Nociplastic Pain: When the Nervous System Keeps Sounding the Alarm

For years, chronic pain was usually placed into one of two categories. Nociceptive pain comes from actual or threatened tissue damage, such as an injury, inflammation or arthritis. Neuropathic pain is connected to damage or disease affecting the nerves.

But what happens when pain continues long after tissues have healed or when the intensity of the pain cannot be fully explained by an injury or nerve damage?

That is where a third category called nociplastic pain may come into the conversation.

What Is Nociplastic Pain?

Nociplastic pain occurs when the nervous system begins processing pain signals differently. Instead of responding only when danger is present, the system may become overly protective and amplify sensations that would normally feel mild or may not hurt at all.

The International Association for the Study of Pain describes nociplastic pain as pain arising from altered nociception without clear evidence that tissue damage or a lesion of the somatosensory system is responsible. In simpler terms, the pain is completely real, but the nervous system’s interpretation of sensory information may have changed.

Think of the nervous system like a home alarm.

A properly functioning alarm sounds when someone breaks a window. A hypersensitive alarm might sound when a branch brushes against the house or even when nothing dangerous is happening.

The alarm itself is working. It has simply become too sensitive. That is one way to understand nociplastic pain.

The Pain Is Real

This is one of the most important points to understand: nociplastic pain is not imaginary, exaggerated or “all in your head.”

Pain is created through an incredibly complex process involving the brain, spinal cord, nerves, immune system, past experiences, environment and perceived level of safety or threat.

When the nervous system remains on high alert for a long time, it may become better and faster at producing pain. Researchers sometimes refer to this heightened responsiveness as central sensitization.

This can lead to:

• Pain from normally nonpainful sensations, known as allodynia
• A stronger-than-expected response to painful sensations, known as hyperalgesia
• Pain that spreads or becomes more widespread
• Increased sensitivity to touch, sound, light, temperature or movement
• Fatigue and unrefreshing sleep
• Difficulty concentrating or “brain fog”
• Symptoms that fluctuate with stress, illness, poor sleep or activity

The absence of visible damage on a scan does not mean nothing is happening. It may mean the problem is related more to how the nervous system is processing information than to a structure that can be seen on an image.

More Than One Type of Pain Can Exist

Pain does not always fit neatly into one category.

Someone may begin with an injury that produces nociceptive pain. If a nerve is affected, neuropathic pain may also develop. Over time, ongoing pain signals and prolonged stress on the nervous system may contribute to nociplastic changes.

That means nociceptive, neuropathic and nociplastic mechanisms can overlap. This may help explain why an approach that once provided relief eventually stops working or why focusing only on the original injury does not resolve the complete pain experience.

A 2025 review from the Cleveland Clinic explains that nociplastic pain involves amplified pain transmission, reduced pain inhibition or a combination of both. It also discusses how nociplastic features may occur alongside conditions such as fibromyalgia, chronic back pain, headaches and other persistent pain conditions.

Conditions Commonly Associated With Nociplastic Pain

Fibromyalgia is probably the most widely recognized example, but nociplastic mechanisms may also be present in:

• Complex Regional Pain Syndrome
• Chronic migraine and recurring headaches
• Irritable bowel syndrome
• Temporomandibular pain
• Chronic neck or back pain
• Widespread musculoskeletal pain
• Some forms of pelvic pain
• Chronic fatigue conditions
• Other overlapping pain syndromes

Having one of these conditions does not automatically mean every symptom is nociplastic. It simply means altered pain processing may be one part of a much larger picture.

What Can Make the Nervous System More Sensitive?

There is rarely one simple cause. Nociplastic pain may develop through a combination of biological, physical, emotional and environmental factors. Possible contributors can include:

• Long-lasting pain
• Repeated injuries or medical procedures
• Severe illness or infection
• Chronic stress
• Trauma
• Poor or interrupted sleep
• Overexertion followed by prolonged inactivity
• Fear of movement or reinjury
• Ongoing inflammation
• A nervous system that rarely feels safe enough to leave “fight-or-flight” mode

This does not mean stress is the sole cause of pain. Stress is only one source of information the nervous system processes. Pain can increase during stressful periods because the brain may interpret the overall environment as less safe and become more protective.

Why Rest Alone May Not Be Enough

Rest is essential following an acute injury, but prolonged avoidance of movement can sometimes reinforce the nervous system’s belief that movement is dangerous. On the other hand, pushing through too much activity can overwhelm an already sensitive system and trigger a flare.

The goal is often to find a middle ground: gentle, gradual and predictable activity that allows the nervous system to experience movement without repeatedly confirming danger. Depending on the individual, helpful strategies may include:

• Pain neuroscience education
• Gradual movement and strengthening
• Activity pacing
• Improving sleep
• Stress regulation
• Relaxation and breathing practices
• Addressing nutritional needs
• Supportive counseling
• Reducing fear surrounding safe sensations or movements
• Creating positive sensory experiences
• A coordinated, whole-person approach

Understanding what is happening can itself be powerful. When someone realizes that pain does not always equal new damage, movement and daily activities may begin to feel less threatening.

Could Scrambler Therapy Be an Option?

Scrambler Therapy is a noninvasive form of neuromodulation that sends electrical information through electrodes placed on the skin. The goal is not simply to block pain temporarily. The technology is designed to introduce synthetic “non-pain” information through the nervous system, potentially changing how the brain interprets signals coming from the painful area.

Most published Scrambler Therapy research has focused on neuropathic pain rather than nociplastic pain specifically. A small randomized study involving chronic neuropathic pain reported substantial improvements following a series of Scrambler Therapy sessions, but larger and more condition-specific studies are still needed.

Because nociplastic pain involves altered sensory processing, it is reasonable to ask whether a therapy focused on changing pain information could be helpful for some people. However, Scrambler Therapy should currently be viewed as a possible option, not a proven solution for every form of nociplastic pain.

Pain mechanisms can also overlap. Someone may have neuropathic and nociplastic features at the same time, making it especially important to look beyond a single label and consider the complete picture.

A Different Way to Understand Chronic Pain

Learning about nociplastic pain can feel validating, especially for anyone who has been told that everything “looks normal” while their pain remains anything but normal.

The pain is real. The symptoms are real. And an overly protective nervous system is capable of changing.

That change may require more than one approach, but understanding the role of the nervous system opens the door to possibilities that may have been overlooked.

At Light Therapy Resource, we offer personalized Scrambler Therapy sessions in Camarillo and take time to understand each person’s pain history, sensations and goals. If you are curious whether Scrambler Therapy might be an appropriate option to explore, schedule a free consultation with us by calling (820) 203-3996 or click here.

This article is for educational purposes only and is not a substitute for advice from a qualified healthcare professional.