Last updated: August 17, 2026, by Dr. Melissa Tiessen

AI Disclosure: In writing this guide, I used Claude (Anthropic, 2026) for structural organization, copyediting, and to support meeting Google's EEAT criteria. All of the personal examples shared are my real experiences and the core content was written by me, based on my own professional experiences and reflections.

My Teacher, The Lightning Bolt

Spring 2020.

The Covid-19 pandemic had just started. Hospitals were telling everyone to stay away unless it was truly life-threatening. And I was in my garage, doing the very glamorous work of putting away grocery bags, when I accidentally whacked my eye on a shelf. Hard. Thankfully, there was no cut and no blood. But there was the full force of my glasses frame smashing into my eyeball.

The pain was excruciating. Searing, eye-watering, could-not-keep-my-eyes-open pain. Slowly over the day it faded. By the next day, it was basically gone, and my vision seemed fine. Given everything else going on in the world, I filed it under "well, that was super unpleasant, but it’s over" and moved on.

Except that a few weeks later, the pain came back. It wasn’t constant, but it showed up periodically, in a very intrusive way. Typically, it was worst first thing in the morning, right when I woke up, just as I opened my eyes. This wasn’t a dull ache either — it was actually like a lightning bolt, straight through my eye.

Eventually, a few months in (remember, this was the era of "don't go to the doctor unless you're basically dying"), I finally did go to see an eye doctor. The good news: no damage. Both eyes looked identical. The bad news: the pain didn't care. It kept showing up, lightning bolt and all, for months.

Here's the part that changes the story: A while later, I started my very first official training in Pain Reprocessing Therapy. I'd bumped into the ideas before, but was still unsure about how to make use of them, especially for myself. Partway through the training, it hit me (like a bolt of lightning, pun intended): Holy smokes, my eye pain is neuroplastic! And in fact, I realized, all kinds of other symptoms over the years have been neuroplastic too. The signs were clear. I was living the exact thing I was there to learn how to treat.

So I used what I was learning, in real time, on myself. And the stabbing pain that had been showing up in my eye every morning for months? It resolved.*

(*Ok, sometimes it, and other symptoms, do pop back up, but this is actually a good thing. I’ll get to that in a later part of this guide.)

If I hadn't stumbled into that first training, I probably would have just kept living with that eye pain, assuming it was one of those unexplainable things you learn to put up with. I now actually think fondly about my eye pain experience, because it taught me something nobody had ever told me before (even though I did a residency rotation in a chronic pain clinic!): This kind of pain is incredibly common, it has a name, a mechanism, and a way out.

Once I understood what my nervous system was actually doing, I could work with it instead of just enduring it.

That's exactly the gap this guide is here to close. Hopefully without your own lightning bolt experience to get there.

I presume if you’re here, though, it’s because your body has been sending you signals that traditional medicine can't quite explain. Maybe it's back pain that won't go away. Maybe it's a twitch in your eye, or numbness in your hands, or a stabbing pain that shows up out of nowhere.

Or maybe you are a health professional who has worked with clients who have symptoms like this. Or maybe you help others with these symptoms, and experience them yourself, and you just feel confused, and a little embarrassed, that you're the one with symptoms that won’t go away.

Either way, this guide is for you. You're not alone. And you're not broken. Let's talk about why.

Table Of Contents

Who Am I, And Why Am I Writing This?

I also live this. That list of ‘example’ symptoms I noted earlier are all mine: I have indeed had back pain, neck pain, shoulder pain, tailbone pain, that stabbing pain in my eye, an eye twitch, and numbness and tingling in my hands. Thankfully, not at all at the same time! But at different points in my life. And all of those symptoms have been real, yet neuroplastic. I have also recovered from every one of them. The symptoms may come and go at times, but they do not freak me out. (They can actually be welcome!) This is because I have learned to relate to myself and my symptoms in a new way. And, I’ve done this in the midst of a stressful life, not in the absence of stress.

While I can never guarantee anything, there is a very good chance that you can learn to do this too. Please keep reading to find out how.

Who This Guide Is, And Isn't, For

One important clarification before we go further: if what you're dealing with is a clearly structural issue, i.e., a tumour, an active infection, a fracture that hasn't healed yet, or you're in the middle of an active disease process or its recovery, this guide isn't written for you. (More soon on distinguishing a structural issue from a neuroplastic one.)

