By Alex Klassen MSW, RSW

Unfortunately, it’s not always easy to tell! After all, pain/symptom signals tell us (very convincingly) the body is in danger. It doesn’t feel like an easy thing to disagree with. This why our course provides an in-depth assessment to help you understand what’s happening in your body and mind.

Neuroplastic pain/symptoms occur when the brain mistakes safe signals from the body as dangerous, generating pain/symptoms to protect you¹. It’s a habitual mistake the brain develops 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 very alarmed and starts barking. Research shows us that when the brain receives the input of signals from the body, cognitive, memory and emotional factors have a critical influence on whether or not it generates pain/symptoms².

We’ll use the term “structural pain/symptoms” in contrast to neuroplastic pain/symptoms. Structural pain/symptoms occur when there’s an injury or physical problem in the body, and the brain accurately perceives these danger signals. These pain/symptoms protect us, showing 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/symptoms, we’re not suggesting you start viewing all your symptoms as neuroplastic. We don’t want to jump too quickly to this conclusion. The purpose of this post is to help you understand the signs of neuroplastic pain/symptoms, so you can reflect on your experiences, engage in self-assessment, and get an idea if the pain you’re experiencing is suitable for The Somatic Safety Method course³.

An important note: You don’t need to check off every point below for your pain/symptom to be neuroplastic!

CATEGORY 1: THE PAIN/SYMPTOM ISN’T BEHAVING LIKE STRUCTURAL PAIN

Inconsistency

Structural Injuries, damage, and diseases in the body typically behave quite consistently. In contrast, when experiencing neuroplastic pain/symptoms, our clients often notice their symptoms change day-to-day. Sometimes it’s quite confusing, as there’s no clear sense of why it feels better or worse. Because structural pain/symptoms are caused by physical conditions that change slowly over time, quicker or more spontaneous shifts in sensation location and intensity can suggest they are neuroplastic¹.

Spread and Movement

The spread of symptoms often causes fear, confusion, and frustration, but on the bright side, it can suggest your pain/symptom is neuroplastic and treatable with a mind-body approach. Structural pain/symptoms are typically localized to injury sites or structural problems in the body. If your symptoms have migrated around the body over time, or become symmetrical, this suggests they may be neuroplastic rather than structural¹.

Multiple Symptoms

If there are multiple symptoms 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 injuries or systemic disorders, when medical assessment finds no structural cause or cure, it suggests a sensitized brain is the central cause¹.

Pain/Symptoms are Triggered by Things that Shouldn’t Cause Problems

Stimuli and activities like weather, smells, foods, workplaces, noises, or lighting can become associated with pain/symptoms. If the brain believes certain stimuli are dangerous, we’ll feel emotionally dysregulated the next time we’re exposed to it. To protect us from the danger, our brain triggers neuroplastic pain/symptoms, reinforcing the idea that the stimuli is indeed dangerous. This is called a conditioned response. If you’re noticing triggers you wouldn’t expect to harm you are causing physical pain/symptoms, it could be neuroplastic¹.

Delayed Onset

Sometimes we engage in a physical activity or task, and it feels ok in the moment, only for pain/symptoms to emerge later. Structural pain/symptoms don’t typically behave this way. Injuries and dangerous movement/stimuli should cause symptoms when they happen. Pain/symptoms emerging following exposure to a movement, activity, or stimuli are often neuroplastic, not structural¹.

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/symptoms, it can suggest they are neuroplastic. Furthermore, many of our clients have been given a structural diagnosis, yet their symptoms are neuroplastic. If the diagnosis just isn’t making sense, or you’ve tried many different physical treatments and medications with little success, it can suggest that you’re trying to heal problems in the wrong place. We always recommend extensive physical assessment from a skilled medical provider. 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

Pain Emerged During a Stressful Time or Life Transition

During life events and change, our brain may be functioning on high alert for an extended period of time. This nervous system dysregulation can make our environment, emotions, and body feel more dangerous. It’s in this unsafe, sensitized brain-state that neuroplastic pain is more likely to develop¹.

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 in pain/symptoms. It is common for human beings to experience physical symptoms during stressful or emotionally difficult times. If your pain/symptoms are worse with stress and emotionally difficulty, and reduced when you feel safe and calm, it suggests they are neuroplastic¹.

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/symptoms. 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

Childhood Adversity

Experiences of neglect, trauma, bullying, and accidents in childhood can lead to feeling unsafe in our bodies and relationships. Research shows strong connections between childhood adversity and chronic pain/symptoms^4,5. A brain that feels chronically unsafe is more at risk of developing neuroplastic pain and symptoms.

Trauma

Survivors of physical, sexual, and psychological trauma are much more likely to develop chronic pain/symptoms. 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 and symptoms⁸.

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

Pain and symptoms are designed to protect us. So is entering a nervous system state of fight, flight, freeze, or shutdown. While our bodies are designed to move in and out of 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 neuroplastic pain and symptoms^{9, 10}.

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, when the pain is actually 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.

References

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