Category: Understanding Pain

One of the questions people often ask is, is my back pain neuroplastic? Or it could be pelvic pain, fibromyalgia, IBS, burning mouth, migraine, tinnitus and so on.

Yes, the symptom matters, and it’s essential to get medically checked out and properly investigated. But when it comes to neuroplastic pain and persistent symptoms, the question is not only what symptom you have, but how the symptom behaves.

Neuroplastic symptoms on the move

Sometimes neuroplastic symptoms move, spread, switch sides, appear on both sides, or show up in different parts of the body over time. Someone may have pelvic pain now, but remember years of neck pain, wrist pain, headaches or digestive flares that came and went.

For others, the pain stays in one main area, while the intensity, the edges, the quality or even the way the sensation feels can change.

In my own case, the abdominal pain didn’t move much, but it came and went, sometimes mild, often severe. Sometimes it wasn’t a neat, solid ball of pain, but something with soft, moving edges, like a jellyfish. Sometimes it completely disappeared, once for a whole year, and often on holiday. And the back injury that became chronic was equally hard to pin down. Sometimes I couldn’t bear the lightest touch, and at other times I wanted a pummelling.

Looking back, what stands out is how reactive my nervous system had become. In persistent pain, the nervous system can become sensitised, meaning it becomes more responsive to incoming signals and more ready to produce a protective response. That can help explain why relatively ordinary sensations or movements can sometimes produce a much bigger pain response than we might expect.

Pain and physical findings do not always match neatly

Sometimes there is a clear physical reason for pain, perhaps structural changes, degeneration or evidence of injury. But in persistent pain, the severity and behaviour of symptoms don’t always line up neatly with what’s found physically.

That was true for me. I did eventually have physical findings, including evidence of nerve damage after my back injury and endometriosis after years of abdominal and pelvic pain. But those findings did not explain the whole pattern, or why the pain could be so severe at times and then barely there at others.

Many presentations are mixed like this, so structural findings still matter. But when the pain seems out of proportion to what’s found, or behaves in ways the physical findings don;t’fully explain, that’s useful information.

It can have triggers that make no obvious physical sense

What’s perhaps most surprising is that symptoms can become linked to things that have no obvious reason to injure the body, such as a particular food, a smell, a certain light, a sound, a change in weather, an ordinary movement like turning your head or picking up a piece of paper, a particular place, or even a time of day.

These patterns aren’t all necessarily happening for the same reason. A sensitised nervous system can become increasingly responsive to sensory or physical input, while other triggers may behave much more like learned or conditioned responses.

For years, mine was time, with pain arriving around four o’clock with extraordinary regularity. Once I understood more about the patterns of neuroplastic pain, I realised that something as abstract as time had become part of my pattern.

And sometimes there’s no obvious trigger at all. A flare doesn’t have to be preceded by a conscious thought, fear or stressful event. The nervous system is constantly making predictions outside our awareness, and sometimes we just don’t know what has set a particular flare off.

Symptoms can respond to context

Symptoms can also flare simply from thinking about them, from someone asking how you are, or from anticipating something stressful, perhaps a difficult conversation, a medical appointment or a family visit.

And they can ease, sometimes dramatically, in circumstances that have nothing to do with tissue healing: a holiday, a good conversation, being absorbed in something you love.

My abdominal pain, which could be crippling in everyday life, could disappear completely on holiday. Nothing structural had necessarily changed in that moment, but something in the wider context had.

Inconsistency is a clue

Perhaps one of the most useful clues is inconsistency. The same movement might be fine on a good day and provoke pain on a hard one. The same food might cause a flare one week and nothing the next. An activity may apparently trigger symptoms one time and cause no problem at all another time. And sometimes symptoms don’t appear until hours after the activity being blamed for them.

This unpredictability can feel maddening, but it’s useful information. It tells us that the symptom response may be influenced by more than the physical stimulus alone.

Structural and neuroplastic contributors can coexist, but movement, changes in intensity or quality, delayed responses, unexpected triggers, changes with context, inconsistency, and a mismatch between symptoms and physical findings are all pieces of information worth noticing.

