When I introduce an Evidence List to someone, I usually have to clarify one thing pretty quickly: We are not making a list of reasons you should convince yourself your symptoms are neuroplastic. That would be much easier. We could write My tests were normal at the top, add Stress makes it worse, call it a day, and hope your brain finds our PowerPoint presentation compelling. Unfortunately, nervous systems tend to be a little more skeptical than that.
An Evidence List is a tool used in Pain Reprocessing Therapy to look at the actual pattern of your symptoms. Instead of starting with This is definitely structural or This is definitely neuroplastic, we gather information that points in either direction. What evidence suggests there may be an ongoing physical or structural process contributing to the symptoms? And what evidence suggests the brain and nervous system may have learned to produce or amplify them? I often think of it as detective work. We’re not trying to manipulate the evidence until it gives us the answer we want. We’re looking for clues.
And sometimes the most useful clues are things you’ve been experiencing for years without realizing they were clues at all.
Why make an Evidence List?
One of the hardest parts of PRT is that understanding neuroplastic symptoms intellectually doesn’t necessarily make them feel safe. You may have read The Way Out. You understand that pain is created by the brain and isn’t always an accurate measure of tissue damage. Your doctor may even have told you that nothing dangerous is happening.
Then the pain hits. And suddenly your brain says, Okay, sure, but THIS feels structural.
That’s understandable. Symptoms are designed to get your attention. A burning sensation feels like something is burning. A stabbing pain feels like something is being stabbed. Dizziness can feel like something is seriously wrong with your balance system. Bladder urgency feels remarkably convincing when your brain is telling you that you need a bathroom immediately. The sensation itself doesn’t arrive with a little label saying neuroplastic. An Evidence List gives us something more concrete to work with.
Rather than asking you to blindly believe that you’re safe, we can look at your own history and ask: Does the way these symptoms behave make sense if ongoing tissue damage is the entire explanation?Sometimes it does. Sometimes it really doesn’t. And sometimes the answer is somewhere in the middle.
That last category matters. Structural and neuroplastic processes aren’t mutually exclusive. Someone can have arthritis and also develop nervous-system sensitization around a joint. A person can have endometriosis and a sensitized pelvic pain system. An injury can genuinely hurt at the beginning and later become part of a learned pain pattern after the tissue has healed.
We’re not trying to decide whether something was ever physically wrong. We’re trying to understand what is contributing to the symptoms now.
Start with evidence that supports a physical or structural explanation
I usually like having two sides to an Evidence List.
On one side, we put evidence that seems to support an ongoing structural or physical explanation. This might include a known medical condition that can reasonably produce the symptom, abnormal testing that corresponds with the symptoms, a recent injury that is still healing, inflammation, or another finding your medical provider believes is clinically significant. This side of the list is important.
PRT should not require you to ignore medical evidence in order to make the neuroplastic explanation work. If something doesn’t fit, I want to know about it. If a doctor has identified a medical condition that needs treatment, that information belongs in the picture.
What I don’t want to do is assume that every abnormal finding automatically explains every symptom. Human bodies are full of abnormalities.
Imaging in particular can identify structural changes in people who have no pain at all. Degenerative findings in the spine become increasingly common with age, for example, including among people without symptoms. That doesn’t mean an MRI finding is never relevant. It means the finding has to make sense alongside the rest of the clinical picture.
So instead of writing MRI abnormal = structural and closing the case, we might ask: Does the finding actually correspond with the location and behavior of the symptoms? Does the treating physician believe it explains them? Does it explain why symptoms vary so dramatically? Again: detective work.
Then look for evidence of a neuroplastic pattern
This is often where the list becomes interesting. There isn’t one symptom behavior that proves something is neuroplastic. We’re looking for a collection of clues. Maybe the symptom moves. Your pain started in the right shoulder, disappeared, then appeared in the left. Or your back pain changes location from one day to another. Maybe the symptoms spread over time in a way that isn’t easily explained by a single injury or disease process. Maybe the intensity varies dramatically. You’re in severe pain one day and relatively comfortable the next despite doing essentially the same things.
Perhaps there are exceptions to a rule you thought was absolute. You believe sitting always causes pain, but then you sit through a two-hour dinner with friends and realize afterward that your back barely bothered you. You usually become dizzy in grocery stores, but one day you’re distracted by a conversation and make it through the store without much difficulty. Those exceptions should get our attention. So should context.
Maybe symptoms are much worse at work than at home. They disappear or improve significantly on vacation. They increase when you’re stressed, worried, or paying close attention to them. They sometimes begin before you’ve actually done the thing that supposedly causes them. That last one can be particularly interesting.
If your bladder urgency starts as soon as you think about taking a long car ride, even though you’re still sitting on your couch, what is your bladder responding to? If your back tightens while you’re imagining bending over but you haven’t moved yet, what just happened? If nausea begins when you look at a food you’ve learned to fear, before you’ve taken a bite, that’s useful information. It doesn’t prove the symptom is neuroplastic. But it belongs on the list.
