Is it Neuroplastic or Physical? (The Unapologetic Truth)
One of the most common inquiries I get from my clients in my mind body practice is "is this neuroplastic [TMS/mind body syndrome] or is it physical?". Interestingly, this is also one of the most common questions I see on my professional mind body listerv; providers, too, are trying to answer this question. It seems a reasonable enough question to ask. But, it also ends up being a place that a lot of people get stuck. And getting stuck here means we never actually get to the healing part.
So, although you might be reading this and thinking "oh my, I want her to tell me how I know!", I'm here to tell you something different: this is actually the wrong question to be asking. And if you want to heal your pain, I'll tell you why that's the case, and what might work better. Let's dig in to the unapologetic truth.
First, pain is real. Always.
When I first started practicing in this realm, I noticed the discomfort in my patients (or friends or family members or colleagues) when I tried to talk about pain neuroscience. Describing pain neuroscience often got replies such as "yeah, but some pain is real, right?" (from my collaborating physician in orthopedics), or "yeah, but I know it's about my weak core" (from a family friend). It's troubling that pain neuroscience often leaves people feeling unheard, unseen, or undermined. You might relate to this. I know I do. It took me years to tweak my education in order to stay connected to my patients in the face of pain. And, at some point, I also became unapologetic about it. Not about the human suffering in front me, but about the science. Because pain science tells us that, no matter the cause of pain, the pain experience is always real.
So, as we start this exploration into pain science and breaking down why the question "is my pain neuroplastic or physical" can lead us astray, let's not get any crazy ideas here. If you're reading this and already feeling your cackles rise in defense of your own pain experience, I want this to be really really clear: Your pain is real. And your pain is always real, no matter if someone once told you it was neuroplastic or had no known physical reason for it's presence. Or if someone looked at you confused and said, "huh, your level of pain doesn't fit with this physical finding". Or if you were diagnosed with something that will not heal or go away (like arthritis, or scar tissue), but your practitioner recommended meditation or emotional expression as a path to changing your pain for the better. It's still real. And it makes sense. As long as you stay close to the science.
So, let's talk science. Here we go:
Pain Neuroscience: The Unapologetic Truth
Pain is a danger meter, not a damage meter.
The statement above is one of the best ways I've found to describe pain neuroscience as succinctly as possible. It really does capture it, but it also requires more explanation, especially if this is new to you or doesn't yet feel true to your experience. So let me expand that a bit.
First, let me acknowledge that the most intuitive way to think about how pain happens is that something happens to your body that is damaging, the nerves at the location of the damage send pain signals to your brain, and your brain registers these pain signals so that you actually then experience pain. This may seem to fit...but it really doesn't explain how pain works at all, especially when pain happens without damage (which we know happens!). How can we have pain without damage initiating it? Already, you might be able to see (or feel) how hearing an explanation pain science can make you feel undermined if you subscribe to this more intuitive way of thinking about pain. Because, if it doesn't fit this intuitive path we believe creates pain....then....[enter here anything you'd like to that feels dismissive or deligitimizing such as: it must be made up, you must be looking for attention, it's not really that bad is it?, it's just your anxiety/depression, you just need to calm down]. The fact that I know this happens so often in the medical setting makes me:
To shift this, we actually need to let go of this super intuitive way of thinking about pain. We need to snuggle up close to the less intuitive (but science backed) truth about how pain happens.
Here's what the science says: Pain is actually created by the brain and is a danger alarm that happens in order to protect you from harm.
Let's explore this with an example. If I mistakenly put my hand over an open flame, as soon as I feel pain, before I can even think, I pull my hand back. And, often, that happens when no damage has even occurred yet. But pain definitely happened! This is a clear example of how pain can happen without damage, and one I would expect you might have even directly experienced. It's also a great way to see the science of pain in action. Let's break down what's happening here, and how pain actually happens.
