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Neuroplastic Pain: Could This Be the Reason for Your Agonizing Back Pain?

“Neuroplastic pain?!”

Steve articulately asked in return when I asked him if he’d heard of the term neuroplastic pain.

He focused his eyes in the distance, as if retrieving data from his memory.

“They have diagnosed me with degenerative disc disease, spinal stenosis, and a herniated disc.”

“But… I’ve never heard of neuroplastic pain before!”

Steve lifted his chin and leaned forward, his fingers laced before him on my office table.

“So, tell me… what does this neuroplastic pain have anything to do with my back pain?”

Like many people, Steve has been conditioned to look at the cause of his back pain through the lens of his X-ray, MRI, or CT scan result.

These medical imaging results give doctors a lot of information on the condition of your spine and what could potentially cause your back pain. 

However, in reality, there is no relationship between what the medical imaging pictures show and how you feel or function.

Dr. David Hanscom, a renowned orthopedic spinal deformity surgeon and author of Back in Control: A Surgeon’s Roadmap Out of Chronic Pain, has this to say about imaging results and surgery:

“We generally don’t know where back pain comes from exactly. We do know very clearly that disc degeneration has nothing to do with back pain. So conditions such as arthritis, bone spurs, bulging, herniated, “slipped” or ruptured discs are rarely the underlying cause of the problem.”

After hearing this, Steve’s eyebrows went up.

He then asked, “So if the diagnoses of degenerative disc disease, spinal stenosis, or a herniated disc on my MRI are not the cause of my pain and dysfunction, where else could it be coming from?” 

In this article, you will learn the what, why, and how of neuroplastic pain, and why it is the most plausible and likely cause of persistent, recurring, or chronic low back pain. 

What is Neuroplastic Pain?

To understand neuroplasticity, let us break it down to its root words:

  • Neuro – brain
  • Plasticity – the brain’s ability to change in response to its environment

Another way to better understand neuroplasticity is to think of it as a kind of like a fork in the road:

When you initially experience back pain (acute episode), your brain interprets nerve signals from your back as PAIN and danger.

pain and danger

Pain is a message.

It is your brain and body’s way of communicating with each other; your body telling your brain, “Hey, there’s an actual or perceived threat to the body!”

In response to the information received from your body, your brain determines whether the message is indeed credible or not.

Pain serves a vital function in protecting you from further injury.

However, if this pathway is used a lot, your brain changes its structure or rebuilds itself (plasticity) to make the signals travel easier.

pain highway

Why Does Neuroplastic Pain Develop?

The property of neuroplasticity means that your brain is constantly changing, learning, and evolving. As a result, your beliefs, perceptions, feelings, and the behaviors you repeat on a regular basis will ultimately change how your brain is structured and connected. 

In the case of persistent, recurring, or chronic low back pain, because of your prolonged experience with pain, your brain has difficulty distinguishing between real and perceived danger. 

The problem arises when your nervous system continues to send “danger signals” even when the initial injury is already healed or resolved.

In my book, Back Pain Unlocked, I likened this system to your “living pain alarm system.”

There are various factors that can influence and change the structure of your brain, such as traumatic events, health conditions, chronic stress, social interactions, meditative practice, learning, attention, new experiences, diet, and exercise.

phantom limb pain

Ever heard of “phantom limb pain?”

Phantom limb pain is when a person feels pain where an arm or leg has been amputated.

Despite the limb being gone, the nerve endings at the end of the remaining limb still send pain signals to the brain that make it think the amputated limb is still there!

The pain caused by phantom limbs can range from mild to agonizing and even disabling. For some people, it leads to a lifelong battle with chronic pain.

So, in case you may be wondering where the pain is coming from – we process pain in the brain.

How Neuroplastic Pain Develops?

Neuroplastic pain occurs when your nervous system begins to adapt negatively to pain signals. 

pain superhighway

It occurs when the pain receptors in your central nervous system are stimulated for a prolonged period and change your reaction to pain signals – think of it as the pain highways toward your brain being much wider and easier to travel – your brain has developed a superhighway for pain!

This change in your brain’s structure may sometimes also result in increased sensitivity to your other bodily processes. Some people report hypersensitivity to:

  • Odors
  • Sensations
  • Vision
  • Sound
  • Taste

Others report increased:

  • Emotional distress
  • Anxiety
  • Fear
  • Stress
  • Depression

 The things that used to hurt, now hurt more.

The things that didn’t hurt before, now do!

How to Tell If Your Back Pain Is Neuroplastic?

The following signs may indicate that neuroplastic pain is the most likely cause of your low back pain:

  1. You have inconsistent low back pain symptoms – Pain that’s mechanically or structurally caused does not present with a lot of variabilities, so no matter how good or bad your day is, you’ll still have pain and symptoms. In contrast, neuroplastic pain varies with the quality of your day.
  2. Do you experience worse pain and symptoms when in high-stress situations? Does your back pain get worse when you are stuck in traffic? Or when you’re about to give a presentation, or attend a high-stakes meeting, or have a job interview? Your brain is on high alert, and your nervous system becomes hypersensitive to pain when you are stressed.
  3. Having persistent pain after the healing period – mechanical or soft tissue injuries either heal spontaneously or respond to medical or physical therapy treatment within 3 months or less. If you still experience low back pain after the normal healing time frame, your pain is likely caused by neuroplastic pain.
  4. The presence of multiple symptoms – assuming you don’t have a systemic disease like rheumatoid arthritis, lupus, or multiple sclerosis, the presence of pain in more than three or four different joints or body parts is highly unlikely. A single underlying cause, most likely neuroplastic pain, may explain the condition.
  5. You can gain a lot of insight from delayed pain. If you experience low back pain after finishing an activity, it is probably neuroplastic in origin. In the case of structurally caused pain, you are most likely to feel it even while you are still doing the activity.

How To Treat Neuroplastic Pain?

The good news is…

A brain that can cause pain can also alleviate or ease the pain.

In this article, I gave a step-by-step framework on how to treat chronic low back pain using the biopsychosocial model of treatment.

comfort and safety

You see, if you use a different pathway a lot, the brain rebuilds itself to make that new journey easier – it will make a new superhighway toward comfort and safety!

The latest research on the study and neuroscience of pain has taught us that the most sensible and effective way to treat neuroplastic pain is by using a multifactorial and integrative model that addresses the biological, psychological, and social components of your back pain experience.

After all, you are a whole body, not a body part.


Steve rubbed his shoulders to ease the tension in the back of his neck.

He puffed his chest out and exclaimed, “I knew there is an explanation for my back pain!”

You can see a smile crease his face. He is empowered.

Now, you are as well.

Your MRI result may not have any correlation to the back pain and dysfunction you are suffering from.

But do not let anybody tell you that your pain is not real.

Your pain is real. But so is hope.

Have an ample discussion with your healthcare provider while not getting too focused on structuralism (or the practice of always looking at structural issues as the cause of pain and dysfunction). Have a thorough evaluation to see if your persistent, recurring, or chronic low back pain is actually neuroplastic… in disguise.

Understanding what does NOT work is every bit as important as what does work.

You (and your brain) have the power!

Dr. Lex Gonzales
Dr. Lex Gonzales, PT, DPT is an author and speaker who has been working as a licensed healthcare professional for over 24 years. On he provides quality information and practical solutions you can use to achieve the best version of your healthy self.

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