That doesn't mean this guide can't still be useful to you. Your brain is always involved in how you experience pain, structural or not. But other factors are at play too, ones this guide doesn't address. Treating a structural problem as purely neuroplastic can delay the care you actually need. So especially if you are experiencing any new onset symptoms, please get them checked out by the appropriate medical professional(s).

That said, the part most people don't realize is this: With chronic symptoms, almost none of us are dealing with a purely structural problem.

Every person alive experiences neuroplastic processes, to some degree, at some point, simply because we're human and our brains are always involved in what's happening in our bodies. Which is a good thing! Most people just never notice, either because their symptoms (thankfully) don’t turn into suffering, or because no one's ever explained how pain actually works.

But the underlying mechanism is universal. Let's talk more about it.

What Exactly Does 'Chronic Neuroplastic Pain' Mean?

Let's get clear on what we are talking about in this guide.

The International Association for the Study of Pain defines pain as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” (See: https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/)

Notice that word "resembling." It's already telling us something important: pain doesn't require actual damage to nonetheless be completely real.

Chronic pain is simply pain that outlasts typical healing time, usually three to six months. Yet, our bodies are actually incredibly resilient and capable of healing from all kinds of injuries and infections. So how is it that so many people (Statistics Canada notes 1 in 5 adults) experience chronic pain?

This is where the category of chronic neuroplastic pain comes in: It's pain (and other symptoms) that persist without ongoing tissue damage or disease driving it. Instead, it's generated and maintained by a nervous system that's become sensitized, through fear-based learning and threat conditioning, to keep sounding an alarm, even when there is no apparent threat present.

Neuroplastic symptoms can be incredibly wide ranging, including anything from all kinds of musculoskeletal pain, to headaches, migraines, tinnitus, dizziness, brain fog, fatigue, gastrointestinal issues, and more.

Let me be very clear: Neuroplastic symptoms are not imagined. They are not fabricated. They are not "all in your head" in the terribly dismissive sense that phrase usually communicates. The sensations are completely real, processed by a completely real nervous system.

What's different is the cause. Neuroplastic symptoms dont' come from damaged tissue or disease processes. They come from a brain that has learned, understandably and largely sub-consciously, to treat certain sensations, movements, situations, or experiences as dangerous, and to respond accordingly, with pain (as a protection, see the next section) exactly the way it would to an actual acute injury.

Think of it like a hardware problem versus a software problem. Structural pain, i.e., caused by a fracture, a tumour, an active infection, is a hardware problem. Neuroplastic pain is a software problem: the wiring itself is intact, but the program running on it has gone sideways.

And here's the genuinely good news in that distinction: software problems are not permanent by nature. If a pain pathway can be learned, and it can, then it can also be unlearned.

Chronic neuroplastic symptoms are not a life sentence. Again, our bodies are amazingly good at healing, and this is greatly facilitated when the actual obstacle — a nervous system stuck in alarm mode — gets addressed directly.

How Pain Works - In 4 Acts

To fully understand how neuroplastic pain works, first it is helpful to understand how pain in general works. So here is my take on pain science, shared through the lens of some real life experiences.

Act 1: Pain As Protection

Please don't put your hand on a hot stove! And also, pain is not the enemy you think it is

In my early twenties, I was cooking dinner with a friend at my apartment. Afterward, for a reason I really wish I could recall all these years later, I felt a need to demonstrate to my friend that the stove element was off. And I did this by putting my hand directly on the old-school-style electric coil.

The element was not off.

All four fingers were in instant, excruciating pain. I yanked my hand back and shoved it under cold running water, but the damage was already done: you could see the individual coil marks across my fingers. It hurt for hours. It stayed sensitive for weeks. And in the decades since, I have touched exactly zero stove elements to "prove" anything to anyone. Believe me, I learned my lesson!

So why am I sharing this painful-to-remember and slightly embarrassing story? Because it's a really great example of what pain is actually designed to do.

