If there’s nothing wrong with my back, why does my back hurt?
This is usually where conversations about neuroplastic pain get a little tricky. Because when someone hears that their brain may be producing their pain, what they often hear is: The pain isn’t real. Or worse: I’m doing this to myself. Neither is true.
Neuroplastic pain is real pain. It can be mild and annoying or completely debilitating. The difference isn’t in how real it feels. The difference is in why the brain is producing it. I understand why that’s a hard idea to wrap your head around. When I was living with chronic pain myself, I wasn’t walking around thinking, You know what would really explain this? My brain. I was going to doctors because my body hurt. I had symptoms in multiple places, had accumulated diagnoses, and eventually became so limited that I was largely bedridden and using a wheelchair. Everything about my experience told me that something was physically wrong with my body.
So when I eventually began learning that pain could be generated by the brain even when the body wasn’t damaged or in danger, it required a pretty significant rewrite of what I thought I knew about pain.
The piece that finally started making sense to me was surprisingly simple: Pain is not a direct measurement of damage. Pain is a protective response. And sometimes the brain can protect us when we don’t actually need protecting anymore.
Pain has a job
If you put your hand on a hot stove, your brain creates pain so you’ll pull your hand away. If you sprain your ankle, pain encourages you to protect it while it heals. This is a very useful system. I am personally in favor of knowing when my hand is on fire.
The tricky part is that your brain doesn’t have a tiny camera inside your body showing it exactly what’s happening at all times. It receives information from the body and combines that information with context, previous experiences, expectations, and everything else it knows about the situation. Then it has to decide whether you need protection. Most of the time, it gets this right. But sometimes it doesn’t.
Imagine walking outside and seeing something long and curled up near your feet. Before you’ve had time to think, you jump backward. Your heart starts pounding. Your muscles tense. And then you realize you’re looking at a garden hose. Your body’s reaction wasn’t fake. You didn’t pretend to be startled. Your brain genuinely believed you might be standing next to a snake, and it produced a very real protective response based on that interpretation.
The danger wasn’t real, but the response was.
Neuroplastic pain can work in a similar way. The brain interprets information from the body as dangerous and produces pain to protect you, even when the body may actually be safe. Sometimes this happens after an injury. Sometimes symptoms develop in a much more complicated context. Either way, the brain can become very good at producing a response that originally made sense.
And brains are excellent learners.
If bending repeatedly hurts, your brain can learn bending = danger. If sitting is followed by back pain over and over, sitting = danger. Eventually, you don’t need to consciously think, I expect sitting to hurt. You sit down, the brain recognizes a pattern it has learned, and the alarm can activate automatically. Then, because the pain is completely real, you understandably think, See? Sitting really is hurting my back. Which gives your brain another reason to keep protecting you the next time you sit. Nobody is consciously doing this. You aren’t sitting around deciding to make your back hurt. I promise your brain does not need your permission.
Sometimes the danger ends before the pain does
This is one of the pieces I understand especially well from my own experience. I had shin splints. Not “shin splints” that were secretly neuroplastic from day one. I really had shin splints. There was an actual injury and a perfectly legitimate reason for my legs to hurt. The problem was that they kept hurting. I rested. I went to physical therapy. I tried treatment after treatment. More than a year later, my legs were still hurting, and the original injury was no longer enough to explain what was happening. Somewhere along the way, my brain had gotten very good at protecting my legs.
For me, understanding that distinction was huge. I didn’t need to rewrite history and convince myself that nothing had ever been wrong. Something had been wrong. It just wasn’t necessarily still wrong. That’s an important distinction for people whose symptoms started after an injury, illness, surgery, or other very real physical event. The idea of neuroplastic pain does not require us to pretend the original event didn’t happen. Sometimes the better question is whether the thing that started the pain is still the thing sustaining it. That was a much easier question for me to consider.
Pain science gives us some dramatic reminders that pain and tissue damage aren’t as tightly linked as we tend to assume. Phantom limb pain is probably the clearest example: someone can experience very real pain in a limb that has been amputated. The mechanisms behind phantom limb pain are complex, and I’m not suggesting it’s the same thing as ordinary neuroplastic back pain. But it makes one point extraordinarily well: the location where we feel pain does not always tell us exactly where the problem is coming from.
That doesn’t make pain less physical. Your brain and nervous system are physical. And that was one of the mindset shifts I needed myself. “Coming from the brain” doesn’t mean imaginary any more than anxiety causing your heart to pound means your heart isn’t actually pounding. The experience is real. We’re trying to understand the mechanism behind it.
So why doesn’t the brain just figure out that I’m safe?
Wouldn’t that be nice? Unfortunately, once the brain has learned that something is dangerous, it doesn’t necessarily update that prediction just because the original danger is gone.
You’ve been hurting for a year, so of course you pay attention to the pain. You may avoid movements that have hurt before, brace when you have to do them, or notice a little twinge and immediately wonder what it means. None of this means fear caused your pain or that you handled it incorrectly. These are completely normal responses when something hurts and you believe that pain may mean something is wrong. But they also help explain why a learned pain response can stick around. Your brain has accumulated a lot of evidence that this sensation, movement, or activity deserves its attention. Being told once that your body is safe doesn’t automatically erase everything it has learned.
