Neuroplastic pain (also known as primary or nociplastic pain, mindbody symptom, or TMS (coined by Dr. John Sarno) is 100% real physical pain that is not caused by ongoing injury, structural damage, or disease affecting the body’s tissues or organs. Instead, it results from physical changes in the brain’s nerve pathways and the way the nervous system processes and responds to perceived threat.

This type of pain is generated by a nervous system that has learned to stay in a heightened, protective state — often shaped by stress in its many forms: adversity in childhood, difficult life experiences, emotional conflict (both internally with self and externally with others), and/or deeply ingrained learned coping patterns like perfectionism and people-pleasing. This largely happens outside of conscious awareness.
Because the brain produces all pain sensations, neuroplastic pain can feel identical to pain caused by injury or illness. The pain can be intense and may persist for months, years, or even decades, often without clear findings on medical tests or without improving as expected with conventional treatments.

Research in neuroscience has shown that these learned pain pathways can change (a process known as neuroplasticity). With the right approaches—including pain neuroscience education, nervous system regulation, and a deeper understanding of past and present life challenges that may contribute to underlying stress,—many people are able to significantly reduce or even eliminate their pain.

In Mindbody Medicine, chronic refers to symptoms that persists or recurs over time and continues beyond the body’s normal tissue healing period (typically around three months).¹ It may be constant, or it may come and go.

This differs from how the word chronic is sometimes defined in conventional (biomedical) medicine, where it often refers to pain lasting more than 3 or 6 months, or meeting specific diagnostic criteria. For example, the International Classification of Headache Disorders (ICHD-3) defines chronic migraine as 15 or more headache days per month for at least three months, with at least 8 of those days having migraine features.

¹Krafts, 2010; Gonzalez et al., 2016.

When the brain perceives threat or danger, it can activate protective responses in the body. Because the brain communicates with and regulates all systems in the body—including the nervous, muscular, digestive, and immune systems—these responses can show up as a wide variety of physical symptoms such as pain, fatigue, digestive issues, muscle tension, burning sensations, tingling, or numbness.

Neuroplastic symptoms can appear for a short time, but when they persist or recur over time—typically for three months or longer - the latest neuroscience now knows the nervous system and learned neural circuits in the brain are typically involved

Common examples include:

• Back, neck, or shoulder pain
• Dizziness or vertigo
• Fatigue
• Fibromyalgia or widespread pain
• Interstitial cystitis / bladder pain
• Irritable bowel syndrome (IBS) and other digestive symptoms
• Jaw pain (TMJ)
• Migraine and chronic headaches
• Pelvic pain
• Persistent pain after an injury that has already healed
• Tinnitus (ringing in the ears)

Pathway 1, Symptom Assessment, has a more complete list in the resource section.

Recovery looks different for everyone. Some people notice improvement soon after learning about the neuroplastic approach and recognizing connections between their symptoms and life events around the time the symptoms began. For others, it takes more time as the brain gradually learns that the body is safe again and the protective alarm system can settle.

Research and clinical experience show that most people with neuroplastic symptoms experience significant improvement or complete relief and are able to return to a meaningful quality of life—even after years of persistent symptoms.

Because every person’s history and nervous system are unique, recovery timelines can vary widely from person to person.

Skepticism is completely normal — and encouraged.

This approach may feel unfamiliar or even contradict what you’ve been told about pain, the body, and what to expect given your condition. This work challenges long-held beliefs and identity around being ill, and invites a shift toward understanding and empowerment through knowledge. We know how hard it can be to feel hopeful again, especially if you’ve tried many things that promised relief but fell short.

You don’t need to fully believe it to begin — just a willingness to stay curious.

Many people start out doubtful, but as they explore the work, they begin to notice shifts. That experience becomes their own evidence.

We’re not here to convince you — just to introduce an approach that’s helping many people,  and supported by growing research,  grounded in neuroscience. With this awareness, you have new choices and can decide what feels right for you.

Even though it’s estimated that ~ 40% of patients seen by their primary care physician have neuroplastic symptoms¹, this approach remains relatively unknown to many medical providers.

This field is still emerging and rapidly evolving. While physicians are dedicated to helping their patients and genuinely care about their well-being, many have had limited exposure to the latest neuroscience and growing body of research in this area.

Advances in our understanding of neuroplasticity and the brain’s role in chronic symptoms have accelerated in recent years, and it can take time for new approaches to become widely integrated into medical training and everyday practice.

¹Source: Haller et al., Deutsches Ärzteblatt (2015)

While we cannot offer medical assessments, it’s important to know that many findings seen on spine MRIs are very common and increase with age.

Changes such as disc bulges or herniations, disc degeneration (often called degenerative disc disease), spinal stenosis, Modic changes, and annular tears are frequently found on imaging—even in people who have no back pain.

Research suggests that structural findings alone do not always explain pain, and that the brain and nervous system also play an important role in how pain is generated and experienced. This may help explain why an estimated 20–40% of patients continue to experience significant pain after spinal surgery, a condition known in medicine as failed back surgery syndrome (FBSS).

¹ Brinjikji et al., American Journal of Neuroradiology, 2015.
² Thomson S., British Journal of Pain, 2013.

No — this approach is accessible to anyone and can be started at no cost.

At its core, it’s about knowledge, awareness, and understanding how the mind and body function as one interconnected system. This work focuses on the mindbody connection, building nervous system regulation & resilience, and reducing fear and perceived danger around symptoms.

There are no medications, supplements, or devices required.

Many people begin with free resources such as videos, podcasts, and educational content. While some choose to invest in books, programs, or one-on-one or group support from a NSRC coach (Neuroplastic Symptom Recovery Coach) or practitioner — many of whom have healed themselves and are passionate about helping others — this guidance can provide helpful structure, clarity, and save you countless hours of navigating this work on your own. These services are always optional.

This approach is ultimately about self-agency — empowering you to take your health back into your own hands, rather than relying solely on external solutions. It invites you to understand what’s happening in your body and make informed choices about what feels right for you in supporting your healing.

“All pain is real,” as Dr. Howard Schubiner — a physician, researcher, author, and one of the leading experts in mindbody medicine — often says. And so are all symptoms.

Neuroplastic (mindbody) symptoms are just as real as those caused by injury or disease. All pain is generated by the brain — the difference is what the brain is responding to. When there is injury, pain reflects tissue damage. In neuroplastic pain, the brain is responding to perceived threat, not ongoing physical harm.

This process is often outside of conscious awareness, is automatic, and protective — and not your fault. The brain believes it is helping by trying to keep you safe from a perceived threat.

This can be hard to hear — especially if you’ve felt dismissed or not believed in the past.  However, the encouraging news is that because the brain and nervous system can change through a process called neuroplasticity, this pain can change too — by providing the brain with new input that you are both physically and emotionally safe.

With awareness and the right approach, you can begin to shift these patterns, reduce perceived danger, and move toward a healing state — giving you more influence over the pain and/or symptom than you may have realized.

Treatment begins with reducing the fear that your body is damaged.

From there, the focus shifts to two key processes: increasing your felt sense of safety and reducing the brain’s perceived danger.

The beauty of this approach is that these two processes work together — as you reduce perceived danger, you naturally increase your sense of safety, and as you build safety, perceived danger begins to decrease.

There are many ways to do this, including approaches that address the unique drivers causing your brain to perceive threat, support nervous system regulation & resilience, foster emotional awareness and processing, and reconnect you with self-compassion, authenticity, and personal power.