That instant, searing pain did four things for me, all at once, before I'd even consciously registered what happened:

1. It got my attention immediately, faster than thought could have.
2. It protected me by spurring action. The second I felt it, my hand was already moving away, limiting how bad the burn got.
3. It supported healing, because the ongoing soreness in the following days encouraged me to avoid bumping or re-injuring those fingers while new skin formed.
4. And it helped me learn something very valuable: This is dangerous, don't do it again!

Think about those lessons for a moment. Pain is designed to get attention, protect, support healing, and help us learn. It’s aversive on purpose. Which is not a flaw in the system, but rather the system working exactly as intended.

So that's what pain looks like when the threat is obvious and concrete — a hand on a stove leaves no room for doubt. But most of what your nervous system responds to isn't nearly that clear-cut. Most of the time, it's working with partial information, and filling in the gaps. You can imagine how these processes become especially important in the experience of chronic pain, which isn’t so obvious or concrete.

On that note, here’s another slightly embarrassing but illustrative story about the predictive function of pain.

Act 2: Pain As Prediction

"I think we're being chased by a jaguar!" How the brain generates threat (and pain) from incomplete information and predictions

Years ago, my husband and I were backpacking through Mexico on spring break. We spent a day at the Mayan ruins in Palenque, and decided to take a short hike through the jungle canopy nearby. Everything was fine, lovely really, until somewhere in the distance we started hearing growling. Actually, it was more like roaring, and it was getting louder.

We couldn't see whatever was making the sound. We just knew it was coming closer, and it did not sound friendly. We picked up the pace, trying not to trip over jungle roots, while also, you know, fleeing for our lives.

Then my husband said the sentence that will live in my memory forever: "I think we're being chased by a jaguar."

My heart rate did something I didn't know it could do. We all but sprinted out of that jungle path.

Spoiler alert: There was no jaguar.

It was a howler monkey.

Which are extremely loud, but only about two feet tall, and not really fierce predators. (Thankfully!)

-->And yes, we do realize that an actual jaguar hunting you would not be announcing itself with that much noise. We've had time to think about this. However, in defense of our nervous systems, they do sound quite similar! 🎧Jaguar roar versus 🎧Howler Monkey roar

But in the moment, my brain only had what it had to work with — a loud, unfamiliar sound, dense jungle, limited visibility — and it did what brains do under those conditions: it filled in the gap with the most plausible explanation, and then it acted on that explanation as though it were confirmed fact. My blood pumped, my muscles locked up, my breathing went shallow and fast. My body wasn't reacting to a howler monkey. It was reacting to a jaguar that, as far as my nervous system was concerned, was completely real.

Here's the thing most of us were never explicitly taught: the brain doesn't just respond to information as it comes in. Responding is slow, and expensive, energy-wise. So instead, your brain mostly predicts. It takes what's happening right now, layers it against everything you've experienced before, and makes a best guess about what's about to happen, then acts on the guess before the full picture ever arrives.

Most of the time, this is remarkably efficient and keeps us safe. Occasionally, it's wrong. And when it's wrong, it's not because your brain failed. It's because it made a reasonable bet with incomplete information — the same bet that had me convinced a monkey was a jaguar.

This is precisely what's happening with neuroplastic symptoms. Somewhere along the way, your nervous system started associating a sensation, like a tension in your back, a flutter in your stomach, a specific kind of muscle ache, with danger. Not because that sensation was actually dangerous, but because the brain, in a moment of genuine threat or distress, linked the two together. And once that link is formed, your brain doesn't need the danger to still be present. It just needs the sensation to show up, or the fear of danger to show up, and it'll respond exactly as if the threat were still real — same as it did for me and that monkey.

That story shows how a brain can manufacture a full threat response out of nothing to actually fear. But your nervous system doesn't only react to what's happening right now — it also reacts to links it built in the past, whether or not the original circumstance is still around.

Act 3: Pain As Conditioned Associations

The pie that still makes me queasy – And how this negative association is a good thing

Again in my early twenties (apologies to my younger self!), two friends and I went out for a treat at a Perkins restaurant near our apartment. Being broke students who were nonetheless excellent at arithmetic, we calculated that one whole pumpkin pie split three ways was a far better deal than three individual slices. So we ordered the whole pie.