This is where the hope lies

The International Association for the Study of Pain describes pain as an experience influenced, to varying degrees, by biological, psychological and social factors. Signals from the body matter, but they are only part of what shapes the pain we actually feel.

My Pain Matrix Recovery Programme uses this understanding to look at each individual pain experience through body signals, attention, emotion, meaning and appraisal, expectation and prediction, learning and memory, and context.

That’s where looking at symptom behaviour can become hopeful, because these are exactly the kinds of patterns we can work with and, importantly, change.

See how we can work together

You are also welcome to book a free introductory call to see if this approach is right for you.

One of the hardest things about chronic pain is not just the sensation itself, but not knowing why it’s there. This is where uncertainty and chronic pain collide — the ache is only half the story; the not-knowing is the other half.

Why is it worse today? Why was I fine yesterday? Why does the scan not explain how bad this feels? Why does it move around? Why does it flare after something that seemed harmless last week? Why does no one seem to have a clear answer?

And because uncertainty feels so uncomfortable, the mind does what minds are designed to do — it looks for patterns. It tries to create cause and effect. It tries to solve the problem. When the body feels unpredictable, certainty starts to feel like safety.

The detective work begins

Was it the walk, the chair, the weather, the stress, the argument, the poor sleep, the food, the timing, the fact that you did too much — or not enough? Before long, life becomes a kind of investigation, with every detail pulled in as possible evidence.

This makes complete sense. If you are in pain, of course you want to know why. If your symptoms feel unpredictable, of course you want to find the pattern. If your body feels unreliable, of course you want something solid to hold on to.

The exhausting search for patterns

But over time, the detective work can become exhausting. It is depleting, confusing, and often takes you down far too many rabbit holes — testing theories, following advice, reading one line somewhere and wondering if that might be the missing clue. And often, just when you think you have found the answer, the pattern changes again.

That is one of the most frustrating parts of persistent pain — you can spend so much energy trying to make sense of something that does not seem to make sense. And after a while, the search itself starts to take a toll.

The strange thing is that we live with uncertainty all the time.

We do not know what our next thought will be, what mood we will wake up in tomorrow, whether plans will change, what someone else will say, or what life will ask of us next. Some of this is tiny. Some is enormous. None of us really knows what is coming.

And yet, most of the time, we are not trying to solve this — we are living inside it. Life has always been unpredictable, but we do not usually treat that as an emergency.

Uncertainty and chronic pain

Pain can change that.

When a symptom appears, uncertainty can suddenly feel like danger. The sensation is hard enough, but then comes the second layer: What does this mean? What have I done? What if something is wrong? What if this never stops?

And now we are not only feeling the symptom — we are feeling the alarm, fear and urgency that gather around it. And when the brain detects threat, the body naturally moves into protection: muscles brace, attention narrows, breathing changes, and we become extra vigilant. This is the nervous system trying to keep us safe. 

But if we keep responding to every uncertain sensation as though it is a case to be solved, our attention can become increasingly organised around pain and possible threat. Research has found that people with chronic pain can show an attentional bias towards pain-related information. So the detective work, understandable as it is, can become part of the loop we are trying to step out of.’

This does not mean ignoring symptoms, pretending pain is not there, pushing through, dismissing your body, or refusing sensible medical care. It means noticing when the search for certainty has become part of the suffering.

Learning to sit with not knowing

Instead of asking more and more questions, the practice becomes simpler — stop, notice, and be willing.

Be willing to feel the sensation without immediately turning it into a problem to solve. Be willing to feel the uncertainty that comes with it — and pause before going down another rabbit hole. Remind yourself: ‘I do not have to work this all out right now.’

Chronic pain can feel a bit like an abstract painting — we are always trying to find the shape, the figure, the meaning. We want the dots to join. We want to know what it is — we’re only human. But sometimes, especially when pain is persistent, staring harder does not make the picture clearer.

Sometimes the work is to step back, and become steadier in the face of uncertainty. To notice the sensation, notice the alarm around it, and make enough room for both — allowing them to move through in their own time. Not every unknown needs to be solved before you are allowed to live your life.

