How Do I Know If My Pain System Is Being Overprotective?

Neuroscience teaches us that our amazing brains and bodies create pain to alert us and protect us from harm. However, for a multitude of reasons, sometimes this protective system can go haywire and become overprotective – hurting us even when there is no harm.

This kind of pain is known as nociplastic pain, and it is this category of pain that fibromyalgia falls under.

It's important to note that even if you have diagnosed injuries, arthritis, scoliosis, or other "real" pain conditions, nociplastic pain is likely also a part of your pain experience. Just as you can be diagnosed with fibromyalgia, as well as other conditions.

So then, you may be wondering, is it possible to retrain your brain to stop feeling pain? The good news, is that yes, we can retrain our brains to be less protective. And we can learn to interpret appropriate messages from the body as safe and not dangerous.

First we need to address an important question… one you probably really want to know the answer to – is your pain nociplastic?

This article gets a bit neuroscience-y, outlining the important role the brain plays in pain. As with all things fibro and pain, it can get a bit complicated. So if you are battling a flare-up or feeling overwhelmed, please take good care of yourself first and foremost. This might be an article to bookmark and come back to later.

What is the role of the brain in the pain system?

Did you know that all pain is processed in the brain? In fact, many different parts of the brain are involved in pain processing.

When pain is experienced over long time periods and becomes chronic, neural pathways between certain parts of the central nervous systems (which includes the spinal cord and the brain) can become sensitized. You've probably heard the phrase "neurons that fire together wire together". The medial prefrontal cortex and amygdala – parts that are associated with learning and memory – start lighting up, indicating that the brain has unintentionally learned to be in pain!

In these cases, our neurons have made a complex task (interpreting potentially harmful signals from the body) into an automatic response – and this can continue long after an injury is healed. Even just thinking about movement or pain can create a physically painful response.

What has danger got to do with pain processing?

Nociceptive pain happens when the brain determines that there is credible evidence of danger. It produces pain to make us pay attention and take steps to protect ourselves and stop doing the dangerous thing.

An ongoing sense of danger produces and maintains high levels of stress hormones, such as cortisol, in the body. These hormones can sensitise the nervous system to pain and being in a state of high alert means we respond to pain with fear. This inadvertently reinforces the perception that the sensation or situation is dangerous. And the pain persists.

But with nociplastic pain, your sensitized pain response system interprets many different things that aren't necessarily a physical threat, as "dangerous". This includes mental and emotional triggers, such as stress, feelings of anxiety, or even harmless sensory input like changes in temperature. No matter where the “perceived’ danger is coming from, you get the pain.

Where do we get danger messages from?

Anything that puts your brain into high alert mode will create a sense of threat or danger.

It doesn’t have to be life threatening. It might be a part of daily living, such as a disagreement with a loved one, stressful deadlines or appointments, or the constant buzz from your phone. It might be from thoughts you frequently have about your pain – “I can't handle this”, “it’s never going to get better!” – or particularly unhelpful support people (such as those who may not understand pain science and say hurtful things like “it's all in your head.”). It could even be something that triggers a memory or past trauma.

What are the different types of pain?

What happens once the brain has become hard-wired for pain? First, let’s get clear (or recap!) on a few different types of pain.

• Nociceptive pain – this is pain that comes from nerves detecting danger from temperature, mechanical force or certain chemicals. For example, you are out running, trip on something and you experience the pain of a sprained ankle.
• Neuropathic pain – when nerves become injured, compressed or damaged pain may result.
• Nociplastic pain – when pain occurs as a result of pain processing errors in the nervous system. Nociplastic pain is now recognized by the International Association on the Study of Pain (IASP) and is also referred to as neuroplastic pain by psychotherapist and Pain Reprocessing Therapy (PRT) expert, Alan Gordon¹.

Emerging evidence suggests that diffuse pain processing in the brain is altered in fibromyalgia^2,3, and that an imbalance between the body’s threat and soothing systems plays a major role in the severity of symptoms⁴. So, if you have been diagnosed with fibromyalgia, then there’s a good chance we are talking about an aspect of nociplastic pain coming into play for you.

Before we power ahead, it needs to be said, loud and clear. Pain, regardless if it's acute or chronic, due to a physical injury or the result of pain processing errors, it's always a very real sensation being felt in the body. Anyone who tells you otherwise, is 100% mistaken. Pain is not in your head or imagined, even though it is processed by the brain.

How do I know if my pain is nociplastic pain?

Pain is real and very convincing. I can’t tell you if you have nociplastic pain and you should always talk with your healthcare team to find or rule out underlying causes and other co-occurring conditions.

That said, there may be a few clues that point towards nociplastic pain. When pain is random and isn't consistent with structural damage (for example, if it comes and goes, spreads and shifts, or if you have had specific damage ruled out). Perhaps your pain feels worse when you have challenging emotions or thoughts, and becomes better when you are happy or distracted.

Consider the following questions:

1. Is your pain widespread or in multiple places?
2. Is your pain disproportionate or unpredictable?
3. Do the pain sensations change and move around?
4. Is the pain unrelated to an injury, and did it seem to arrive out of the blue?
5. Did your pain first appear during a stressful time?
6. Does your pain get worse with stress?
7. Do you have a history of failed treatments?

Given the link between trauma, stress and pain conditions like fibromyalgia, if you answered “yes” to a lot of the questions above, it might point towards nociplastic pain being a part of your pain experience.

Interestingly, Alan Gordon’s years of clinical practice show that certain personality traits are linked to the development of nociplastic pain⁵.

• The Worrier – this might not even be about your pain, but if you are a bit of a worrier (come on, it's OK, hands up!) then this puts your system into alert (danger) mode.
• The High Achiever – if you are placing high expectations on yourself (maybe even leaning toward perfectionism) then this creates a sense of alert because you are constantly pushing towards goals and expectations that might be unattainable (self imposed or societal/cultural).
• The Self-critic – that voice that beats you up for every decision or action (I am sure you are familiar with it!) can trigger danger messages and negatively impact on mental health⁶ and pain.

If some of these questions or personality traits resonate for you, you can consider them evidence that at least some of your pain is nociplastic. This evidence can help when it comes to retraining your brain. Any bit of information you can gather that helps to reinforce the message that pain does not equal damage will help your overprotective pain processing system to relax a little and realize you are safe.

Try our “know your pain” quiz and see if your pain might be nociplastic!

If any of the content of this article has raised concerns for you and you need immediate assistance, please contact:

• Lifeline – free Australia-wide crisis support and suicide prevention service, 13 11 14 (24 hours, every day) or text 0477 131 114 (24 hours, every day).
• Beyond Blue – free mental health and wellbeing information and support for all in Australia, 1300 22 4636 (24 hours, every day).
• Blue Knot Foundation Helpline – information, support or referral for adult survivors of childhood trauma and abuse, 1300 657 380 (9am to 5pm, every day).
• Full international list of Crisis Support Helplines.