Your Evidence List should be specific to you
This is where I think generic checklists can only take us so far. “Symptoms get worse with stress” is useful. “Last Christmas, I was having a terrible pain week, but while everyone was opening presents I realized I’d been sitting on the floor for forty-five minutes without noticing my back” is better. Your nervous system doesn’t live in a textbook. It has your history. I want the weird examples.
Maybe your pain disappears in the shower. Maybe it reliably starts at 3:00 p.m. Maybe you can walk around Target for an hour but a ten-minute “exercise walk” causes symptoms. Maybe your neck hurts every time you drive except when you’re singing loudly enough that the people in the next car are concerned about you. Write that down.
One of my favorite categories is simply: Things that don’t make sense. Not because we’re trying to catch your body doing something wrong, but because inconsistency can tell us something about how much context is influencing the symptom. If a purely structural explanation says an activity should always be dangerous to the same tissue, but your body can sometimes perform that activity comfortably under different circumstances, I become curious.
That curiosity is very different from See? It’s all in your head. The experience was real in both situations. We are asking why the brain produced a different experience.
How to make your own Evidence List
You don’t need anything elaborate. A piece of paper, a note on your phone, or a document works perfectly well. I would divide it into two sections: Evidence for a Physical/Structural Component and Evidence for a Neuroplastic Component. Then start with what you actually know.
On the physical or structural side, you might include medically relevant findings, diagnoses, injuries, or other evidence that could reasonably contribute to your symptoms. I would be careful about interpreting test results yourself here. If you aren’t sure whether something is significant, that’s a question for the medical professional who evaluated you.
On the neuroplastic side, you can look for patterns such as:
Symptoms that move, spread, switch sides, or change significantly
Symptoms that vary substantially despite similar physical circumstances
Symptoms that improve when you’re distracted, engaged, relaxed, or away from your normal environment
Symptoms that increase with stress, fear, attention, or anticipation
Symptoms that sometimes begin before the supposed physical trigger
Activities that are painful in one context but comfortable in another
Symptoms that have persisted beyond the expected healing period of an injury
Multiple persistent symptoms that have appeared at different times
A symptom disappearing while another becomes more prominent
Moments when something you believed you “couldn’t” do happened without the expected symptoms
You don’t need to check every box. This isn’t a diagnostic quiz where six neuroplastic clues earns you a certificate. In fact, I’d rather have three very specific pieces of evidence from your own life than fifteen generic statements you copied from the internet.
You can also add to the list over time. That part is important because new evidence often appears once you start looking for it. You may be convinced that walking more than twenty minutes always causes symptoms. Then one day you’re sightseeing, get distracted, and walk for forty-five minutes before realizing what happened. Add it.
The list isn’t supposed to make you 100% certain
This may be the most important part. Sometimes people make an Evidence List and then look at me as if we’re waiting for a jury verdict. So… is it neuroplastic? Maybe.
An Evidence List is one piece of an assessment, not a diagnostic test. There are symptoms and medical conditions that require evaluation, and patterns that look neuroplastic can sometimes occur alongside genuine physical disease. If symptoms are new, changing, unexplained, or haven’t been appropriately evaluated, a list on a piece of paper shouldn’t replace medical care.
But when someone has already had appropriate evaluation and we’re considering whether nervous-system learning may be contributing, the Evidence List can help loosen an assumption that has felt unquestionable.
Maybe you began with: My back hurts because something is wrong with my back. And after looking at the evidence, you’re at: There is actually a decent amount here that doesn’t fit that explanation. That’s useful. You don’t necessarily need to leap all the way to I AM 100% SAFE AND THIS IS DEFINITELY NEUROPLASTIC. Your nervous system may not buy that yet. Sometimes There might be another explanation for this is enough to begin.
Keep the list as evidence, not reassurance
There is one final trap worth mentioning. An Evidence List can become another checking behavior. The symptom appears. You panic. You pull out the list. Okay. Number one: it moves. Number two: MRI was reassuring. Number three: vacation. Number four… You feel better for five minutes. Then the symptom changes. Back to the list.
If that happens occasionally, I wouldn’t worry about it. Especially early in PRT, reviewing your evidence can be genuinely helpful when an old danger story feels particularly convincing. But ultimately, I don’t want you needing to present a legal case to your nervous system every time your back hurts.
The Evidence List is there to help build a new understanding. Once that understanding becomes more familiar, we can begin creating experiences that support it—through somatic tracking, graded exposure, changing how we respond to symptoms, and gradually returning to activities the brain has learned to fear.
That’s where the evidence starts moving off the paper. You bend and discover you can respond differently. You have a symptom flare and don’t panic. You do something you’ve avoided for six months. You forget about the symptom for an afternoon. Those experiences become evidence too. And often, they’re the evidence the nervous system finds most convincing.
Want to Keep Exploring?
If you’re building an Evidence List, How Do I Know If My Symptoms Are Neuroplastic? is a good place to start. You may also find What Is Somatic Tracking? helpful for understanding what we do with the evidence once we’ve gathered it.
An Evidence List is also something I regularly work through with clients because the most useful clues aren’t always obvious when you’re looking at your own history. If you’re wondering whether your symptoms may have a neuroplastic component, I offer a free 15-minute connect call where you can tell me a little about your symptom pattern and we can talk about whether this approach might make sense for you.
