How to Know If Your Pain or Symptoms Are Nociplastic
Most persistent pain is nociplastic, but because all pain feels like it’s coming from the body, it can be difficult to distinguish between structural pain and neuroplastic pain - nociplastic pain and symptoms are just as real as those stemming from an injury or tissue damage. Still, there are some signs that point to nociplastic pain and symptoms that can be reversed through a neural repatterning approach. Below is a short list that can help you make this distinction*. You can also explore a more detailed questionnaire to help you determine the likelihood that your symptoms are nociplastic, and a list of conditions that are commonly nociplastic in origin or have a significant nociplastic component and can be reversed through a neural repatterning approach.
*This list is by no means a substitute for medical diagnosis, I highly encourage that you see a physician with experience in the field of nociplastic pain / mind-body medicine for accurate and individualized assessment. Please know that even if you’ve been diagnosed with a “structural” condition, or have a diagnosis or illness that is thought to explain your pain, a mind-body approach can still be a path towards greater ease and wellbeing for you. And even if you answer no to every single one of the questions below, there are still infinite possibilities and potential for healing. If you’re curious about how this approach can help you, let’s explore it together, contact me.
You’ve been diagnosed with one or more of the following: “functional” digestive or bladder condition like irritable bowel syndrome (IBS) or interstitial cystitis, fibromyalgia, ME/CFS, intractable migraines, or repetitive strain injury;
You experience a cluster of symptoms including brain fog, mood related difficulties like depression or anxiety, unrefreshing sleep and fatigue, or multisensory hypersensitivity;
Your pain or other symptoms started during a stressful time or after a stressful life event, or are triggered by stress;
Your pain or other symptoms originated without injury or have persisted long after the injury has healed;
Symptoms are inconsistent (e.g. sometimes walking will be super painful but other times it will be fine; sometimes fatigue will set in after exertion but sometimes it doesn’t);
There is a large number of symptoms in the absence of a systemic disorder (such as lupus, rheumatoid arthritis, or multiple sclerosis) that can explain them;
Symptoms spread or move;
Symptoms fluctuate with external triggers (like the weather, or certain chairs, or day of the week);
Symptoms are symmetrical (e.g. you experience numbness in both hands);
Pain or other symptoms are delayed, meaning you don’t experience them while doing an activity, but a while after doing it;
You’ve had experiences of childhood adversity;
You’ve been diagnosed with post-traumatic stress;
You can identify certain personality “traits” such as perfectionism, people pleasing, an overactive inner critic, conscientiousness, conflict avoidance, constant worrying, and fearful thoughts.
Learn more about the role of adversity, depression, post-traumatic stress, and personality traits in the next entry.
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About the author:
Dr. Lilia Graue is a physician, psychotherapist, and mindbody healing mentor.
After living with chronic pain for more than a decade, she found freedom through an integrative mindbody approach grounded in neuroscience, mindfulness, and compassion.
She is passionate about helping people who are living with chronic pain, fatigue, long COVID, and other persistent symptoms to find freedom and reconnect with joy, vitality, purpose, and agency. She also loves mentoring fellow practitioners—therapists, coaches, and clinicians— to support them in creating trauma-integrative, relational, and sustainable healing spaces, while keeping their sanity and their passion and thriving personally.
With over 25 years of experience in medicine and psychotherapy, Lilia’s work prioritizes consent, curiosity, and co-creation, honoring individual context, systemic influences, and the power of genuine relationship in supporting long-term change and healing. She works with people globally in both English and Spanish.
Originally from Mexico City, she currently lives in London with her husband and the two rescue cats who own them, Ziggy and Lupito. In addition to her work, she loves spending time in nature, baking, reading, traveling, and enjoying live music.
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