Neuroplastic Pain: Why Your Chronic Pain May Be Solvable
Carolyn Evans, LISW-CP | Licensed psychotherapist and chronic pain specialist
If you've spent years searching for an answer to your chronic pain — going from one specialist to the next, trying treatments that didn't quite work, watching your imaging come back without a clear answer — there is a name for what you may be experiencing. It is called neuroplastic pain, and the research behind it is reshaping what clinicians understand about persistent pain.
This page is here to give you a clear, evidence-based explanation of what neuroplastic pain is, how it differs from structural pain, and what current science tells us about reversing it. The goal is not to convince you of anything. It is to give you information you may not have been offered by the medical system yet — information that, for many people, changes everything.
What is neuroplastic pain?
Neuroplastic pain is chronic pain generated by the nervous system itself, in the absence of ongoing structural damage. It is not imagined. It is not exaggerated. It is a real, measurable pain experience produced by a nervous system that has learned to stay on high alert — and is doing exactly what it is built to do, a little too well, for a little too long.
The word "neuroplastic" comes from neuroplasticity, the brain's capacity to change in response to experience. Just as the brain can learn skills, languages, and habits, it can also learn patterns of pain. When pain signals fire repeatedly in the context of stress, vigilance, injury, or unresolved emotion, the nervous system can become more efficient at producing them — until the pain becomes self-sustaining, independent of any continuing damage in the body.
To say it is all in your head is dismissive, but it really is all in your brain. Every pain experience — including pain from a clear injury — is ultimately produced by the brain interpreting signals and generating a sensation. With neuroplastic pain, the signals have outdated information. The threat that originally activated the alarm has passed, but the alarm has not yet been told it can stand down.
The good news is that what neuroplasticity created, neuroplasticity can resolve. A nervous system that learned a pain pattern can update its information — and as it does, the pain often eases or disappears entirely.
How is neuroplastic pain different from structural pain?
Pain researchers generally describe three categories of pain. Briefly:
Nociceptive pain
Pain from tissue damage. A sprained ankle, a broken bone, a pulled muscle. Your nerves detect the damage and signal the brain, which produces a pain experience to protect you while you heal. This is the kind of pain most people think of when they think of "pain."
Neuropathic pain
Pain caused by damage or dysfunction in the nerves themselves. Examples include diabetic neuropathy, sciatica from a true nerve impingement, postherpetic neuralgia (the lingering pain after shingles), and carpal tunnel syndrome. Neuropathic pain has characteristic sensations: burning, electric, shooting, tingling, and numbness. Diagnosis usually involves imaging showing compression, along with clinical workup.
Neuroplastic pain
Pain generated by the nervous system in the absence of ongoing tissue or nerve damage. The signals are real, the experience is real, but the source is the nervous system's own learning, not damage in the body.
Here is where it gets clinically interesting. The sensations associated with neuropathic pain — burning, electric, shooting, tingling, numbness — can all be produced by the brain as part of a neuroplastic pain pattern. This is why symptoms alone do not differentiate the two. A person can have burning and tingling that is fully neuroplastic, and a person can have burning and tingling that is fully neuropathic. The symptoms look identical.
The way to tell the difference is through a thorough clinical workup. If imaging shows clear nerve compression, or if testing identifies an underlying condition like diabetes that damages nerves, the pain is likely neuropathic. If a thorough medical workup has been completed and the imaging is clean, neuroplastic pain becomes a much stronger possibility.
For clinical purposes, I bucket the first two together as structural pain — pain with a clear physical source in damaged tissue or damaged nerves. Neuroplastic pain is a different category entirely. It is pain generated by a nervous system protecting you from a threat that has already passed.
The science behind neuroplastic pain
The mechanism that creates neuroplastic pain is called central sensitization. It is one of the most well-documented phenomena in modern pain research, and it works like this:
When the nervous system is exposed to repeated pain signals, stress, vigilance, or unresolved emotion over time, it begins to amplify ordinary sensations. The volume dial on the pain system gets turned up. Signals that a calmer nervous system would let pass unnoticed start producing pain experiences. The nervous system is not malfunctioning. It is doing what nervous systems do — adapting to what it has been taught to expect, which in this case is threat.
