Recognizing the Symptoms of Nociplastic Pain (or Central Sensitization)

When a person is in pain for a prolonged period of time (3+ months), their brain and body change. It forms "pain pathways" that can be triggered by emotional factors, early trauma, or stress, and can persist even when there’s no physical injury. These are called Learned Neural Pathways.

Like learning to ride a bike, the body learns pain. Overtime, it becomes an automatic response to physiological, psychological, and social factors.

Doctors use the latest understanding of pain to identify patients who have neural pathway pain (possibly in additional to structural issues). After ruling out significant structural disorders, physicians may use clinical evidence to rule in neural pathway pain. Following are some guidelines that may help to link a patient’s symptoms to neural pathways:

• History of nervous-system syndromes: headaches, migraine, irritable bowel syndrome, interstitial cystitis, neck or back pain, pelvic pain, fatigue, insomnia, anxiety, and depression

• Early-life trauma

• Personality traits of people pleasing, self-criticism, lack of self-compassion, lack of assertiveness, perfectionism (increased pressure upon oneself may further activate the danger/alarm mechanism)

• Pain that:

  • worsens over time

  • spreads to new regions of body

  • shifts from region to region

  • turns “on and off”

  • has an onset upon awakening

  • worsens with increased stress / improves with less stress

  • radiates to areas that do not conform to structural norms

  • is often bilateral in nature.

    
    

The Power of Neuroplasticity

Fortunately, the nervous system has an ability to change, known as neuroplasticity, that offers hope for patients with neural pathway pain. With the right interventions, these brain circuits can be rewired, allowing the brain and body to stop generating pain. This represents a paradigm shift: instead of managing pain, it’s possible to eliminate it.

Case Example: Pain Recovery Through Rewiring the Brain

A powerful case example involves a young patient named Casey, who experienced debilitating abdominal pain for three years. Despite extensive medical testing and treatment, including surgery and pain management techniques, no physical cause for his pain was found. His pain continued until he was diagnosed with neural pathway pain. By helping Casey understand that his pain was brain-generated and not due to physical injury, his fear of the pain diminished. Over time, his brain’s danger mechanism was “turned off,” leading to a complete recovery within three months.

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Modern research shows that psychological and emotional elements can play a major role in chronic pain. These non-physical components can help the brain “learn” to be in pain. By training the brain, we can re-wire the body’s neural circuitry to dial down pain sensations and bring relief.