Reading about this shift is one thing; learning how your own nervous system responds is another. In my sessions, hypnosis sits alongside Pain Reprocessing Therapy, ACT, and CBT — different ways of reaching the same goal. Together, we work gently and practically to interrupt the loops keeping your system on alert, and help you build real evidence that movement, and life, are safe again.

See how we can work together →

MRI and back pain can seem to offer a simple cause-and-effect story. There it is in black and white: the disc bulge, the degeneration, the protrusion, the ‘wear and tear’. It seems official and final, and if you are already in pain, of course the mind makes the link.

Except pain is rarely that simple.

Scan findings can be useful — sometimes they show things that genuinely need medical attention, and proper assessment matters. But a scan shows structure, not the whole story. It does not always explain why someone is in pain, why the pain feels so severe, or why it has taken over so much of life.

When findings cut both ways

Scan findings can cut both ways. If something shows up, the mind may latch onto it as proof of damage. If very little shows up, you may feel dismissed — or left wondering how you can hurt so much when everything apparently looks normal.

Neither situation tells us, on its own, how much pain somebody should be experiencing.

What the research shows about MRI and back pain

Research consistently shows that people with no back pain at all can have spinal findings that sound alarming. A large systematic review looked at imaging from 3,110 people without back pain and found that disc degeneration was estimated in 37% of people at age 20, 52% at age 30 and 68% at age 40. Findings such as disc bulges and protrusions were also seen in people without pain and became increasingly common with age.

Brinjikji et al., American Journal of Neuroradiology, 2015 — read the systematic review

That does not mean scans are pointless, or that findings mean nothing. Some findings are clearly clinically important. It means that a scan needs to be interpreted alongside the whole clinical picture — your history, medical assessment, symptoms and, importantly, how the pain actually behaves.

Like going grey, some changes in the body may simply be signs of having lived in one for a while.

We humans do not like uncertainty, so a diagnosis or scan result can feel like relief at first: finally, there is something concrete. But sometimes what reassures us at the start can quietly frighten us later.

When a scan result changes how you move

If you are told that your spine is degenerating, it is understandable to think: ‘I am fragile. Movement is risky. I need to be careful.’ That meaning can change your whole relationship with your body.

You may start bracing before bending, avoiding lifting, sitting more carefully, scanning for symptoms, cancelling plans or organising your life around not making things worse. All of this makes sense when you believe your back needs protecting.

The hearing aid turned up too loud

A sensitised pain system can be a little like a hearing aid with the volume turned up too high. The signals have not necessarily become more dangerous, but the system is paying more attention to them and responding more strongly.

Over time, caution can become a cage. A movement that was once ordinary can begin to feel threatening before you have even done it. Your muscles may brace, your attention may narrow and your brain may become increasingly ready for the pain it expects.

Whether the scan shows something significant or very little at all, the meaning we take from it matters. If the result leaves you frightened, constantly searching for answers or treating every sensation as evidence of harm, the nervous system may become more protective.

That does not mean the pain is imagined. It means the brain and body may be doing more protection than the current state of the tissues requires.

A living system, not just tissue

We are not just structures. Pain is shaped by a living system — brain, body, nervous system, previous experience, attention, expectations, movement, emotion, meaning and context.

That is one reason symptoms can settle, return, shift or change depending on what is happening around you. The way pain behaves can give us useful clues about what may be contributing to it.

Could I have neuroplastic symptoms? Look at how they behave →

And this is hopeful. If pain is not simply a read-out of tissue state, there may be more to work with. We can reduce fear around movement, stop treating every sensation as automatic proof of danger, and begin gathering new evidence that the body may be safer, stronger and more changeable than it currently feels.

Persistent back pain: when the pain no longer seems to make sense →

The better question

So the question is not simply: ‘What does my scan show?’

A better question is: ‘Does this finding actually explain the whole pattern of what I am experiencing — why the pain feels so severe, why it changes, why it flares, or why certain movements have become so difficult?’

Sometimes the answer will be yes: a structural problem is clinically important and needs appropriate medical care. Sometimes the answer is ‘only partly’. And sometimes the scan does not explain very much at all.

Where the structural story does not fully account for the pain, it may be useful to look at whether the brain and nervous system have become part of what is keeping the protective response going.

