A brain that feels chronically unsafe is more at risk of developing neuroplastic pain and symptoms.

  2. Trauma

    3. 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 pain15. 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 symptoms16.

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

    4. 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 pain6. 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 symptoms6,17.

  4. Pathological Views of the Body

    5. 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 pain11.


*Please note it is important to meet with a medical professional to ensure neuroplastic pain is assessed for properly. Please do not use these criteria to diagnose yourself. We request all of our clients first see a physician to ensure medical conditions with a clear structural cause have been ruled out. For a formal diagnosis of neuroplastic pain, we refer our clients to physicians specialized in it.


WHAT IS THE TREATMENT FOR NEUROPLASTIC PAIN/PSYCHOPHYSIOLOGIC DISORDER/MIND-BODY SYNDROME?

Our approach utilizes tools and education from Pain Reprocessing Therapy, Polyvagal Theory, Emotional Awareness and Expression Therapy, and other cognitive, somatic, behavioural, and trauma-focused therapies, to treat chronic pain and symptoms. We use a detailed and holistic approach focused on 5 main areas:

  1. Changing thoughts and beliefs
  2. Retraining the brain through gradual exposure
  3. Processing emotions
  4. Treating trauma and regulating the nervous system
  5. Increasing social safety

Our approach is one of the most comprehensive approaches to healing chronic pain and symptoms by treating the brain and nervous system.


HOW LONG DOES IT TAKE TO TREAT NEUROPLASTIC PAIN/PSYCHOPHYSIOLOGIC DISORDER/MIND-BODY SYNDROME?

Treatment length for neuroplastic pain and symptoms differs for each person. The length of time a person’s symptom has been occurring, their mental health concerns, their level of nervous system dysregulation, and social factors in their life can impact the time it takes to rewire their brain and nervous system to reduce or eliminate their chronic pain or symptoms.


 

  1. Clarke, D. D., & Schubiner, H. (2019). Introductions. In D. Clarke, H. Schubiner, M. Clarke-Smith, & A. Abbass (Eds.), Psychophysiologic disorders: Trauma informed, interprofessioal diagnosis and treatment (pp. 5-25). Psychophysiologic Disorders Association.

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

  3. Kirwilliam, S. S., & Derbyshire, S. W. G. (2008). Increased bias to report heat or pain following emotional priming of pain-related fear. Pain 137(1), 60-65.

  4. Barrett, L., & Simmons, W. K. (2015). Interoceptive predictions in the brain. Nature Reviews Neuroscience 16, 419-429.

  5. Kross, E., Berman, M. G., Mischel, W., Smith, E. E., Wager, T. D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences of the USA 108, 6270-6275.

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

  7. Mills, S. E. E., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: a review of its epidemiology and associated factors in population-based studies. British journal of anaesthesia, 123(2), e273–e283. https://doi.org/10.1016/j.bja.2019.03.023

  8. Schubiner, H., Jackson, B., Molina, K. M., Sturgeon, J. A., Sealy-Jefferson, S., Lumley, M. A., Jolly, J., & Trost, Z. (2023). Racism as a Source of Pain. Journal of general internal medicine, 38(7), 1729–1734. https://doi.org/10.1007/s11606-022-08015-0

  9. Zajacova, A., Grol-Prokopczyk, H., Liu, H., Reczek, R., & Nahin, R. L. (2023). Chronic pain among U.S. sexual minority adults who identify as gay, lesbian, bisexual, or "something else". Pain, 164(9), 1942–1953. https://doi.org/10.1097/j.pain.0000000000002891

  10. Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., Dube, S. R., & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience 256, 174-186.

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

  12. 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.

  13. 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.

  14. 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.

  15. 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)

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

  17. 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