If you've ever seen one of these pies, they were enormous. (At least that is how I remember it.) Far more pie than three young women needed, or frankly should have, eaten in one sitting. We ate the whole thing anyway, on principle.

Of course, our stomachs did not thank us. And here's the part that's actually relevant to you and your symptoms: to this day, decades later, just writing about that pie makes my stomach turn a little. Not because pumpkin pie is inherently nauseating, and in fact I quite like it, I just do not like that pumpkin pie. It’s because my brain built a link, back in that apartment, between "Perkins pumpkin pie" and "feeling sick" — and that link doesn't need the actual overeating to happen anymore. The thought alone is enough.

This is the same mechanism behind Pavlov's famous dogs: ring a bell every time you present food, and eventually the dog salivates at the bell alone, food or no food. It's a conditioned association — two things that had nothing to do with each other, linked together by repetition and consequence, until one alone can trigger the response that used to require both. Note that the predictive processing abilities of our brain (as highlighted in story 2) are what makes this effect possible.

And so it is with chronic pain, which works the same way, more often than most people realize. That jolt of pain the instant you sit in a particular chair, or the tightness in your legs every time you walk toward your boss's office. These aren't necessarily fresh injuries randomly ruining your day. They can be (ahem, likely are) predictions — your brain, having linked a sensation or a situation to past distress, generating the response in advance, the same way my stomach still reacts to a pie I haven't eaten in years.

And again, from your brain’s perspective, this is protective. Evolution built us brains that create associations and make predictions quickly, because that’s a lot safer than learning slowly. The effect is not always pleasant, but the intention is wise.

I’d rather have a brain that makes me feel queasy at the thought of Perkins pie than one that doesn’t. Because the queasiness is an attempt to protect me from a bad outcome.

Sure, overeating one pie is not so bad, but what if I’d felt sick because the pie was actually spoiled? Then nausea, even years later, is a great harm prevention symptom.

The problem isn’t the system but rather the signals it uses. None of us would mind if, instead of pain and nausea and other aversive experiences, our brain protected us by depositing money into a vacation fund! Alas, that’s not how our brains work. Better, then, to understand how they do work, so that we can work with them instead of against them.

And there is one more important point I want to make about how our brains work in relation to pain. So far, every example I’ve shared has been physical — a burn, a jungle sound, an overstuffed stomach. But the sensation-danger link isn't limited to physical experiences. Sometimes what gets linked to a bodily sensation is something we're feeling, not something we're doing. Sort of like when the call is coming from inside the house...

Act 4: Pain As Emotional Cover-Up

Grief (and any other emotion) can be a cause, not just an effect, of pain

This final story is less lighthearted, and a bit more serious, but I think it’s important to share because it’s such a key aspect of how pain works, that also often gets ignored. This experience also taught me something the hot stove, 'jaguar', and pie couldn't.

My mom sadly passed away in the early months of the pandemic. Not from Covid, but from Amyotrophic lateral sclerosis, or ALS. Given this pre-existing (rotten) diagnosis, we knew her time was limited, but her death was still sudden, and because of pandemic restrictions, we had to delay her funeral for months and severely limit who could attend. If you lost someone for any reason during that stretch of time too, I am deeply sorry. It was a uniquely hard time to grieve. And please reach out to a qualified health professional if any of your symptoms or experiences (grief or otherwise) are leading to a long-term struggle. 

A day or two after my mom died, I was sitting on my couch reading through an ALS handbook, and I noticed my hamstrings were sore. Like really sore, but with no apparent physical reason for it, as I hadn't done anything to strain them, and the couch wasn't uncomfortable. I found it odd, then brushed it off, and got up to do something else.

The next day, reading the same handbook again, the exact same soreness came back in the exact same place. That's when it hit me: this wasn't random. My brain had linked reading about my mother's illness, with something in my hamstrings. This was a conditioned association, just like the pie, except this one wasn't carrying nausea. It was carrying grief.

I still don't know why hamstrings, specifically. It can be interesting to consider symbolic explanations, like maybe hamstrings are hidden supports, holding weight without complaint — but honestly, we don't need to solve that particular mystery.

What matters isn't the specific location. What matters is noticing that something showed up, and that it was pointing at something real: grief about my mom.