Putting this into practice

carefully at your medical history, what your scans and assessments have shown, how your pain behaves and what may be keeping your system on high alert.

The aim is not to dismiss the physical or tell you to push through pain. It is to understand the whole picture, reduce unnecessary fear around symptoms and movement, and gradually build real-world evidence that helps your brain and body respond differently.

See how we can work together →

Have you ever gone away for a weekend — or maybe a longer holiday — and noticed some genuine holiday pain relief, or even completely disappeared for a while?

You probably noticed, of course — how could you not? But perhaps, like most people, you didn’t think too much more about it. You just enjoyed that feeling of lightness and freedom, of being more like yourself again — revelling in the fact that you could walk further, sit longer, sleep better, eat out, make plans, and forget about your body for a few hours.

And then you came home, perhaps with that sinking feeling as the old familiar pain crept back.

It’s easy to file the whole experience under the ‘nice while it lasted’ — as if it was just a lucky break. But what if it was actually far more important than that?

If the pain were purely structural — a disc, a joint, a mechanical problem, a bit of damaged tissue — why would a change of scenery make such a difference? Why would the same body that felt so fragile at home suddenly cope better on a relaxed walk somewhere beautiful?

More than a change of scenery

Of course, holidays change practical things too. You may well be resting more, sleeping differently, walking at a different pace, feeling warmer, spending less time at a desk, or simply doing fewer of the things that usually wear you down. And all of that matters, but more often than not there is something else going on as well.

On holiday, many of the usual pressures drop away — we all have small daily decisions and familiar roles: that low hum of demand we carry so constantly that we barely notice it anymore.

What loosens on holiday

And sometimes there are even deeper, well-established patterns — the people-pleasing, guilt, self-judgement, self-criticism — that loosen a little too. They don’t vanish just because you’ve changed location — but they may soften enough for the body to register something different is going on. Could it be that the body hasn’t completely forgotten what it feels like to be safe?

The physiology behind holiday pain relief

The answer lies in our physiology.

When the nervous system begins to feel safer — even temporarily — the brain can finally wind down its protective alarm. It can activate the body’s natural pain-dampening pathways, allowing the parasympathetic nervous system — the rest-and-recover branch — to come back online.

This is one of the most useful clues in persistent pain. If symptoms can ease when the context changes, then the brain is clearly taking in far more than just tissue information — it is looking at the whole situation: where you are, what you expect, how much pressure or fear is present, and whether your body feels like a problem to solve.

This is why pain can reduce when you are absorbed in something, or laughing with someone you love, or away from responsibility. Your body hasn’t suddenly repaired itself or changed structure while you were lost in nature, looking at the sea, or painting a flower. It simply felt safe enough to turn down the alarm.

And if sensations disappeared entirely, it is not that you simply didn’t ‘notice’ the pain. The truth is, if you are not experiencing your pain, the brain has simply stopped generating it in that moment.

Our experience of pain changes with the context, the meaning, the emotions, the expectations.

Meaning changes everything

We already know this from ordinary life. A racing heart at the gym can feel healthy — even satisfying. The same racing heart at 3am can feel terrifying. Same sensation, completely different meaning. So the brain does not respond only to the signal, but to what the signal appears to mean.

And if the brain senses danger, it can turn the volume up. But if it concludes there is safety — even briefly the volume can come down. That is why the holiday effect is worth taking seriously.

Not because you can move to Lisbon and solve everything — tempting though that may be — but because it shows the system can change.

Coming home

The challenge, of course, is that you eventually come home. And if nothing has changed in how the brain understands the pain, the old pattern often returns — because the brain thinks: oh yes, I remember this — small threats, old routines, familiar fears. And now it starts bracing.

So the holiday pain relief is not a fluke. It is important information — your body showing you, even briefly, that it can do something different.

The work now is learning how to bring that message of safety back home into an ordinary Tuesday, not just a sunny week away. Because if your symptoms can change in one context, they are not nearly as fixed as they feel.

Reading about this shift is one thing; learning how to apply it to your own nervous system is another. In my sessions, we work with this gently and practically — helping you map out what your nervous system is responding to, unpick the automatic alarm around your symptoms, and begin building a predictable, lasting sense of safety in your body again.

See how we can work together →