Is my pain impacted by my brain?
How do we know if pain and other symptoms are mostly physically driven or nervous system driven?
The reality is that it’s probably both most of the time. Pain is rarely driven by structural issues alone, even with very obvious damage like broken bones. The caveat is that physical sensations may not be coming from actual dysfunction or injury, but rather a misinterpretation of normal benign sensation. Even with positive MRI imaging that shows degeneration, disc changes, or other issues, the brain is always in charge of interpretation and a pain experience can still be largely mediated by a sensitized nervous system. This means the brain might be amplifying a pain sensation beyond what the state of the tissues would normally predict.
We’re at a point with research now that it’s pretty well established that the brain and nervous system can become overprotective and sensitized, creating real pain and symptoms even when there is no injury or danger in the body. This is often referred to as neuroplastic pain, nociplastic pain, or centrally mediated symptoms.
These criteria were adapted from work by clinicians and researchers studying chronic pain and mind-body approaches like Pain Reprocessing Therapy (PRT).
Research has also consistently shown that many structural findings are also present in people without any pain at all. Around half of your pain free friends and family members very likely have spinal degeneration and herniations, even though they have no pain. These numbers go way up with every decade. You can think of it like grey hair and wrinkles. There are normal tissue changes that happen throughout our lives and most of them are safe! Maybe your spine has grey hair and wrinkles too.
Signs that pain or symptoms may have a strong neuroplastic/nervous system component
Symptoms began without an injury or during a stressful time
Pain or other symptoms often begin during or shortly after significant life stressors like transitions, illness, burnout, conflict, loss, etc. We don’t always connect these until we really examine the timelines. Annoyingly, this can include both good and bad stressors.
Symptoms don’t follow normal healing timelines
Maybe you did have an obvious injury or irritation, but symptoms continue long after tissues would generally be expected to heal. This is about 4-6 weeks for soft tissue injuries like muscle strains, but can be multiple months for nerve irritation.
Symptoms are on both sides or one whole side of the body
Pain developing in matching locations on both sides of the body may be less likely to represent a single local tissue issue.
Symptoms move or spread out
Pain that shifts locations, shows up on the other side, or spreads out over time is inconsistent with normal tissue healing.
Multiple symptoms or diagnoses or many pain areas
Having several unrelated chronic symptoms, pain areas, or pain syndromes can suggest a sensitized nervous system. It’s pretty unusual to have a bunch of unrelated conditions and way more likely that they’re all tied to the same issue.
Symptoms are in an area that you injured long ago
The nervous system can be extra sensitized to an area or body part that had an injury previously.
Symptoms are delayed
Symptoms that don’t appear during a physical activity, but hours later or the next day point to a nervous system that is sensitive rather than to direct tissue injury.
For example, “maybe I did those squats wrong in pilates yesterday and that’s why my hip hurts again.”
You feel symptoms when someone asks about them, you think about them, or you think about engaging in a triggering activity
This means without actually moving or changing any inputs or sensations, just changing your thoughts.
Symptoms are inconsistent or unpredictable
Examples include:
Pain changing significantly from day to day
Different responses to the same movement in different contexts, like walking in the morning vs walking at night
Symptoms varying based on stress, attention, environment, or mood. Some people notice their symptoms disappear when on vacation or when caring for a sick child.
Large fluctuations without a clear mechanical reason
Your stress changes your symptoms or perceived severity
Symptoms that worsen during periods of stress and improve during enjoyable, distracting, or calming experiences often reflect nervous system involvement.
Non-physical triggers affect symptoms
Things like changes in the weather, time of day, sounds, smells, environments, social situations, or certain thoughts can be a sign of learned protective responses in the brain and nervous system.
History of prolonged stress or adversity
Early experiences of anxiety, instability, fear, unpredictability, or emotional overwhelm can increase nervous system sensitivity over time. This includes adverse childhood events (ACES), periods of dieting or food restriction, and any kind of physical or emotional trauma even if it feels small. This can be super common in the queer and trans populations.
Personality traits and coping patterns
Certain traits can be associated with chronic pain and nervous system sensitization. This doesn’t mean your personality is wrong or bad! You’re lovely; it just means your brain might be more likely to look at things through a lens of fear.
Perfectionism
People-pleasing
High self-pressure or high-achieving
Hypervigilance
Tendency to be anxious or worried
Self-criticism
The tendency to “push through” or “what doesn’t kill me makes me stronger” attitude
When there’s no clear physical explanation that fully accounts for the breadth of your symptom profile
Sometimes imaging can be helpful. Sometimes imaging finds incidental findings that are unrelated to your experience. Sometimes imaging can actually hurt and prolong or amplify a pain experience because it can impact your own sense of safety and beliefs about what you might be capable of.
Conditions commonly associated with nervous system sensitization can include:
Fibromyalgia
migraines
pelvic pain
some symptoms of pelvic floor dysfunction like urinary urgency and frequency
IBS
chronic back or neck pain
persistent fatigue
If a few of these patterns feel relatable, it may suggest that the nervous system is playing a meaningful role in maintaining symptoms even if there is also a physical or tissue-based component involved.
Why do the brain and nervous system become more sensitive?
Research suggests the nervous system is more likely to become overprotective when overall stress and “threat load” are high. We can end up looking at the world through a lens of danger alarm, so everything subconsciously becomes a threat. This can lead to a lot of guarding and muscle tension and even create transient physical issues.
Over time, the brain can start interpreting normal sensations, movement, or normal bodily signals as dangerous, even when the body is no longer injured.
This does not mean symptoms are imagined or “all in your head.” The experience of pain is always real no matter what. Nobody can tell you what you’re feeling or not feeling. The difference is that the danger signal may be coming from brain changes that caused an overprotective nervous system rather than ongoing tissue damage.
Start by making an evidence list for yourself
One early step in nervous system–based approaches like Pain Reprocessing Therapy is beginning to notice patterns that suggest sensitivity or irritation rather than damage.
You can write down:
Which criteria match your experience
Times when symptoms were surprisingly different
Situations where symptoms improved
Examples of inconsistency or variability in sensation
Stressors or emotional states linked with flares
The goal is not to ignore symptoms and gaslight yourself into believing you’re ok. We’re just trying to begin building a more accurate and less fear-based understanding of what may be happening in your body.
For many people, even this shift in interpretation can be enough to start reducing fear, frustration, and the intensity of symptoms.
You don’t need to completely buy in before exploring these approaches
Many people begin this work while still unsure whether their symptoms are structural, neuroplastic, or both.
Uncertainty is totally fine and great and expected.
Someone can have MRI findings, old injuries, hypermobility, arthritis, disc degeneration, endometriosis, or other real physical conditions and still experience significant nervous system amplification of pain. In fact, some of these conditions like endometriosis are known to have a lasting effect on the nervous system, which is why severity of endometriosis symptoms do not correlate with level of perceived pain or dysfunction.
In chronic conditions especially, the nervous system usually becomes part of the picture over time. It’s trying to protect you, but maybe you’re already safe.
I like to remind people that the nervous system is adaptable. The same way the brain can learn pain and protection, it can also learn safety, curiosity, and resilience.
If you’re ready to start exploring your own situation, I work with many people like you in person in the East Bay, CA or anywhere through the internet. Book your evaluation or reach out with questions!
Is today the day you try something different?
This information is educational only and is not intended to diagnose or rule out medical conditions. Persistent or concerning symptoms should always be evaluated by a qualified healthcare professional.
