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5 Ways to Tell if Your Pain Is Nociplastic

A new name for troublesome pain.

Key points

  • Your nervous system has adapted to change the strength of pain signals, making it easier or harder for you to notice when you’re in pain.
  • Nociplastic pain is caused by altered pain processing in the nervous system.
  • Nociplastic pain is chronic and associated with sensory sensitivities and difficulties with sleep and concentration.
  • Nociplastic pain is real, and it is not your fault.

Pain is adaptive. It tells you something is wrong and your body needs your attention. Most of the time, pain is telling you about ongoing damage to your body or inflammation that needs to be addressed. For example, when you sprain your ankle, your pain-sensing nerves send signals to your brain telling you that you need to stop what you’re doing and take care of the injury.

Pain in Your Brain

There are many ways your body has adapted to change the strength of pain signals, making it easier or harder for you to notice when you’re in pain. For example, if you have a minor cut on your arm, you may rub the site of the injury. This interferes with pain signals en route to the brain. It is sort of like a highway from arm town to brain city. Pain is like an old sedan. When pain is the only car on the road, it can travel quickly and easily. But when you add a bunch of semi-trucks to the road (in this case, the sensory signals from rubbing the same area), it is much harder for the pain sedan to make its way to the brain city.

Your brain can also choose what it will pay attention to. Imagine you are playing soccer. At some point during play, another player’s cleat brushes your leg and cuts your thigh. You may keep playing for another 20 minutes without feeling any pain at all, totally wrapped up in trying to score the next goal. It is only when the play stops that you realize you are bleeding, and you suddenly feel the pain of the injury. During that 20 minutes, your brain selectively attended to the game and pushed aside the pain signals that were trying to get through. This is an example of distraction reducing the strength of the pain signal getting through to your conscious attention.

In each of these examples, the nervous system reduced how much pain you experienced. Unfortunately, sometimes the way our brains and nerves are built can worsen or even cause pain.

What is nociplastic pain?

You know that feeling when you have the flu, and everything just hurts? You don’t want to be touched, you can’t brush your hair, and even wearing clothes just feels painful on your skin? This type of pain (allodynia) is caused by the misinterpretation of routine touch, pressure, or movement as pain instead of a sensation. In the highway example above, the sensory semi-trucks are being switched out for pain sedans at some point along the highway from your limb to your brain. Unfortunately, this means that the normal ways of treating pain (e.g., healing the injury) can’t reduce this kind of pain. This pain is caused by the nervous system itself, which will require a different kind of treatment.

Pain researchers and clinicians have recently developed a new term to describe pain caused by altered pain processing in the nervous system: nociplastic pain. Noci- means pain. Plastic means change. So nociplastic pain is caused by changes in your nervous system.

Is your pain nociplastic?

Here are some criteria to help you understand if your pain may be nociplastic.

1. Your pain has been around for a while. Nociplastic pain isn’t a short-term problem. People with nociplastic pain experience pain for at least three months but often much longer. When an injury occurs, pain may persist throughout the healing period. But sometimes, the injury changes how your nervous system processes pain, causing nociplastic pain that lasts long after the injury has healed. Not all nociplastic pain starts with an injury. For some people, the pain starts after an infection. For others, a period of high stress or a traumatic event. For others people, their nervous system simply seems to have been wired with this heightened pain processing system.

2. You can’t put a finger on it. Pain networks run together. Imagine standing up and holding your arms out straight to the side. Now imagine a horizontal line extending from each segment of your spine, capturing every body part in its path. These are regions whose pain signals land in the same place when they come first to your spinal cord and are then sent to your brain. Since neuroplastic pain is an alteration of these networks, it is often experienced throughout an entire body region rather than in one specific spot.

3. Your doctor doesn’t “see” anything wrong. Nociplastic pain persists long after injuries have healed. One of the first indicators that your pain may be nociplastic is when doctors have a hard time figuring out what is “causing” it. That doesn’t mean your pain isn’t real. It just means we don’t currently have good tests to pinpoint what part of your nervous system is producing the pain.

4. Where you have pain, you’re also sensitive. Most people with nociplastic pain experience allodynia in the same area. This means that normal sensations like your partner giving you a hug, your child touching your arm, wearing clothes or jewelry, brushing your hair, or routine heat and cold are experienced as painful. The alterations in your nervous system producing the nociplastic pain seem to also pick up these normally non-painful types of touch and interpret them as pain.

5. Your brain seems to be on high alert. People with nociplastic pain are often more sensitive to physical sensations and other senses like light, sound, and smell. They often have light sleep that does not leave them feeling rested, and they frequently wake up throughout the night. People with nociplastic pain also often have difficulty concentrating and memory, since pain is drawing their attention away from everyday tasks.

What can you do about it?

Nociplastic pain is real, and it is not your fault. Do not suffer through doctors who do not trust your experience. Find a doctor who believes your pain experiences are real and is committed to helping you find relief and increase your functioning. They may recommend non-pharmacologic treatments to normalize the altered nervous system producing pain, like nerve stimulation or cognitive behavioral therapy. Exercise likely improves nociplastic pain for a number of reasons, so it is also an important strategy in most treatment plans.

To find a therapist, visit the Psychology Today Therapy Directory.

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