One thing I’ve noticed about neuroplastic pain

Neuroplastic pain has gained a lot of attention in recent years, particularly with the publication of The Way Out (Gordon & Ziv, 2021) and the release of the documentary film This Might Hurt (2019). Put simply, neuroplastic pain (also called central sensitization or primary pain) is pain that is generated by the brain, reflecting learned associations between sensations in the body and feelings of dangerousness or threat. Because it is pain that has been learned over time, it can be unlearned using psychological techniques that teach the brain to stop reacting to normal sensations as dangerous. 

Neuroplastic pain does not have to be all-or-nothing

One thing I’ve noticed about neuroplastic pain is that when people learn about it, many seem to view it in black-and-white way. There is this idea that your pain is EITHER neuroplastic OR it’s caused by a physical problem in the body. That you will ONLY need a psychological intervention to alleviate your pain OR a physical one. We can hardly blame ourselves for thinking this way, as the split between mind and body is pervasive in Western medicine and culture. 

For the people who are completely convinced that their pain is neuroplastic, thinking about it in black-and-white way isn’t necessarily a problem. These people might look at an assessment tool for neuroplastic pain and check every box. A 100% belief in the neuroplastic nature of their pain can give these folks a leg up when using a psychological approach to pain treatment, as they may have more confidence that this is the right approach for them, even during setbacks. 

However, for everyone else, being all-or-nothing about whether your pain is neuroplastic can easily become a sticking point. There can be a desire to say “Well, I don’t match the description of neuroplastic pain completely, so there must really be something wrong with my body.”

Unfortunately, if medical treatments haven’t been working well, this can leave you feeling hopeless about there being a solution to your pain. You might feel increasingly isolated in your suffering and frustrated with the people who tout and adhere to the neuroplastic model. You may approach a psychological treatment for chronic pain half-heartedly and become discouraged easily when it’s not “working.”

Thinking flexibly about your pain

Like most things having to do with the management (and elimination) of chronic pain, flexibility is key here. Rigid ways of relating to pain can be both a cause and consequence of pain. The solution is not to apply more rigidity to your understanding of your pain, but to approach it with a sense of fluidity and openness. 

Let’s explore what this might look like. 

Perhaps you look at the list and notice a few descriptions that resonate with you, such as a tendency to worry a lot, growing up in an environment that made you feel emotionally unsafe, and pain that is triggered by outside sources, such as weather changes or time of day. However, you haven’t really noticed a pattern of your pain being triggered by stress, you don’t have multiple unrelated pain conditions, and your symptoms are fairly consistent day-to-day. 

I have seen many people get to this point and categorically conclude “This doesn’t describe me.” There might be several meaningful ways in which their pain does fit the profile, but instead they conclude that the concept of neuroplastic pain does not apply to them at all, thereby missing out on some potent psychological interventions that could really help. 

What I encourage when this comes up is to start with what does ring true (assuming your pain is consistent with at least a few of the qualities of neuroplastic pain and you have received enough high-quality medical attention to have a good sense of what is and isn’t “wrong” with your body). A psychological approach to pain can still be effective even without complete belief in and overzealous devotion to the idea of neuroplastic pain. In fact, it is often better in the long run not to go all-in on categorizing your pain as fully neuroplastic before you’ve had a chance to convince yourself of this on an emotional level.

Psychological patterns and your pain

For example, noticing that you have a tendency to worry, to people-please, and to be perfectionistic is a fantastic place from which to start exploring how these tendencies relate to your chronic pain. Perhaps you worry a lot about your pain (I don’t know anyone with chronic pain who doesn’t). Maybe having chronic pain has caused you to let people down in ways that are deeply threatening to your self-image. It’s possible that all of these characteristics are connected by a fearful sense of urgency to control things that are actually not under your control. It’s not hard to see how having chronic pain can be harder and more impactful when these tendencies are present. 

Drawing connections between your psychological patterns and your pain opens up a menu of options for approaching your pain that wouldn’t be there if you had previously decided that this wasn’t for you. Now you can start learning about and practicing letting go of your attempts to control outcomes that are uncontrollable. You can confront and work through your psychological barriers to being able to release control. You can identify and resolve tendencies to assume the worst and to jump to conclusions. All of this work creates the conditions for the neuroplastic part of your pain to resolve (and will probably make a lot of other things in your life easier too). 

Keeping an open mind

The key is to be as open as you can, while still being able to believe what you’re telling yourself. There is no need to try to convince yourself of things that you can’t genuinely believe in order to “fit the profile.” On the flip side, there is no need to throw out the whole profile if parts of it do not describe your experience (however, if basically none of it describes you, make sure that you’re working closely with your medical providers to explore and rule out other causes of your pain). Find what does ring true and explore it for all it is worth. This is an act of cognitive flexibility in itself, which is an essential component of unlearning pain. 

Want to work with me directly to explore the psychological side to your pain? Check out my group coaching program for chronic pain and request to join today.

The content shared here is for informational purposes only and is not intended as a substitute for professional medical advice, diagnoses, or treatment. Always seek advice from your physician or other qualified healthcare provider before making changes to your health regimen.