And grief about the pandemic, about how cruel ALS is, about all of it. If that pain had gone on to become chronic, eventually there would be additional layers of anger and grief too about the symptom itself, and about feeling failed by circumstances outside my control.

It’s also important to note that the physical pain I was experiencing was also trying to protect me by trying to distract me from my feelings. Grief is intangible and messy. Physical pain is at least tangible in a way. To our nervous system, that is often preferable to deal with pain. Until, that is, we are able to help our nervous system learn that emotions are safer than it thinks. (See Part 2 of this guide for more thoughts on how we do that.)

Ultimately, we don't get to choose where our bodies decide to carry what we're feeling. But once you know that this happens, that it's normal, and that it's often carrying information rather than just noise, you can meet it differently. These days, if pain shows up in my hamstrings specifically, I already know what it's usually telling me, and I try to make space for it instead of pushing past it.

Why These Stories Are More Than Just Interesting Anecdotes

Put all of these together — the hot stove, the jaguar, the pie, the hamstrings — and you get a fuller picture of what's actually driving neuroplastic symptoms. It's not only about physical danger. Perceived threat can come from your external environment, sure. But it can just as easily come from a bodily sensation itself, from a conditioned association, or from an emotion you never had the space to fully feel. It can also come from a learned personality pattern like always needing to over-function, or to defer to others’ needs, or to be hypervigilant. Our nervous system doesn't sort neatly between "physical danger" and "emotional pain" the way we like to imagine it does. It treats both as data, and it responds to both the same way: with an instinct to protect, that often shows up as alarm, tension, and yes, as pain that has nowhere else to go.

This is the fear-pain loop in a sentence: perceived threat, in any of these forms, creates and maintains the nervous system's danger signaling, which we experience as pain or other symptoms, that are trying to protect us from those perceived threats. And because so much of this runs on prediction and conditioning rather than real-time assessment, it can keep firing long after the original threat, or grief, or overwhelm has technically passed.

The good news, same as always: what got learned can be unlearned. Your brain built these associations for good reasons, trying to protect you as efficiently as it possibly could. It can build new ones too.

Understanding why neuroplastic symptoms happen is one thing. Knowing whether that's actually what's going on, in your own body, or in a client sitting across from you, is a different question, and a nuanced one. So let's move from the why, to the how do I know?

How Do You Actually Know If It's Neuroplastic?

Let's start with the first and most important question: "How do I actually know if this is neuroplastic?"

It's the right question to be asking. Getting it wrong in either direction risks causing harm — dismissing a real structural problem as "just stress," or treating something entirely reversible as a permanent, unfixable injury. So let's go through this step by step.

Step 1 - Always Start By Ruling Out, Before Ruling In

Before anything else, we need to rule out things like: a recent fracture, active infection, active disease process, tumor. Acute injuries and infections happen all the time, and more serious conditions like cancer, even ALS, are frequently diagnosed.

So if you haven't done this already, please get any symptoms checked out by the appropriate medical professional. And know that what can often sound like a structural cause for one's symptoms often is not. For example, disc degeneration is a very common imaging finding for adults across all ages, even those without any pain.

And if you have ever learned anything about statistics, you will know this phrase that is so relevant when it comes to neuroplastic symptoms: Correlation does not equal causation.

Which means, imaging findings can point to the cause of one's symptoms, but often they do not. This is an important distinction and one that can be powerful to understand.

I also appreciate that many symptoms can be confusing to sort out, and an accurate, helpful diagnosis doesn’t always happen quickly. As you potentially encounter frustrations and the need for patience in the diagnostic/rule out process, please keep in mind two things:

1. Our bodies are designed for healing.
2. Our brain is always involved in our pain experiences. Considering the role of the brain, protection, and learning is always helpful, even if it’s not the sole cause.