This is where Pain Reprocessing Therapy can become useful. Rather than simply telling the brain that it’s wrong, PRT works with those learned patterns and helps the nervous system begin gathering different evidence.
For now, the important thing is that a learned response can continue long after you consciously understand that the original danger has changed. You can know that a movement should be safe and still have your nervous system respond with an emphatic ABSOLUTELY NOT. I think that distinction is important because otherwise people end up blaming themselves for not being able to think their way out of pain.
The question isn’t always “structural or neuroplastic?”
This isn’t always a neat choice between my body is damaged and my pain is neuroplastic. Someone can have arthritis, a disc bulge, an old injury, or another medical condition and also have a nervous system that has become sensitized and is amplifying the pain. A structural finding may be relevant without explaining every part of the experience.
That’s why, when I work with someone, I’m less interested in immediately assigning their pain to one category than I am in understanding the whole story. How did it begin? What medical evaluation have you had? What explanation were you given? Does that explanation actually match what your symptoms do? Are there times you can do something without pain that normally hurts? Does the pain move, spread, or change? What are you afraid will happen if you do a particular movement? Does your body ever surprise you by tolerating something you were certain it couldn’t? Sometimes those questions uncover a pattern that is difficult to see when you’ve been living inside it.
I know that feeling too. When I was sick, I could give you an extremely detailed account of everything my body couldn’t do. I had years of evidence. What I wasn’t very good at noticing were the exceptions—the moments that didn’t quite fit the story I had been telling myself about how damaged and fragile my body was. Those exceptions eventually mattered.
And this is one reason I don’t think you need to read an article like this and immediately decide, Yep. My pain is neuroplastic. I probably wouldn’t have. If you’ve spent years believing something is physically wrong with your body, one explanation on the internet shouldn’t instantly undo that.
A more useful starting place might be: Could my body be safer than it feels? If the answer is maybe, that’s enough to get curious.
What if I don’t know whether my pain is neuroplastic?
There isn’t one symptom, scan, personality trait, or experience that proves pain is neuroplastic. What I’m much more interested in is the pattern. Symptoms that move or change. Symptoms that behave inconsistently. Connections with stress, attention, or context. Learned triggers. Experiences where your body unexpectedly does something you thought it couldn’t.
One of the things I often do with clients is look at all of that evidence together rather than trying to force certainty. Maybe there are strong clues pointing toward neuroplastic pain. Maybe there are structural or medical factors that still matter. Often there’s more nuance than people expect when they first encounter this work.
I go much deeper into those clues in How Do I Know If My Symptoms Are Neuroplastic?, and I also created a free Neuroplastic Symptoms Self-Assessment to help you start looking at your own symptom patterns.
But there’s a limit to what a checklist—or an article—can tell you.
Two people can both have back pain and have completely different stories. One person’s pain began after an injury and never stopped. Someone else has pain that moves from one place to another. One person has been terrified of movement for years, while another isn’t particularly afraid of the pain but notices it changes dramatically depending on stress or attention. Someone has an MRI finding they’ve been told explains everything, but their symptoms routinely do things that explanation doesn’t seem to account for.
That’s the part I find interesting. Because I’m not trying to convince every person with chronic pain that their symptoms are neuroplastic. I want to understand whether this framework actually makes sense for your experience.
For me, learning about neuroplastic pain changed the way I understood a body that had felt broken for years. It gave me another explanation for symptoms that had stopped making sense. More importantly, it gave me the possibility that the way I felt wasn’t necessarily a permanent reflection of the condition of my body.
Neuroplastic pain is real pain. But the other side of neuroplasticity—the part that eventually gave me hope—is that learned patterns aren’t necessarily permanent. The nervous system is capable of changing. That doesn’t tell us automatically what’s happening in your body. That’s the part we have to figure out.
If you’d rather talk through your particular symptom history than try to figure it out alone, I offer free 15-minute connect calls. We can talk about what you’ve been experiencing, what you’ve already tried, and whether Pain Reprocessing Therapy might make sense for you.
Neither the self-assessment nor a connect call replaces appropriate medical evaluation, especially for new, changing, or concerning symptoms. But if you’ve spent a long time assuming that pain must be a direct measurement of damage, I hope you leave this article with at least a little more curiosity about that assumption.
Pain is protective. Sometimes protection is necessary.
And sometimes the most protective thing your brain can learn is that you’re safe now.
Want to learn more? If predictive processing is new to you, I recommend Mick Thacker’s TEDx talk, Predictive Processing as a Theory to Understand Pain. It’s a helpful introduction to how the brain’s predictions and expectations can influence our experience of pain.
About the Author
Amberleigh Maida, ICF-ACC, is an Advanced Pain Reprocessing Therapy (PRT) Practitioner with additional training in Emotional Awareness and Expression Therapy (EAET). Having experienced and recovered from years of debilitating chronic pain herself, she brings both professional training and lived experience to her work. She also holds a master’s degree in creative writing with a focus on nonfiction. Through her writing, she explores neuroplastic symptoms, the brain-body connection, and evidence-based approaches to chronic pain and other persistent symptoms.
Learn more about Amberleigh’s personal story and approach or explore her professional credentials and training.