Think of a home security system that has had its sensitivity turned up too far. The wind moves a curtain. The alarm shrieks. The wind did not break in — the sensor is just doing its job a little too well. A sensitized nervous system works the same way. The body is fine. The alarm is what needs to update its information.
One clinical illustration. I once worked with a client who had vestibular migraines that began suddenly during a period of intense stress at work. Every doctor she saw confirmed there was no structural cause — no tumor, no inner ear damage, no stroke. The migraines kept coming. As we worked together, it became clear that her nervous system, after years of running on high alert, had learned a new way to signal danger. When we helped her nervous system understand that the danger had passed and that she was, in this moment, safe, the migraines gradually resolved.
There is something else worth saying here. The nervous system will repeat any symptom it notices you dousing with fear. The more frightening a sensation feels, the more attention the brain gives it, and the more reinforced the pain pathway becomes. This is not because anyone is doing anything wrong. It is the basic mechanics of how the brain learns. Once you understand that mechanism, you can begin to work with it rather than against it.
Neuroplasticity learned the pattern. Neuroplasticity can unlearn it.
Signs your chronic pain might be neuroplastic
After years of working with people whose chronic pain has been resistant to standard treatment, certain patterns repeat. These are the patterns I look for clinically when assessing whether someone's pain is likely neuroplastic. None of these is diagnostic on its own. Several of them together — especially in combination with a clean medical workup — make neuroplastic pain a much stronger possibility.
Patterns in the diagnostic workup
Diagnostic testing without a definite cause. You have had the imaging, the labs, the specialist referrals, and no one has been able to explain why you hurt. Or the explanations you have been given do not fully match the severity or persistence of your pain.
Pain that persists long after an injury should have healed. Most physical injuries heal in 6 to 8 weeks. If your pain began with an injury and the pain has long outlasted the healing timeline, your nervous system may be repeating the pattern.
A history of other symptoms doctors have struggled to diagnose. Different symptoms, different decades, different specialists — and a pattern of "we are not sure what is causing this."
Patterns in how the pain behaves
Pain that moves around. Back pain last month, hip pain this month, and now you are starting to wonder if the knee is next. Structural pain tends to stay where the structure is. Neuroplastic pain wanders.
Multiple symptoms in multiple body areas, sometimes of different types. Back pain and migraines and abdominal bloating and fatigue. The nervous system, when running hot, often produces a constellation of symptoms rather than just one.
Sensations that include tingling, burning, electric shock, numbness, or sensations of heat or cold. These overlap with neuropathic pain — but in the absence of identifiable nerve damage on workup, they often point toward a neuroplastic origin.
Pain that varies with the time of day. Worse in the morning, worse at night, or following a predictable daily pattern that does not match any clear physical explanation.
Patterns around stress and emotion
Pain that flares with stress, or with the anticipation of stress. The difficult meeting on Friday makes the symptoms worse Thursday afternoon, before the meeting has even happened. The nervous system is responding to the threat it is tracking — and the threat is the upcoming event.
Pain that started soon after a scary or traumatic event, or a major life stressor. The connection is often not coincidence. A nervous system that absorbed something overwhelming may begin to produce pain as part of how it carries what happened.
Pain triggered by simply imagining the activity. Bending over, sitting in the car, lifting a child — the thought alone increases the pain before any movement has happened. This is one of the more striking markers and almost always points toward the nervous system rather than structural damage.
Patterns in what makes the pain better
Pain that is less severe when you are absorbed in something enjoyable. On vacation, in flow, deep in conversation with someone you love — and you notice the pain has dropped without you doing anything about it.
Pain that is less severe in environments that feel safe. At home with familiar people, away from the people or settings where the nervous system braces.
Pain triggered by light touch or gentle stimuli — wind, cool air, clothing brushing against skin. When a nervous system has been amplifying ordinary signals, even gentle stimuli can produce strong pain.
Patterns in life history and personality
Patterns I see almost universally — perfectionism, caring for others while struggling to care for yourself, people-pleasing, self-criticism out of proportion to your actual mistakes, adverse experiences in childhood that shaped how you learned to stay safe. These are not character flaws. They are intelligent survival responses, and they can also, over years, keep a nervous system running hot.
My Pain Personality Profile is a free 3-minute quiz that helps you identify which of these patterns is most strongly shaping your experience. You can take it here.
