PRACTICE 1: Neuroplastic symptom assessment

Any time you have an increase in intensity or frequency of a symptom, or you have new symptoms pop up, it's a good idea to reassess. You always want to make sure you're treating yourself with the best care possible, and sometimes that means treating yourself structurally, like supporting a rolled ankle, and sometimes it means treating your nervous system by coming back to safety reassurance and self-regulation.

Ultimately you will get to a point where you can see any new symptom for exactly what it is and you won't need this assessment, but it's always here for you if you're not sure. And if you still need help ruling out a structural concern after this assessment then go see your physician and give yourself peace of mind, knowing that you're giving yourself the care you need at the time.

We follow a FITS Criteria when we assess for neuroplastic symptoms:


You'll be self assessing in the "quiz" below, but for now here's the details:

Functional Assessment

We'll start the assessment by looking at the functional aspects of your symptoms because neuroplastic pain and pain of a structural cause have different functional presentations.

If you haven't had autoimmune or structural concerns ruled out, you need to do that. You're welcome to continue with this assessment as well, but it will not be conclusive until you know that your body is safe.

Once the structural and autoimmune concerns have been ruled out by orthopaedic assessment, imaging and bloodwork, you can trust your physical safety and dive into the neuroplastic clinical diagnosis further.

Inconsistencies Assessment

Next we'll look at whether your symptoms vary in a way that is inconsistent with a structural cause. We're so programmed to seek out physical cause to pain that it can be really hard to see when a physical cause just does not make sense. 

If you really take a good look at how pain with a structural cause behaves and note where your symptoms are inconsistent with that behaviour, you can start to trust a neuroplastic diagnosis more.

This is part of your assessment, but it's also crucial to your recovery. If you're always worrying that every discomfort in your body is damage or harm, you won't be able to feel safe in your body and this is important for choosing to accept some pain as you create new neural pathways to heal.

Triggers Assessment

Now let's take a look at the things you notice that trigger your pain or other chronic symptoms. Triggers for neuroplastic pain and structural induced pain are different.

When innocuous stimuli that would not actually cause the symptom physically still activates the brain to generate the symptoms, this is indication of a neuroplastic cause of pain. This can be incredibly valuable info to notice throughout your recovery, and this awareness is a good skill to be able to tap into when you have moments of doubt during your recovery.

Moments of doubt are bound to happen, even after you have some success so start looking at your triggers and question whether it makes sense that they're structural or neuroplastic to reassure your safety. The road to chronic pain recovery almost always has up and down days, and the more evidence you can lean back on to reassure your safety, the easier the down days will be.

Stressors Assessment (Life, Attachment & Behavioural Coping)

There are several other common features of a neuroplastic pain clinical diagnosis. Most people with neuroplastic chronic symptoms have had a significant amount of stressful life events, especially in childhood, but this is variable.

Neuroplastic chronic pain sufferers have often learned attachment behaviours in childhood that helped them fit in with their family or friends. These may have benefitted the child, but may also have caused a state of chronic stress for their nervous system. To not fit in or be accepted as a dependent child is a threat to survival and a danger signal to the brain, and even in a loving home environment pressures to fit in can be experienced.

The onset of a neuroplastic symptom usually occurs in connection with a significant life stressor, although sometimes this is not the case, or the stressor seems relatively small. And they usually have some personality traits commonly associated with chronic neuroplastic symptoms.

Your FITS Self-Assessment

Below you'll see a "quiz" there's actually no right or wrong answers, this is intended to reduce fear of sensations in the body, and improve trust in safety reassurance. By understanding the difference in behaviour of structural and neuroplastic symptoms we can become far more empowered in how we care for ourselves with CARE.

Simply select the answer for each question below that is most accurate for you. You'll automatically be prompted to see the "correct" selection, and then to continue to the next question. Keep in mind that "correct" simply means it's an indication of neuroplastic symptom behaviour.

Your FITS Results:

Ignore the % and x/13 numbers. Numbers mean nothing in a clinical assessment.

If you've had structural concerns ruled out, or all findings are normal degenerative changes that happen in every body, then you only need one of these characteristics to to rule a neuroplastic / central sensitization cause in.

Any functional patterns that do not make sense in a structural concern as described in the self-assessment, any inconsistent symptom behaviour that you do not see in structural caused pain, or any innocuous triggers of pain indicate neuroplastic cause of symptoms. Stressors highlight areas of life experience or coping strategies we've learned that may be contributing factors.

If you've been diagnosed with an autoimmune disorder or other structural concern like EDS then you do have structural concerns that need to be managed medically. However, many with autoimmune and lifelong structural concerns also find that they present with neuroplastic symptoms and central sensitization. Doing this work will help to diminish the unnecessary neuroplastic symptoms, especially if you're also in the care of a rheumatologist or other provider who you trust has your best interests at heart.

Most people with chronic pain of a neuroplastic cause have several of these features that make it easy to rule this condition in, however, even if you only recognized one neuroplastic characteristic is present, that is enough to confirm a clinical diagnosis of neuroplastic cause because the behaviours are just not consistent with a structural concern.

Please remember that selecting more of the neuroplastic criteria does not mean you are more centrally sensitized. All it means is that you have more evidence to fall back on any time you start to question your safety in your body.

If you selected only one or two neuroplastic criteria, you still present with neuroplastic symptoms, it just means there is less evidence you are aware of right now. For some this can make it more difficult to trust in a neuroplastic cause, but I hope that you will take that leap of faith because this is something you can heal yourself, and isn't that an amazing prospect?!

If you answered no to all questions then I recommend you continue ruling out structural concerns with your physician.

Complete and Continue