Step 2 - The FIT criteria: How To Rule In A Neuroplastic Explanation

Once structural causes have been reasonably set aside, there's a useful shorthand for what tends to point toward a neuroplastic process: FIT. Functional, Inconsistent, Triggered. I credit and gratefully thank Dr. Howard Schubiner for this very helpful framework. (Please check out his website and the newest version of his excellent book, Unlearn Your Pain: https://unlearnyourpain.com/)

I encourage you to refer to these more detailed and foundational resources to comprehensively gather your own evidence, or also to work with a trained health professional or coach. You can find directories of individuals trained in neuroplastic approaches on the ATNS and PRT websites:

Association for the Treatment of Neuroplastic Symptoms Directory – https://www.symptomatic.me/practitioner-directory

Pain Reprocessing Therapy Directory – https://www.painreprocessingtherapy.com/directory-of-practitioners-new/

But while you are here, let’s look generally at each component of the FIT criteria:

➡️ How My Symptoms FIT

I know that the FIT criteria can seem a bit vague at first.  So here’s a concrete example of how they were reflected in my eye pain experience.

Reflecting on these criteria with your own symptoms is a powerful opportunity to gather real, personalized evidence that you're looking at neural circuits switching on and off, and a brain generating a prediction, rather than tissue that's actually damaged.

Indeed, serendipity led to my biggest proof of both inconsistency and symptoms being triggered, which unequivocally demonstrated neural circuits at play. At one point I went to an off-the-grid cabin for a week’s vacation, and despite blinding bright sunlight coming into the room every morning, I had no symptoms. (Symptoms going away on vacation is always a delightful piece of evidence!)

Step 3 - Your History Matters As Much As The Symptoms

Alongside the FIT criteria, it's also valuable to understand the environment your nervous system was created in.  

I get that reflecting on the impact of our life experiences might seem like just another way to dismiss real symptoms or to say that our symptoms are simply stress-related.  But it is so much more than these simplistic interpretations. What we learn as children, especially through our family interactions, about how to be in the world has a real impact on how our subconscious perceives and processes threat. For example:

☮️ What did you learn growing up about the need to stay on guard, to be hypervigilant, to protect yourself? What did you learn about the value of attending to everyone else's needs before your own — being self-sacrificing, holding impossibly high standards, needing to fix things or keep the peace? (Hello all my fellow health professionals!)

😡 What did you learn about which emotions were allowed? Was anger acceptable? Could you disagree with someone and risk the conflict that might follow? Was sadness permitted? Or did you need to 'stop crying before I give you something to cry about'?

💗 Was self-compassion modelled anywhere, or did it look more like self-neglect hidden behind self-discipline?

None of these experiences, by themselves, cause chronic symptoms. And, this isn't about finding “the one” childhood event that explains the pain, nor is it about blame. But what this reflection on history and learning does do is show you the shape of a nervous system that's more likely to be sensitized to threats in the environment, in the body, in emotions, and in thoughts. Because it was trained, early and with good reason, to treat vigilance as safety. And that learning creates potent conditions for neuroplastic symptoms and the threat-pain loop.

Where To Go From Here

That's the foundation: real pain, generated by a nervous system that's learned to overreact to perceived threat, but that can be reversible once you understand the mechanism. And there are characteristics to look for (the FIT criteria) in your symptom experience so that you can tell whether something is neuroplastic versus structural.

And now, congratulations are in order! Both for reading this far, and even more importantly because now you already know more about neuroplastic pain, and how to start to make use of these concepts, than the majority of health professionals. Which is sort of a good news/bad news situation…I remain hopeful that sooner vs later this information will be more widely known. And hopefully this guide can help make that happen.

Of course, the natural next question now becomes, so what do we do with all of this knowledge? How does treatment actually work, and why is it different from simply "managing stress" better? Those topics are all covered in Part 2 of this guide (coming soon!), which also includes some other common questions that people ask about this work, and my responses.

In the meantime, I hope Part 1 of this guide has shown you that chronic neuroplastic symptoms are real, common, and reversible.

And if you are interested in exploring these ideas even further, I also welcome you to check out my online course, You Are Not Broken. It is self-paced and all in an audio format (like a mini-retreat in your ears!), so you can listen whenever and wherever you want, and there is no staring at a screen.

In the course, I go into more detail on the topics this guide has covered, as well as share many of the practical tools I teach in individual work, but for a fraction of the cost.

It’s a gentle way to begin exploring a new relationship with your symptoms and yourself, at a pace and in a context that works best for you.

While I designed the course specifically for other health professionals navigating their own symptoms, the content is applicable to anyone with chronic symptoms.

Please visit the course site for more details.