Patterns that often co-occur
Anxiety or worry out of proportion to circumstances. Sleep disruption. Fatigue. Depression. These often travel alongside neuroplastic pain because they share the same nervous-system substrate. If you are experiencing depression or thoughts of harming yourself, please reach out to your physician — these deserve their own clinical attention, regardless of what is happening with your pain.
How to read this list
If three or four of these patterns ring true for you, neuroplastic pain is worth investigating. If many of them ring true, the conversation becomes much more pointed. The next step is to take the 3-Minute Chronic Pain Assessment, which walks through these patterns in a structured way and gives you a clearer clinical picture.
The Boulder Back Pain Study: what the research proved
The neuroplastic pain framework is not a fringe theory. It is the direct implication of a body of research that has been growing for two decades and reached mainstream recognition in 2022.
In January 2022, the journal JAMA Psychiatry published the results of a randomized clinical trial that came to be called the Boulder Back Pain Study. The study was led by Yoni Ashar, PhD, along with Alan Gordon, LCSW, and Howard Schubiner, MD.
The researchers enrolled 151 adults with persistent chronic back pain — the kind that had resisted standard treatment for years. The participants were randomized into three groups. One group received a new treatment called Pain Reprocessing Therapy (PRT), delivered in 8 one-hour sessions over 4 weeks (two sessions per week). The other two groups received either a placebo injection or usual medical care.
The results were striking. At the end of treatment, 66 percent of patients in the PRT group were pain-free or nearly pain-free. A year later, most of those gains held.
To put that in perspective: most chronic pain treatments consider a 30 percent reduction in reported pain intensity a clinical success. The PRT group was pain-free. Not "better managed." Not "coping more effectively." Resolved.
One study, however well-designed, does not settle a question on its own. But the Boulder Study is the clearest demonstration to date of what has long been suspected in clinical practice — that a meaningful portion of chronic pain is neuroplastic in origin and can be reversed
The framework I use in my own practice and teach in my course draws directly from this research lineage. I trained with Dr. Schubiner and Alan Gordon, LCSW. The course integrates the same approach studied in the Boulder Study, along with neuroscience education and Internal Family Systems parts work, into a complete clinical framework.
If you want to read the original study: Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain. JAMA Psychiatry. 2022;79(1):13-23.
How neuroplastic pain is treated
There are several evidence-based approaches to treating neuroplastic pain. What follows is the integrated framework I have developed in my clinical practice — combining Pain Reprocessing Therapy, neuroscience education, and Internal Family Systems parts work to help clients move from coping to healing.
Treatment for neuroplastic pain is not symptom management. The goal is not to learn to live with the pain — it is to help the nervous system update its information so that the pain itself can resolve. The work happens at three layers, and they support one another.
Neuroscience education
The foundation of the work is understanding what neuroplastic pain is and how it operates. Before anything else changes, the brain needs accurate information about what is happening. When clients genuinely understand that their pain is a learned signal rather than a sign of damage, the fear that has been fueling the pain pattern begins to soften. Education is not a preliminary step before the real work — it is part of the real work. The understanding itself is therapeutic.
Pain Reprocessing Therapy (PRT)
PRT, developed by Alan Gordon, LCSW, is the clinical approach studied in the Boulder Back Pain Study. The core practice is somatic tracking — turning attention toward the pain with curiosity rather than fear and allowing the nervous system to gradually reinterpret the sensation as safe rather than threatening. Over weeks of consistent practice, the brain begins to update its prediction about what the sensation means. The signal becomes less urgent. The volume turns down. PRT also includes work with avoidance behaviors and fear responses that have built up around the pain over time.
Internal Family Systems (IFS) parts work
Founded by Dr. Richard Schwartz, Internal Family Systems is an evidence-based therapeutic approach that helps people work skillfully with the different protective patterns inside them — the parts that have been carrying perfectionism, vigilance, self-criticism, or emotional suppression for years. These patterns often live alongside chronic pain, and they often need to be met with care before the nervous system feels safe enough to settle. Parts work creates the containment that other approaches sometimes lack, especially for people whose pain is tangled with emotional history.
What treatment actually looks like
In my clinical work, the first one or two sessions are about getting to know each other and building the case together for whether your pain fits the neuroplastic pattern. I ask careful questions. I look at your history. We map the signs. Most importantly, I am looking for buy-in — your willingness to genuinely entertain that your pain may be neuroplastic. This matters because the work itself depends on it. A nervous system cannot update its information about safety if the person it belongs to is still convinced something is structurally wrong.
