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