All About Neuroplastic Pain
Over 100 million Americans live with chronic pain. Pain comes in different forms. Pain can be neuroplastic or nocioplastic (results from changes in the central nervous system’s pain processing), neuropathic (nerve damage), and nociceptive (normal pain from tissue damage). Neuroplasticity is the brain's ability to change, which explains how neuroplastic pain persists and can be rewired. In this blog post, I’ll explain what neuroplastic pain is and how to begin to work with it.
Chronic pain for a long duration can alter neuronal plasticity of the central and peripheral nervous systems. Chronic pain changes the signal and perception of pain and causes hypersensitivity to painful stimuli.
Pain functions as danger signal. Pain can also be triggered by neural circuits in the absence of tissue damage. Pain is an interpretation that is made by the brain based on current and past inputs. Pain generated by neural circuits usually happens in the absence of nociceptive (pain caused by tissue damage) inputs.
Remember, all pain is real. There is no such thing as imagined pain. Pain is never your fault.
Neuroplastic pain results from the brain misinterpreting safe messages from the body as if they were dangerous. In other words, neuroplastic pain is a false alarm. This kind of pain can be unlearned.
There is an overlapping set of terms that refer to this type of pain. Dr. John Sarno, a groundbreaking physician, coined the term Tension Myositis Syndrome (TMS). Chronic pain terminology continues to evolve. Below are some terms commonly used within the chronic pain community:
Neuroplastic pain is pain that occurs in the absence of tissue damage or injury or is not explained by a structural cause.
Learned pain is synonymous with neuroplastic pain.
Nociplastic pain is usually used interchangeably with neuroplastic pain. It is a type of chronic pain resulting from a sensitized central nervous system (CNS) that amplifies pain signals, even without clear ongoing tissue damage or disease, often leading to widespread pain, fatigue, sleep issues, and mood problems.
Primary pain is pain that exists as a disease itself, not just a symptom of another injury or illness, often due to nervous system malfunction with no clear structural cause, like fibromyalgia or chronic headaches. The pain is the primary condition, not a warning sign for something else.
Neural Circuit Disorder refers to real, physical symptoms that are generated by sensitized neural pathways in the brain, not ongoing structural damage, often triggered by stress, emotions, or learned patterns. This pain involves learned pathways or repeated experiences, especially with stress or trauma, that create strong, sensitized neural circuits that generate symptoms. Due to the brain’s neuroplasticity or ability to form new pathways, these neural circuits can be unlearned and new, healthier ones formed.
Central Sensitization is a pathophysiologic process in which the central nervous system undergoes changes that alter its processing of pain and other sensory stimuli. The trifecta of central sensitization is:
Hyperalgesia in which a painful stimulus becomes associated with even more pain.
Allodynia in which a previously nonpainful stimulus now causes pain. For example, previously able to receive a hug or pressure on the body and now it feels too physically painful to experience.
Global sensory hyperresponsiveness in which the person is extremely affected by external (noises, brightness, smells, medication) and internal stimuli (heartbeat, peristalsis in the gut).
Central Sensitization Syndromes refer to overlapping symptoms such as pain, fatigue, sleep disorders, paresthesias, cognitive difficulties, and overlapping conditions such as irritable bowel syndrome, restless leg syndrome, interstitial cystitis, temporomandibular joint disorder, and others.
Functional Disorders involve real physical symptoms (like weakness, numbness, seizures, or pain) that aren't caused by structural damage but by a problem with how the nervous system functions or sends signals, often triggered or worsened by stress or emotional distress. These are common conditions where the brain and body systems aren't communicating properly, despite normal anatomy on scans, and can include diagnoses of IBS, fibromyalgia, and functional seizures.
Tension Myositis Syndrome (TMS) is a term created by Dr. John Sarno as part of his theory that chronic pain (like back pain, fibromyalgia, headaches) stems from the mindbody connection, where repressed emotions (anger, anxiety) trigger the autonomic nervous system to reduce blood flow and oxygen to muscles, causing pain as a distraction from these deeper feelings, rather than from structural damage. Sarno believed the pain is very real but the cause is psychological, often linked to perfectionistic, people-pleasing personalities, and healing involves recognizing the emotional source and addressing it. This concept is outdated.
Mind-Body Syndrome is a phenomenon where psychological stress, trauma, and repressed emotions manifest as real physical pain and other symptoms, like back pain, headaches, or digestive issues, as the brain distracts itself from difficult feelings.
Below, I’ve included further explanations of neuroplastic pain.
Foundational Practices
Having an understanding of why you experience pain is essential. The first step to healing from neuroplastic pain is to rule out any structural causes for the pain and rule in neuroplastic pain by working with your medical team. There are many psychotherapy approaches that can help with this pain, including Pain Reprocessing Therapy (PRT) and Emotional Awareness and Expression Therapy (EAET).