Nociceptors (sensory nerve endings) gather information about what is happening in my body: there is increasing heat in my hand
Nociceptors then send that information to my brain
My brain receives that information and consults all additional available information: environmental information brought in through my senses lets my brain know that I'm cooking, an open flame is seen through my vision, the smell of gas is brought in through my sense of smell, and prior experience supports the knowledge that flames cause harm (burns)
The brain determines our level of danger: in this case, there are multiple variables supporting the perception that danger is high for me
The brain creates pain: a sudden sensation of pain is felt at my hand
I change my behavior: The pain catches my attention so quickly that I pull my hand back before a burn occurs
This is how pain works. Every time.
No matter if I walk out of this office, fall off the deck, and break my arm, or if I hold myself up through a traumatic experience when all I really want is to sink into support. Both involve danger, and a lot of it, but from completely different sources. Both involve pain that is very real, but for very different reasons. In each of these examples, the brain collects information (from all sources available), predicts how much danger there is, and creates pain if danger appears high enough.
Pain is an alarm bell. It goes off in warning of impending threat.
Pain is perception. It's your brain's best guess at what is happening with the information it has.
Pain is about danger, not damage. Damage isn't even required to make it happen. But, danger is. And danger information comes from a ridiculous amount of places.
So, hopefully you can already see: Pain isn't physical pain or neuroplastic pain. It's just: pain. And we know how to treat pain because the science points the direction.
How This Changes Things
In my work, I often say that pain is about all the things. This becomes exceedingly important when someone has a physical finding in addition to their pain (like a bulging disc or foraminal stenosis, or arthritis). But it's even more important when someone comes to me without any physical findings and asks "is this physical or is this neuroplastic?", paralyzed by being unable to answer the question and unsure which direction to go in their care. If a patient is trying to decide if it's one or the other because of this binary approach, the process of ruling out a physical cause so that they can move to mind body approaches, sadly, can be a dizzying rabbit hole you can never get out of. Because you'll always be able to find one more doctor who's willing to run one more test.
But, the direction doesn't need to be different. In all cases, pain is about danger. And, in all cases, treating pain is about decreasing danger. And when we finally really lean into that as true, the doors for healing pain swing wide open without ever having to answer that question in the first place. Because this means that:
Even in the setting of arthritis, you can get curious about how your recent flare started when you lost a parent.
Even in the setting of medically unexplained symptoms (MUS) where a medical workup may continue for months (or even years!) without any findings, it opens the door to recognizing that if all signs point to your body being okay so far, you definitely have time to work with the other contributors which are undeniably always a part of it.
It means you don't get stuck before you ever even get started. It means you actually don't have to have the answer to this question at all before you can start make amazing progress in treating your pain. Because, pain is always about all the things.
Okay, so what do I do now?
If you're struggling with this question and can't seem to make progress until it's answered, I get it. This is complex. It's also less intuitive. And it requires some willingness to butt heads with the system a bit. But, I'm here to encourage you. Medicine likes clarity. Medicine likes one variable identified as the cause for one finding. And that filters out to us, the patients, because it's persistently present in our healthcare system, and sometimes even in mind body medicine. And it's the reason I felt called to write this blog and offer something different. Because the truth is, pain science supports a different question to guide treatment. And it's one that actually opens all doors to healing pain, and avoids you getting stuck before you even get started. It's a question I let guide all of the work I do in healing pain, and it's what leads the way to my patients and clients finding a pain free life.
The better question to be asking is: What are the contributors to danger?
Start working on getting this question answered instead. Consider all the things. And see where it takes you.
Because even if there's arthritis, that's not the only thing. Even if there is an imbalance in your hips, that's not the only thing. Even if there is scar tissue, that's not the only thing. And even if there is nothing that can be found physically, that never (ever!) means your pain is not real. It just means we're looking for a different contributor to your pain.
When you lean into this question and get curious about all the contributors to danger, you get to act You're not stuck. All doors are open. Let's get curious.
If your'e looking for resources to begin to explore how you might answer this question, check out my free resources page, my Curable talks, or reach out anytime! *
*And if you still find you're concerned about your physical body, please reach out. Physical contributors do happen! My job is to let you know if they need treatment to help you progress, and I'm happy to support that part of this exploration at any time.
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