How can we tell what is causing our pain and symptoms? Here is a list of criteria developed by Dr. Howard Schubiner, MD in conjunction with a team of other doctors and psychologists, for evaluating whether pain and symptoms are neuroplastic (sometimes also called "neural circuit" or other terms) vs. structural or physiological in nature.

Some chronic or persistent pain and symptoms will have a structural component, but this does not mean you cannot also reduce or eliminate your pain with mind-body techniques like Pain Reprocessing Therapy. Many people who have structural back issues do not experience any pain. Check out the results of this study of 3,300 adults with no pain:

[See other symptom list that these approaches have proven relevant for + resources here. While this is not a comprehensive or full list, it can give an idea of the greater extent of symptoms that can be neuroplastic.]

Criteria for Evaluating if Pain/Symptoms are Neuroplastic:

1. It originated during or right after a stressful time/event.
2. It originated without a clear, immediate injury (or originated with an injury but the symptom lasts longer than it takes for that injury to heal, usually weeks to months).
3. Symptoms with delayed onset (i.e. it flared up after my walk, or my back spasmed the day after a big workout).
4. Symptoms are inconsistent (time of day, same types of movement/different context, pain level goes way up and down).
5. Multiple symptoms: 3+ unrelated physical conditions/pain in the body (or having a history of).
6. Symptoms spread or move around.
7. Triggered or worsened by stress (and decreases when doing something enjoyable).
8. Triggers that have nothing to do with the body (weather, sounds, smells, sun exposure, time of day, day of week - signals a learned associated response).
9. Symmetrical symptoms (develops on same part of body on opposite sides).
10. Childhood adversity (anything that made someone feel ongoingly unsafe/worried/pressure growing up).
11. Common personality traits (linked w/fear - perfectionism, conscientiousness, people pleasing, anxiousness, self-criticism, putting pressure on self, worry).
12. Lack of conclusive physical/medical diagnosis (this can also look like a symptom-based diagnosis that does not explain underlying cause, such as fibromyalgia, pelvic floor dysfunction, or migraines).
    

If 2-3 apply to you, that points to a very high likelihood of neuroplastic pain, or at least a high influence of the nervous system on your symptoms, even if there is an underlying structural, physiological or disease factor.

Research has shown that brains are also more likely to make mistakes and create erroneous pain/symptoms when:

• Your current/general stress level/nervous system state is high (research shows a lot of pain starts during/after major life events like graduation, new jobs/job loss, loss of loved ones, marriage, breakups, moving, change in finances, or any big transition).
  
• Your overall allostatic load is high (meaning your nervous system is holding more long-term accumulated stress, which could be from experiencing everyday adult stress, unstable/unsafe living situations, health experiences, chronic pain/symptoms themselves, discrimination, trauma, or having had challenging childhood experiences). You might think of this as a bucket getting too full over time until it’s at a point where it easily overflows.
  
• Some personality types or psychological states create more internal pressure or intensity (internal threat) such as being self-critical, people pleasers, “Type A” doers/go-getters, perfectionists, over- or high-functioning, catastrophizing, hypervigilant, or experiencing a lot of shame, worry, anxiety, heightened sensitivity, etc.

Start Now: Create an Evidence List

Write down if any of the criteria or correlative life situations apply to you and your symptoms and how. Be specific.

One of the first stages of treatment is gathering evidence, noticing and noting examples for yourself in a journal or note-taking app on your phone. This helps to build a different story, possibility, and relationship with the symptoms themselves.

While this is just the beginning, you might even notice the intensity of your symptoms might change even just by starting to reframe what is happening. Our main goal is to reduce anxiety and frustration—to start practicing coming back to this list when you get scared about what is happening.

3 Main Components for Retraining the Brain and Nervous System:

1. Education to understand the cause of your symptoms. Learn more about how and why the brain can make pain when there is nothing actually wrong here (coming soon)!

2. Handling internal and external stress differently (reducing threat, get us out of danger mode), including our response/stress about the symptoms themselves.

3. Understanding and processing emotions that are contributing a sense of threat (this step is not always necessary, but important if #1 and #2 aren’t creating a shift on their own).

IMPORTANT: You do not have to believe 100% that your pain/symptoms are 100% neuroplastic to start seeing if these approaches can help you.

Many people do have diagnoses or MRI scans that show something “abnormal”, but still are able to retrain their brain to be symptom-free or have greatly reduced symptoms and greatly improved quality of life. Over time, with almost any chronic symptom, whether it has some structural/physical foundation or not, there is some neuroplastic element to the pain that can benefit from this approach. Our brains are amazing!