Day-to-Day Variability in Chronic Pain Recovery
If you are living with nociplastic (neuroplastic) pain* or other symptoms, or supporting someone who is, you may have noticed that pain, mobility, and the ability to do everyday tasks can change from day to day.
It can be confusing and emotionally challenging to notice significant inconsistencies in capacity or symptoms, especially when an activity is possible one day and not the next. We might find ourselves assuming that if something was done before, it should now always be doable, or that stopping or declining reflects a choice, and it’s hard to reconcile the variability with common assumptions about effort and recovery, especially because nociplastic symptoms are often invisible.
Why Pain and Ability Fluctuate
From a neuroscience perspective, this pattern of variability is expected, as a normal expression of a sensitized yet adaptable nervous system. Inconsistency is actually a core feature of nociplastic pain, and one of its diagnostic criteria.
Nociplastic pain arises from changes in how the nervous system processes and regulates sensory input. The brain and spinal cord constantly evaluate context, internal state, and perceived safety to decide how much protection the body needs. Pain, stiffness, weakness, and fatigue are outputs of this system, and because the evaluation is ongoing, symptoms are variable. The nervous system doesn’t always treat past performance as a guarantee of future ability; it can respond differently to the same task on different days, even when the task itself has not changed and when there is no biomechanical obstacle for performing it.
It follows that improvements throughout recovery are not linear: we experience periods of progress, plateaus, and temporary setbacks.
What the Nervous System Is Responding To
On any given day, our nervous system may process the same activity differently depending on internal and external conditions, leading to variations in pain or function that do not reflect motivation, effort, or intent. Factors such as sleep quality, stress levels, emotional load, cognitive demand, prior exertion, illness, and environmental stimulation all influence how sensitized or regulated the system is. When these factors shift, the same movement, chore, or social activity may cross a threshold that triggers pain or functional inhibition. This is not a conscious or voluntary decision, or a lack of effort; it is an expression of a nervous system in a heightened protective state. And sometimes there isn’t really an identifiable cause or set of conditions, it’s merely the inertia of a conditioned response.
In daily life, this means that someone may manage household chores one day and find them overwhelming the next, even though their motivation has not changed. They may be able to socialize on some days and need to withdraw on others, not because they are unwilling, but because sensory and emotional demands are processed differently depending on their nervous system’s current state. They may prepare meals or attend to self-care tasks for a while, and then find themselves struggling again, as standing, planning, multitasking, and repetitive movements all place demands on neural processing that fluctuate in tolerability. These changes reflect moment-to-moment shifts in physiology, not inconsistency of character.
Why Pushing Through and Expecting Consistency Can Backfire
Pushing through symptoms does not reliably retrain a sensitized nervous system. In nociplastic pain, forcing activity when there is threat signaling often increases protective responses rather than reducing them. Conversely, feeling believed, supported, and emotionally safe helps lower perceived threat and supports gradual recalibration of pain processing. Interpersonal conflict, pressure, or accusations of exaggeration can unintentionally amplify symptoms by increasing stress and vigilance in the nervous system.
Often, the people I work with share frustration, either their own or their loved ones’, when they’ve finally managed to do something they hadn’t been able to for a while, only to find they can’t repeat it in the days that follow. It might be something small, like sitting up in bed, taking a shower, or preparing a meal, or something bigger, like going on a road trip or getting on a plane. This is completely normal. The nervous system has learned to tag certain activities as dangerous and to engage protective responses, including pain and other symptoms. We’re helping it create new patterns, but for a while the old pathway is still the one it defaults to. With patience and repetition, the new neural pathway can gradually take over.
Capacity is Content Dependent
A helpful way to understand fluctuating ability is to see it as capacity that is context-dependent rather than fixed. The question is not whether you could do something before, but what you can engage with today. Responding with curiosity and flexibility, rather than expectation or frustration, reduces emotional escalation and supports recovery-oriented behaviors over time.
When reengaging with activity through graded exposure, we generally lean into activities that are challenging enough to encourage adaptation and reconditioning, but not so extreme that they trigger or amplify protective responses. Capacity will not always be perfectly predictable, and some days the balance will be easier to find than others. It’s an ongoing process of calibrating what is tolerable, building consistency over time, and supporting your nervous system and your bodymind as a whole while you weave new neural patterns and recondition.
It can help to focus on what is both doable and challenging today, in alignment with what matters to you and what you want to nourish and build, instead of comparing to what was possible in the past (whether yesterday or two years ago).
Responding with curiosity and flexibility, for yourself and/or someone you are supporting, reduces frustration and supports sustainable progress.
Variability is not an exception in nociplastic pain, it is a defining feature of how the condition presents. Changes in pain and function are not deliberate, manipulative, or signs of giving up. They reflect a nervous system that is sensitive and adaptive, even when that adaptability becomes unhelpful. Understanding this can help you move from blame, resistance, or attempts to fix toward compassion and care, which is one of the most powerful influences on long-term outcomes in chronic pain.
If you’re living with chronic pain, or supporting someone who is, I’d love to explore this work with you 1:1. Together, we can look at day-to-day changes and identify practices and strategies that support sustainable progress and recovery. Learn more and book your Wayfinding Session here.
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*Nociplastic pain is the semantic term suggested by the international community of pain researchers to describe a category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage.
The mechanisms that underlie this type of pain are not entirely understood, but it is thought that they involve pain creation or augmentation by the central nervous system through pathways that involve predictive processing, threat conditioning, sensory processing and altered pain modulation.
The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems.
This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain. While distinct categories are useful to understand the mechanisms playing into a given experience of pain, often there are mixed contributions, so that there can be pain that is primarily nociceptive, with nociplastic contributions, or vice versa.
Like any other kind of pain, nociplastic pain is always and absolutely real, it is never imagined.
You may not have heard of this specific term, but be familiar with other terms used to refer to the same process: neuroplastic, tension myoneural syndrome (TMS), or mind-body symptoms.