What Causes Neuroplastic Pain?

By Tanner Murtagh MSW, RSW

Neuroplastic pain is when pain symptoms are caused by learned neuropathways in the brain, and are not due to structural damage or disease in the body. Neuroplastic pain occurs from a “conversation between body and brain”, however like all conversations sometimes misunderstandings occur¹. Neuroplastic pain is when the brain misinterprets safe signals from the body as if they are dangerous, and as a result produces pain or other symptoms². The factor that fuels the pain to be created, amplified, and maintained is fear.

There are four main ways that neuroplastic pain can begin to develop:

1. An actual structural injury that has since healed
2. A perceived injury or belief that something is structurally wrong with the body
3. A stressful situation
4. A gradual onset².

Now the ways neuroplastic pain develop are not exclusive, and people could have many of these factors play a part in the development of their pain. For example, someone could be on high alert from a stressful situation in their life and develop pain after they thought they injured themselves. It is important to note that the common denominator in the different ways neuroplastic pain occurs is that it develops in an environment of fear².

1. An actual structural injury that has since healed

Neuroplastic pain can begin with a structural injury. The majority of physical injuries heal within a few weeks to a few months, and this makes sense as our bodies have evolved to heal from injury³. Remember “if we didn’t have the ability to heal from injury, we would have died off long ago” ² (Dr. Schubiner). However, after an injury has healed the brain still maintains the neuropathways associated with pain³. These neuropathways can then be triggered by fear and other emotions, causing the pain to continue long after an injury has healed³.

When an actual injury occurs, it can be terrifying! We may fear that we will never heal, or that we won’t be able to do physical activities like we use to. This fear causes us to go into a pain-fear cycle, which is a never-ending feedback loop that causes the pain to lead to more fear, and fear to lead to more pain¹. So long after an actual injury has healed, fear can trigger the learned neural networks associated with the past injury and generate pain.

2. A perceived injury or belief something is structurally wrong with the body

Individuals often share in session that they injured themselves doing an activity and are worried they caused major structural damage to their body. I bent over weird, I sat on an airplane for too long, my shoulder is beginning to hurt and it must be due to the workout I did three days ago, are common narratives people have to explain their pain symptoms. While assessing for neuroplastic pain, a review of a person’s pain history can uncover that their pain is not behaving how structurally caused pain typically does.

The primary fear that people with chronic pain have is that something must be structurally wrong with their body that is causing their pain or symptoms to occur. Researchers have found that fearing or predicting pain, can actually create, maintain and amplify painful sensations^4,5,6. The mechanism in the brain that activates neuroplastic pain is the danger circuits located in the limbic system (amygdala, insula and anterior cingulate cortex)^4,7. Unfortunately when we perceive that an injury has occurred our brain feels in danger, which can produce pain symptoms in the absence of structural damage.

For myself I feared walking, especially walking quickly! I imagined by spine suffering greatly with each impact my feet would make on the ground. As a result, I avoided walking (which is difficult to do!) and spent hours worrying about future times I would need to go long distances. My fear of walking was actually causing the pain to occur, and not a structural abnormality in my back. Often times our clients will believe that they have injured themselves, however during the initial assessment it becomes clear that pain-related fear is responsible for the pain being triggered and maintained.

3. A stressful situation

Stressful situations, life transitions (even positive ones), trauma, adverse childhood experiences, and a buildup of unregulated emotions can cause and amplify neuroplastic pain^2,4. Stressful situations such as divorce, graduate school, unemployment, having a baby, and weddings, have the ability to trigger pain. Really any situation that can activate the danger circuits in our brain has the ability to create and maintain pain and other psychophysiologic symptoms⁴.

One study that took brain scans (fMRI) of people that had a hot probe put on their arm (physical pain) or were shown a picture of their ex-partner who had broken up with them in the last 6 months (emotional pain), found the areas of the brain activated were very similar⁸.The takeaway of these findings is that during states of emotional distress it is possible for the brain to make a mistake and activate physical pain pathways in the brain⁵.

For myself it is new jobs that almost always trigger my pain. When starting a new job, I can count on me being stressed, buying new dress pants, and “throwing my back out” the day before my first shift. The danger circuits in my brain are activated (intensely activated!) when I am starting a new job, and as a result back pain occurs. This happens like clockwork; however, I now recognize early on it is neuroplastic pain, use strategies to calm my brain, and after a couple days the pain dissipates. So even if stressful situations tend to activate your pain, recognizing it is neuroplastic pain and using therapeutic techniques to calm the brain can allow for the pain to dissipate quickly.

