Living With Both Neuroplastic and Structural Pain: A Complex Reality

Pain is rarely simple, and for many people living with chronic conditions, it's not confined to a single cause. Some experience both neuroplastic pain - pain that arises from the nervous system’s learned patterns of over-sensitization or misfiring - and structural pain, caused by identifiable damage or dysfunction in the body’s tissues, joints, or organs. This dual experience complicates treatment, challenges common medical frameworks, and profoundly shapes daily life.

Understanding the two types of pain

Structural pain is often more familiar in medical practice. It results from clear physical abnormalities, such as joint instability in Ehlers-Danlos Syndrome (EDS), disc degeneration in the spine, or arthritis in the hips. Neuroplastic pain, on the other hand, is less tangible. It stems from changes in the nervous system, where pain signals persist or amplify even after tissue damage has healed, or arise in the absence of damage altogether. Both types of pain are as genuine as each other and originate from the same area in the brain. However, the methods we use to treat them differ. (For a longer article on neuroplastic pain, its causes and treatments, click here.)

For people living with both, the boundaries blur. A person with EDS, for example, may experience acute pain from frequent joint subluxations, while also developing a hypersensitive nervous system that heightens or prolongs pain signals far beyond the initial injury. This combination can make their suffering more severe and less predictable.

The challenge of recognition

One of the most challenging aspects for patients is navigating recognition in healthcare. Structural causes are often taken seriously because they are visible on scans or measurable in physical exams. In contrast, neuroplastic pain is sometimes mistakenly dismissed as psychological or unreal, yet for those experiencing both, each type of pain interacts with and intensifies the other. Neglecting one aspect can lead to incomplete or ineffective treatment.

The impact on daily life

Experiencing two kinds of pain at the same time can seem like a continuous negotiation. Structural pain might restrict movement or lead to recurring injuries, while neuroplastic pain intensifies sensations, making the body feel constantly under threat. This often leads to feelings of exhaustion, frustration, and unpredictability. Many individuals talk about having good days and bad days without fully grasping what causes the shift.

Self-management requires a delicate balance between pacing activities, protecting vulnerable joints, and gently retraining the nervous system to reduce its alarm signals. For example, someone with EDS may use braces or physiotherapy to stabilize their joints, while also practicing somatic and reprocessing therapies to calm neuroplastic pain responses.

Psychological and emotional dimensions

The psychological impact is considerable. Individuals frequently find themselves torn between different interpretations of their suffering: "Is this pain due to structural issues, or is it my nervous system overreacting?" This uncertainty can lead to self-doubt and even guilt, especially in healthcare systems that still prefer either/or explanations. Therefore, validation from informed providers is crucial, not just for treatment, but also for rebuilding trust and alleviating the isolation that many patients experience.

Toward integrated care

The most successful method is integrated care that considers both dimensions of pain. This might include addressing structural issues with medication, physical therapy, or other medical treatments. Tackling neuroplastic pain could involve methods like pain reprocessing therapy, cognitive-behavioural strategies, or somatic approaches to help calm the nervous system. It also involves supporting lifestyle changes, from managing activity levels to enhancing sleep and nutrition, along with offering emotional and psychological support to handle uncertainty and daily difficulties.

Conclusion

For individuals experiencing both structural and neuroplastic pain, the journey is complex. Their pain is neither solely "in the body" nor entirely "in the brain," but rather a nuanced combination of both. Acknowledging and respecting this complexity is the initial step toward providing compassionate and effective care. By moving beyond rigid categories, healthcare can more effectively assist those whose daily lives are influenced by this challenging yet genuine dual experience.

If this is something you’ve been affected by, please leave a comment below. If there’s something important you’d like to add, please do so. I'd love to hear from you.

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Dr. Ingela Thuné-Boyle is a licensed Practitioner Health Psychologist and a Doctor in Behavioural Medicine who specializes in stress and loss, especially in improving the quality of life of people struggling with long-term health problems, chronic pain and (medical) trauma. She runs a private online (telehealth) practice at www.ingelathuneboyle.com.

Please note: Advice given in this blog is not meant to take the place of therapy or any other professional advice. The opinions and views offered by the author is not intended to treat or diagnose, nor is it intended to replace the treatment and care that you may be receiving from a licensed physician or mental health provider. The author is not responsible for the outcome or results following their information and advice on this blog.