On Neuroplastic Symptoms That Aren't Pain

This is the final article in this series on chronic pain. This time, I'll focus on symptoms that aren't pain, but which can similarly appear without damage in the body. These symptoms are called neuroplastic — that is, they stem from changes in neural circuits in the brain.

In fact, just as the brain and nervous system are capable of causing pain in the absence of injury, they're also capable of causing any other symptom — from dizziness, exhaustion and nausea, to tinnitus, unexplained itching, and even paralysis. The symptoms are of course entirely real, and because they're tied to abnormal brain activity, they're potentially reversible.

To understand whether a symptom is physical or neuroplastic (of "brain" origin), a careful medical workup is needed to rule out a source in the body.

Chronic fatigue, for example, can be neuroplastic but can also stem from changes in the body such as anemia (iron deficiency) and other metabolic changes. Chronic dizziness may be neuroplastic, but can also stem from various causes in the body such as "crystals in the ear," blood-pressure problems, and even damage to brain tissue.

In many cases the medical workup doesn't identify a physical cause for the symptom. When that happens, care providers sometimes refer to these symptoms as "psychological," a problematic term that usually leads to belittling and blaming the patient, as if they were doing it on purpose.

This happens mainly because it's very hard (even for doctors and other clinicians) to grasp how the brain can create symptoms this strong: like dizziness that leads to a fall, or fatigue that keeps you from getting out of bed for days.

But we do know that mental states cause real symptoms in the body: for example, the nausea and diarrhea that come on before a stressful job interview. Everything is fine in the belly, there's no bacterium and no disease, yet the intestines are churning, aching, and pushing to empty. It isn't imaginary, but it is driven by psychological stress. And it's of course a normal phenomenon.

Other examples include the dizziness/fainting that happens to people in extreme states of tension, or the physical paralysis (freeze) that occurs in victims of violence.

Like pain, the symptom can be "momentary" and pass as the stress goes down. But there can be a state in which the nervous system and brain "learn" the symptom and keep transmitting it over time, so that it becomes "chronic" (see the "pain cycle" — article no. 5 in the series).

At the bottom of this article I've put a list of medical diagnoses that reflect various neuroplastic symptoms, along with links to more information about them.

Everything Is Normal on the Tests — How Can I Know My Symptoms Are Neuroplastic?

If everything is fine on the tests, it doesn't mean "there's nothing," only that no physical explanation was found in the body. But, in order to diagnose a neuroplastic symptom, certain features of the symptom also need to be identified [1], for example:

1. Inconsistency — if the symptoms change according to the time of day, occur after (but not during) physical activity, or occur in certain activities but not consistently (sometimes yes, sometimes no). If the symptoms are minimal or absent when engaging in relaxing or distracting activities (such as on vacation, or when you aren't thinking about them) or after some kind of treatment — such as massage, chiropractic, reiki, acupuncture, or an herbal supplement.
2. Triggered by triggers — the symptoms are produced by non-physical stimuli such as food, smells, sounds, light, screens, weather changes, light touch, or innocuous stimuli like wind or cold. If the symptoms occur in stressful situations or in anticipation of stress, or when you think about them. If the symptoms are triggered when I imagine the activity that provokes them in reality.

Stress in general, and specifically the anticipation of and pressure from the symptoms, can contribute to the brain continuing to transmit them (similar to the "pain cycle"). And indeed, psychological distress has been found to be linked to the development and persistence of "unexplained" symptoms [2–3].

When it comes to dizziness of non-physical origin, there's a significant correlation between stress and the intensity of the dizziness [4–5], and anxiety has been identified as the most significant risk factor for developing chronic dizziness [6].

Similar findings have been identified in medical conditions such as irritable bowel syndrome (chronic abdominal pain, cramps, and diarrhea in the absence of physical damage), "Long Covid" (chronic fatigue after exposure to the coronavirus), and POTS (unexplained heart-rate spikes during changes of posture) [7–9].

It's important to say that this doesn't mean anxiety and stress directly cause these symptoms (since they don't appear in everyone who suffers from anxiety), but rather that they contribute to the process in which the brain and nervous system sustain the symptoms. Exactly as in the "pain cycle," where anxiety and stress can increase the activity of the brain's "danger mechanism" and thereby amplify the pain, which increases the anxiety, and round it goes. It's exactly the same with symptoms that aren't pain.

And What Do We Do With All This?

Well, as in the world of pain treatment, here too the approaches split between approaches for managing the symptoms ("learning to live with them") and recovery approaches (reducing the symptoms up to recovery).

Similar to recovery treatment for nociplastic pain (see article no. 6 in the series for more), the path for symptoms that aren't pain is similar:

1. Diagnosis — a medical workup to rule out a physical cause for the symptoms, and identification of neuroplastic features of the symptoms.
2. Reducing fear of the symptoms by deepening knowledge about their mechanism and their non-dangerousness.
3. A gradual return to all the activities that cause the symptoms, from an experience of curiosity and safety rather than fear and avoidance.
4. Processing stressful and traumatic life events identified as influencing the "danger mechanism" and the symptoms, if there are any.

All of this may sound simple, but it's definitely not easy. And so, it's advisable to turn to a therapist who knows how to work with recovery approaches, and who understands the specific symptom that's troubling you.

I'll end with a case from the clinic, of a female soldier who had a concussion and, even a year later, continued to suffer from dizziness, fatigue, headaches, and difficulty sleeping.

She underwent an extensive medical workup that found no physical damage explaining the symptoms — that is, "everything is normal." But, when we began treatment, we identified that her dizziness didn't appear consistently, worsened under mental pressure, and that when she imagined movements that increase it, they appeared even though she was at rest.

After a detailed explanation of the brain's "danger mechanism" and the way the brain "learns" symptoms after an injury, we began mental practice aimed at reducing the fear of the dizziness, and gradually exposing her to it from a sense of safety and control. In parallel, we identified many stressors in her life that contributed to the level of danger she felt, so that she could take active steps to reduce them.

Over the course of treatment her dizziness began to gradually decrease, as she raised her level of activity and function. In parallel, there was a marked improvement in the headaches and fatigue too, until all the symptoms she'd suffered from disappeared easily about two months after treatment began. At a one-year follow-up, the patient told me the situation had held; she's working and studying, and planning a big trip around the world.

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A list of medical diagnoses that include neuroplastic symptoms:

• Dizziness: Persistent Postural-Perceptual Dizziness (PPPD), Mal de débarquement Syndrome (MdDS). More info
• Fatigue: Chronic Fatigue Syndrome (ME/CFS), Long Covid. More info
• Digestive system: Irritable Bowel Syndrome (IBS), Interstitial Cystitis. More info
• Heart: Postural Orthostatic Tachycardia Syndrome (POTS). More info
• Paralysis: Functional Neurological Disorder (FND), Somatoform disorder, Conversion disorder. More info

Recommended links:

• Podcast — Dr. Yonit Arthur on recovery from non-pain neuroplastic symptoms
• A recovery story from chronic fatigue syndrome and Long Covid
• A recovery roadmap: the 5 stages of recovering from neuroplastic symptoms

Sources:

Disclaimer: The information in this article is for general knowledge only. It is not personal medical or psychological advice and is not a substitute for it. If you have any health or mental-health concern, please consult a qualified professional to evaluate it.