On the extreme end of stressful situations, is traumatic experiences. In my work with clients, I have come to recognize that traumatic events have the ability to generate intense pain symptoms. A traumatic event, such as sexual abuse, physical abuse, childhood abuse or neglect, or a life-threatening event, cause our brain to feel terrified. Even after a traumatic event has past, individuals can feel constantly unsafe and subsequently develop chronic pain. Researchers have found that adults are 2.7 times more likely to have chronic widespread pain if they have significant trauma in their past⁹. However, in therapy trauma and chronic pain can be focused on simultaneously and often leads to relief for both.

4. A Gradual Onset

This category is really considered the “other category”². There are a group of people that develop neuroplastic pain gradually and not by an initial injury, perceived injury, or stressful situation². I find that people who have a gradual onset of neuroplastic pain are slowly being worn down by the personality traits they have and the behaviors they are prone to engaging in.

People with neuroplastic pain commonly have the personality traits of perfectionism, conscientiousness, people pleasing, and anxiousness^1,2,10. Because of these personality traits people are prone to self-criticism, worrying, and placing pressure on themselves, which causes the brain to be on high alert and feel emotionally in danger. Again, when the brain feels emotionally in danger it can trigger and maintain physical pain ^2,4,6.

For myself, I tend to be quick to place a lot of pressure on myself for my responsibilities in life. Whether it is performing the best at work or simply ensuring my toddler eats a balanced diet (which he makes very difficult…), the pressure in my life can build up quick if I’m not careful. A sign for me that I need to lower the amount of pressure I am putting on myself is when pain symptoms start to appear.

Whether it is prolonged worry, pressure, or self-criticism that is triggering your pain, utilizing skills from Pain Reprocessing Therapy can support you in changing your behaviors and beginning to make your brain feel safe.

Final thought

In closing, I encourage everyone to think about the ways your pain symptoms developed and are continuing to be maintained. Having an understanding of this is a vital first step in eliminated or greatly reducing your chronic pain symptoms. Please feel free to contact Pain Psychotherapy Canada to begin getting professional support in eliminating your pain.

References

1. Gordon, A., Ziv, A. (2021). The way out: A revolutionary, scientifically proven approach to healing chronic pain. Sony/ATV Music Publishing LLC.
2. Pain Reprocessing Therapy Center (2021). Pain reprocessing therapy training.
3. Hanscom, D. (2019). Making the right choice about spine surgery. In D. Clarke, H. Schubiner, M. Clarke-Smith, & A. Abbass (Eds.), Psychophysiologic disorders: Trauma informed, interprofessioal diagnosis and treatment (pp. 83-98). Psychophysiologic Disorders Association.
4. Schubiner, H. & Kleckner, I. (2019). The neurophysiology and psychology of pain in psychophysiologic disorders. In D. Clarke, H. Schubiner, M. Clarke-Smith, & A. Abbass (Eds.), Psychophysiologic disorders: Trauma informed, interprofessioal diagnosis and treatment (pp. 45-68). Psychophysiologic Disorders Association.
5. Bayer, T. L., Baer, P. E., & Early, C. (1991). Situational and psychophysiological factors in psychologically induced pain. Pain 44(1), 45-50.
6. Kirwilliam, S. S., & Derbyshire, S. W. G. (2008). Increased bias to report heat or pain following emotional priming of pain-related fear. Pain 137(1), 60-65.
7. Barrett, L., & Simmons, W. K. (2015). Interoceptive predictions in the brain. Nature Reviews Neuroscience 16, 419-429.
8. Kross, E., Berman, M. G., Mischel, W., Smith, E. E., Wager, T. D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences of the USA 108, 6270-6275.
9. Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., Dube, S. R., & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European archives of psychiatry and clinical neuroscience, 256(3), 174–186.
10. Clarke, D. D., & Schubiner, H. (2019). Introductions. In D. Clarke, H. Schubiner, M. Clarke-Smith, & A. Abbass (Eds.), Psychophysiologic disorders: Trauma informed, interprofessioal diagnosis and treatment (pp. 5-25). Psychophysiologic Disorders Association.