Once we have established that buy-in, the work moves in a sequence I have refined over years of practice. We begin with neuroscience education. We move into somatic tracking as the central daily practice. And when clients are open to it, we layer in parts work to address the patterns that have been keeping the nervous system on high alert.
The typical arc is about three months — twelve weekly sessions. Most clients see significant change by the end of the first two months. The earliest signs that the work is taking hold are not pain reduction (that comes later). The earliest signs are subtler:
● An openness to a new way of understanding the pain
● Genuine curiosity about the neuroplasticity of the brain
● A willingness to turn toward the sensation without fear
These are the precursors. When they show up, the nervous system has begun to update its information. The pain reduction and cessation follows.
The Solve Chronic Pain course is structured around the exact sequence I use in private practice — neuroscience education, then somatic tracking, then parts work. It is not a watered-down version of clinical care. It is the same framework, packaged for self-paced learning, so that people who cannot access private therapy still have a clear path through this work.
What to do if you think your pain is neuroplastic
Before exploring this further, a real medical workup matters.
Neuroplastic pain is a diagnosis of exclusion. That means it is what we are left with after the structural workup has come back without a clear cause. If you have not yet had your symptoms thoroughly evaluated by a physician — imaging, blood work, specialist referrals as appropriate — that is the first step before anything else. There are conditions that need medical treatment, and the goal of this page is not to talk anyone out of pursuing a proper diagnosis.
That said: if you have already done the testing, seen the specialists, and been told that nothing structural explains your pain — or that the structural findings do not seem to match the severity of what you are experiencing — then you may be a strong candidate for neuroplastic pain work.
The first step
Take the 3-Minute Chronic Pain Assessment. It is the same clinical tool I use with new clients to help determine whether their pain fits the neuroplastic pattern. It is free, takes about three minutes, and gives you immediate results along with a short note from me on what to do next.
Take the 3-Minute Chronic Pain Assessment →
The next step
If your assessment results suggest your pain is likely neuroplastic, the Solve Chronic Pain course walks through the complete framework — neuroscience education, Pain Reprocessing Therapy methods, and Internal Family Systems parts work — at your own pace. It is structured around the exact sequence I use in clinical practice, and it is designed for people who want to do the work themselves without flying to a specialist or booking months of private therapy.
Learn more about the Solve Chronic Pain course →
About Carolyn Evans, LISW-CP
Carolyn Evans, LISW-CP, is a licensed clinical social worker and psychotherapist based in Charleston, South Carolina. She specializes in working with people whose chronic pain has not responded to standard medical treatment, using an integrated framework that combines Pain Reprocessing Therapy, pain neuroscience education, and Internal Family Systems parts work.
Carolyn trained with Dr. Howard Schubiner, one of the leading clinical researchers in neuroplastic pain, and completed clinical training in the founding cohort of Alan Gordon's Pain Reprocessing Therapy training program. Alan Gordon, LCSW, is the founder of Pain Reprocessing Therapy and lead clinician on the 2022 Boulder Back Pain Study published in JAMA Psychiatry.
In addition to her private practice, Carolyn created Solve Chronic Pain, an online course that walks through the same clinical framework she uses with private clients. The course is designed for people who want to do this work themselves, at their own pace, without needing to travel for specialized clinical care.
Carolyn struggled with chronic pain for years before finding this work. She writes and teaches about the science of chronic pain because she believes that most people who are suffering have never been offered an accurate map of what is actually happening — and that once they have one, much of what feels permanent becomes solvable.
Take the next step
If you have read this far, something in this framework probably rings true for you. The most useful thing you can do right now is take the 3-Minute Chronic Pain Assessment. It is the clinical self-check I use with new clients to help determine whether their pain is neuroplastic, and it will give you a clearer picture of what kind of work might actually help.
Three minutes. Immediate results. No cost.
Take the 3-Minute Chronic Pain Assessment →
If you have already taken the assessment and want to go deeper, the Solve Chronic Pain course is the full framework — eight modules, designed around the same clinical sequence Carolyn uses in private practice.
Learn more about the Solve Chronic Pain course →