September is Pain Awareness Month, which makes it a good time to talk about something that can be both confusing and frustrating for people living with persistent pain:
Why can something still hurt when the original injury has healed, or when scans and tests don’t seem to explain how much pain you’re experiencing?
For years, pain was often viewed fairly simply: something hurts because something in that spot is damaged. And sometimes that is exactly what is happening. An injured muscle, an inflamed joint, a fracture, or another tissue problem can produce pain.
But pain science has taught us that the story can be much more complicated.
Sometimes the nervous system itself changes the way it processes pain.
Nociceptive, Neuropathic and Nociplastic Pain
It helps to understand that not all pain works the same way.
Nociceptive pain is associated with actual or threatened tissue damage, such as an injury or inflammation.
Neuropathic pain results from a lesion or disease affecting the somatosensory nervous system. Peripheral neuropathy and some nerve injuries are examples.
Nociplastic pain involves altered nociception when the pain cannot be adequately explained by ongoing tissue damage or by a lesion or disease of the somatosensory nervous system.
In plain English, sometimes the body’s pain-processing system becomes overly sensitive.
That does not mean the pain isn’t real.
It means the mechanism producing or amplifying the pain may have changed.
Where Does “Neuroplastic Pain” Fit In?
You may also hear the term neuroplastic pain.
Neuroplasticity is simply the nervous system’s ability to change and learn. It’s essential to how we learn movements, skills and behaviors. But those same adaptive abilities can sometimes contribute to persistent pain.
Imagine that you hurt your back bending forward. At first, bending hurts because you’ve injured something.
Eventually the tissue heals, but your nervous system has spent weeks or months associating that movement with danger.
Bending = danger = pain.
For some people, that protective response can persist even when the original tissue injury is no longer the primary problem.
“Neuroplastic pain” is generally used as a clinical concept for pain maintained or amplified through these learned nervous-system patterns, while nociplastic pain is a formal pain-mechanism classification. There is considerable overlap, but the terms aren’t necessarily interchangeable.
And there’s an important piece of good news hidden in the word plastic:
A nervous system capable of changing in one direction is also capable of changing again.
Pain Doesn’t Always Fit Neatly Into One Box
This may be the most important part.
A person doesn’t necessarily have either tissue pain or nerve pain or altered pain processing.
More than one mechanism can be happening at the same time.
Someone with arthritis, for example, may have genuine joint changes contributing to pain while also developing increased nervous-system sensitivity that magnifies the pain experience.
That’s one reason I believe it is so important to understand what may be driving a person’s pain before deciding how to treat it.
If inflammation or tissue injury is a significant contributor, treating the tissue may make sense.
If a damaged or dysfunctional nerve is contributing, the treatment approach may be different.
And if the nervous system has become sensitized, repeatedly treating only the body part that hurts may not address the entire problem.
This is also why there isn’t one treatment that is appropriate for every person who walks through my door.
“Nothing Showed Up” Doesn’t Mean Nothing Is Wrong
People with persistent pain sometimes endure years of appointments, tests and treatments without receiving a satisfying explanation.
Being told that imaging looks fine can be reassuring medically, but it can also be incredibly frustrating when you’re still hurting.
Pain that isn’t adequately explained by ongoing tissue damage is still real pain.
Modern pain science gives us a much broader understanding of how the brain, spinal cord, peripheral nerves, tissues and our protective systems interact to create the experience we call pain.
For me, that is one of the most hopeful developments in pain care.
The question can begin to shift from simply:
“Where does it hurt?”
to:
“Why does it hurt, and what mechanism might be keeping the pain going?”
That is a much more useful place to start.
Source & Further Reading
This month’s post was inspired in part by Cindy Perlin’s excellent article, Neuroplastic vs. Nociplastic Pain: When the Nervous System Keeps Pain Going, published by the Alternative Pain Treatment Directory. Her article goes deeper into these concepts, including potential contributors, signs and treatment approaches.
Read Cindy Perlin’s original article at the Alternative Pain Treatment Directory
For formal pain terminology, the International Association for the Study of Pain (IASP) maintains definitions of neuropathic, nociceptive and nociplastic pain.