By Tanner Murtagh MSW, RSW & Alex Klassen MSW, RSW

Many forms of chronic pain and symptoms are not caused by structural damage or systemic diseases, but occur due to a rewiring in the brain and nervous system^1,2,3. Neuroplastic symptoms are triggered and perpetuated when our danger circuits become sensitized by fearful beliefs about the body and dysregulation in the nervous system^4,5.

Neuroplastic pain/symptoms can develop due to:

1. Initial Injury
2. Perceived Injury
3. Stressful Situations or Life Transitions
4. Trauma and Childhood Adversity
5. Depression, Anxiety, or Obsessive Thinking
6. Maladaptive Coping Mechanisms
7. Feeling Unsafe in Your External World

 1. INITIAL INJURY

Neuroplastic pain/symptoms can begin with a structural injury or condition⁴. Typically, we’ll heal within a few weeks or months; our body is designed to heal. However, after the body has healed the brain may maintain the neural pathways associated with the pain/symptoms. Essentially, the brain continues trying to protect you, misinterpreting signals from your body and warning you with pain/symptoms, even though you’re safe⁶.  Fearful beliefs about the body, difficult emotions, and nervous system dysregulation can all cause pain to persist, spread, or worsen long after the body has healed⁴.

2. PERCEIVED INJURY

With chronic pain/symptoms, our primary fear is, “there is something wrong with my body”⁴. However, it’s common for us to incorrectly perceive an injury or problem. Research on pain/symptoms and the brain shows us that, in absence of physical damage, believing our body is damaged and expecting symptoms to occur can trigger, amplify, and maintain pain/symptoms in the brain^7,8,9.  We frequently hear stories of how fear of physical damage/disease worsened the symptoms our client's symptoms. Conversely, we also witness how education, gathering evidence for physical safety, and brain retraining exercises reduce the frequency and intensity of pain/symptoms.

 3. STRESSFUL SITUATIONS OR LIFE TRANSITIONS

Stressful situations and life transitions, even positive ones, can trigger neuroplastic pain/symptoms^3,4. Events such as divorce, work stressors/changes, going to university, having a baby, living through the pandemic, and experiencing the death of loved one can all cause difficult emotions and dysregulation in the nervous system. Chronic dysregulation can cause neuroplastic pain/symptoms because the brain becomes more sensitive when receiving signals from inside and outside the body². Remember, physical pain/symptoms are common when human beings feel in danger! The problem arises when pain/symptom sensations confuse and scare us, leading to scary and incorrect beliefs about our bodies that perpetuate pain/symptoms.

 4. TRAUMA AND CHILDHOOD ADVERSITY

Trauma can cause the brain and nervous system to become chronically dysregulated, leading to overactive responses of fight, flight, freeze, or shutdown⁵. Trauma and adverse childhood experiences increase the likelihood of chronic pain developing^10,11. In fact, adults are 2.7 times more likely to develop chronic widespread pain if they have significant trauma in their past, and 4 times more likely to develop chronic fatigue syndrome^10,12. The connection between trauma and chronic pain/symptoms makes sense, as trauma sensitizes the nervous system. Safe sensations from our bodies are accidentally viewed by the brain as dangerous, and so the brain generates pain/symptoms to (over)protect us.

5. DEPRESSION, ANXIETY, OR OBSESSIVE THINKING

Depression, anxiety, and obsessive thinking are all signs that the nervous system is dysregulated and functioning in survival mode^5,13. In our brain, the amygdala, posterior insula, anterior insula, anterior cingulate cortex, and mid cingulate cortex are involved in producing pain/symptoms, emotions, anxiety, and depression¹⁴. When we are experiencing mental health concerns, both emotional pain and physical pain/symptom sensations can be produced, as shared brain regions are responsible for both¹⁴.

  6. MALADAPTIVE COPING MECHANISMS

People with neuroplastic pain/symptoms commonly engage in coping mechanisms including avoidance of activities/movements, perfectionism and people pleasing⁴. These coping mechanisms typically helped us create safety at some point in our lives, but can also lead to sustained nervous system dysregulation⁴. For example, perfectionism can cause intense pressure and stress, people-pleasing can cause anxiety and lacking boundaries, and avoidance of activities/movements can lead to isolation, increased fear, and declining physical/mental health. Part of healing neuroplastic pain/symptoms is building more healthy daily behaviours.

 7. FEELING UNSAFE IN YOUR EXTERNAL WORLD

Social factors such as poverty, isolation, abusive or toxic relationships, race, gender and sexual orientation influence the likelihood of chronic pain/symptoms developing and persisting^15,16,17. Social experiences of violence, abuse, and oppression can cause us to feel unsafe in our communities, environments, and bodies. Remember, pain/symptoms are designed to alert us to danger; and when we feel unsafe in our internal or external world, neuroplastic symptoms can be triggered and perpetuated even though the body is healthy^3,4.

SUMMARY

As you can see, there are multiple factors in the development of neuroplastic pain/symptoms, unique to each person. The Somatic Safety Method course offers an effective, evidence-based process to help our community members understand how neuroplastic pain/symptoms developed, restore a sense of safety in their bodies, reduce symptoms, and live more fully.

References

1. Woolf C. J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2–S15. https://doi.org/10.1016/j.pain.2010.09.030
2. 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.
3. Gordon, A., Ziv, A. (2021). The way out: A revolutionary, scientifically proven approach to healing chronic pain. Sony/ATV Music Publishing LLC.
4. Pain Reprocessing Therapy Center (2021). Pain reprocessing therapy training.
5. Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. WW Norton & Co.
6. Hanscom, D. (2019). Making the right choice about spine surgery. In D. Clarke, H. Schubiner, M. Clarke-Smith, & A. Abbass (Eds.), Psychophysiologic disorders: Trauma informed, interprofessioal diagnosis and treatment (pp. 83-98). Psychophysiologic Disorders Association.
7. Castro, W. H., Meyer, S. J., Becke, M. E., Nentwig, C. G., Hein, M. F., Ercan, B. I., Thomann, S., Wessels, U., & Du Chesne, A. E. (2001). No stress--no whiplash? Prevalence of "whiplash" symptoms following exposure to a placebo rear-end collision. International journal of legal medicine, 114(6), 316–322. https://doi.org/10.1007/s004140000193
8. Bayer, T. L., Baer, P. E., & Early, C. (1991). Situational and psychophysiological factors in psychologically induced pain. Pain, 44(1), 45–50. https://doi.org/10.1016/0304-3959(91)90145-N
9. Picavet, H. S., Vlaeyen, J. W., & Schouten, J. S. (2002). Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. American journal of epidemiology, 156(11), 1028–1034. https://doi.org/10.1093/aje/kwf136
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(3), 174–186. https://doi.org/10.1007/s00406-005-0624-4
11. Green, C. R., FloweValencia, H., Rosenblum, L., & Tait, A. R. (2001). The role of childhood and adulthood abuse among women presenting for chronic pain. The Clinical Journal of Pain 17, 359-364.
12. Afari, N., Ahumada, S. M., Wright, L. J., Mostoufi, S., Golnari, G., Reis, V., & Cuneo, J. G. (2014). Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosomatic medicine, 76(1), 2–11. https://doi.org/10.1097/PSY.0000000000000010
13. Dana, D. (2019). 2-Day Workshop: Polyvagal Theory Informed Trauma Assessment and Interventions
14. Schubiner, H. & Kleckner, I. (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. 
15. 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
16. 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
17. 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