Understanding the Diagnostic Criteria for Neuroplastic Pain

Chronic pain affects millions worldwide, yet for many, the root cause is not structural damage or injury, but rather the brain’s own processing of pain signals. This phenomenon, often referred to as neuroplastic pain, reflects the brain’s ability to learn, adapt, and, unfortunately, misinterpret sensory experiences. Understanding the diagnostic criteria for neuroplastic pain can help patients and clinicians distinguish it from structurally based pain and open doors to effective, non-invasive treatments.

Below is a summary of the key diagnostic indicators:

1. Symptoms Begin Without Injury

A hallmark sign of neuroplastic pain is when symptoms emerge without a preceding injury. Even when pain starts after an injury, if it persists well beyond normal healing time, it is often neuroplastic in nature. Studies show that tissue healing typically occurs within weeks to months; pain that lingers much longer may indicate central sensitization rather than ongoing tissue damage (Moseley & Butler, 2017).

2. Symptoms Arise During Stressful Periods

Psychological stress can significantly influence pain pathways. When pain begins during a time of heightened stress, it suggests the brain is amplifying danger signals. Stress is known to activate the hypothalamic-pituitary-adrenal (HPA) axis, which plays a central role in both mood and pain regulation (Vachon-Presseau et al., 2013).

3. Inconsistent Symptoms

Unlike structural pain, which tends to follow predictable patterns, neuroplastic pain is often inconsistent. This can include symptoms that:

• Move or spread to different areas of the body

• Appear after activity rather than during it

These inconsistencies highlight the role of neural circuits, rather than tissue damage, in sustaining symptoms.

4. Lack of Structural Explanation

When medical evaluations reveal no clear physical cause, neuroplastic pain becomes a strong possibility. Additionally, three sub-patterns are particularly telling:

• Multiple symptoms in unrelated systems (e.g., headaches, back pain, digestive issues)

• Symmetrical symptoms on both sides of the body

• Normal imaging results despite ongoing pain

Research suggests that multisite pain without identifiable pathology is more often linked to central nervous system sensitization than to local tissue damage (Clauw, 2014).

5. Non-Physical Triggers

Neuroplastic pain often flares in response to non-structural factors, such as stress, certain environments, or even specific times of day. These conditioned responses mirror Pavlovian learning, where neutral stimuli become linked with pain experiences. Encouragingly, studies have shown that interventions like exposure therapy and pain reprocessing can break these learned associations (Ashar et al., 2022).

6. Childhood Adversity

Adverse childhood experiences (ACEs), including abuse, neglect, or chronic insecurity, increase vulnerability to chronic pain in adulthood. Early adversity can prime the nervous system to remain on “high alert,” creating a fertile ground for neuroplastic pain (Anda et al., 2006).

7. Personality Traits

Certain traits are disproportionately common in individuals with neuroplastic pain. These include:

• Perfectionism

• High conscientiousness

• People-pleasing tendencies

• Anxiety-proneness

While positive in many contexts, these traits often heighten stress responses, inadvertently fueling pain circuits.

8. Co-Occurring Mental Health Conditions

Depression, anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and eating disorders share overlapping neurobiological pathways with chronic pain. The presence of these conditions often signals that pain may be neuroplastic in origin (Bair et al., 2003).

9. Family History of Chronic Pain

A family history of varied but unexplained pain conditions is another red flag. This clustering reflects shared psychological and neurobiological vulnerabilities rather than genetic transmission of a single disorder.

Why These Criteria Matter

These diagnostic criteria don’t just label pain—they reshape how we understand it. Recognizing neuroplastic pain helps patients move away from fear of structural damage and toward treatments that retrain the brain, such as pain reprocessing therapy, cognitive-behavioral therapy (CBT), and mindfulness-based approaches.

As research continues to demonstrate, the brain is not just a passive recipient of pain signals but an active player in creating and sustaining them. By identifying the markers of neuroplastic pain, clinicians and patients alike can take an empowered approach, fostering recovery through education, stress reduction, and rewiring maladaptive neural pathways.

Interested in a consultation to assess whether pain psychotherapy approaches are a good fit for you? Liz is accepting new clients through our online booking portal.

References

• Anda, R. F., et al. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186.

• Ashar, Y. K., et al. (2022). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain. JAMA Psychiatry, 79(1), 13–23.

• Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K. (2003). Depression and pain comorbidity. Archives of Internal Medicine, 163(20), 2433–2445.

• Clauw, D. J. (2014). Fibromyalgia: A clinical review. JAMA, 311(15), 1547–1555.

• Moseley, G. L., & Butler, D. S. (2017). Fifteen years of explaining pain. Pain, 158(S1), S1–S14.

• Vachon-Presseau, E., et al. (2013). Corticolimbic anatomical characteristics predict individual differences in chronic pain. Brain, 136(9), 2751–2761.