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When The Nervous System Learns Suffering

A Supplement on Nociplastic Pain and Related Symptoms

If the "higher-gain systems" bit in Session 2 landed for you, or if you know someone whose chronic pain or weird sensitivity stuff has never quite fit a medical explanation, this may be the deeper story.

What it is

• Nociplastic pain is a relatively new clinical category (IASP, 2017). Alongside nociceptive pain (tissue damage) and neuropathic pain (nerve damage), it names pain that comes from altered processing in the nervous system itself, without clear injury or lesion.
• The mechanism is central sensitization. The system gets agitated and pain thresholds drop. Things that shouldn't hurt do, and things that should hurt a little hurt a lot. Or things feel bad but in a different way from physical pain.
• In the predictive-processing frame from Session 1: the brain's model has learned to generate pain in the absence of the signals that used to cause it. The model itself is what's stuck.
• Similar causes can underlie many other conditions that aren't all painful. Fibromyalgia, a lot of chronic low back pain, IBS, tension headaches, chronic dizziness, interstitial cystitis, chemical sensitivities, some pelvic pain syndromes, etc.
• These symptoms often overlap with connective tissue issues (e.g. hypermobility), neurodivergence, anxiety, sleep issues, cognitive fog, or multi-sensory hypersensitivity.

Relevance to the course

• The course thesis is that our subjective experience - including valence (feel-good/feel-bad) - is constructed by an active predictive model, and that working with the feedback loops that build this model is an effective way to get it to generate more positive sensations. Nociplasticity is what happens when that construction gets into a bad configuration for long enough that it gets stuck in that rut.
• Substrate, signal, processing. Nociplasticity is a processing pattern that's gotten stable enough to act like altered substrate. That's why it's hard to shift with signal work alone.
• A lot of what we cover (felt sense, interoception, gentle somatics, attention training, feel-good practice) is exactly the intervention class for this, and that's not by accident. Contemplative traditions figured out how to work with these patterns long before they had a name.

The broader pattern

• The clinical literature is pain-shaped because that's where the research urgency was. But the mechanism generalizes. The same plasticity that generates pain from nothing can generate other things from nothing.
• Because the brain is an allostatic manager - it actively anticipates needs and uses its predictions to manage the body's resources - prediction errors in the unconscious mind propagate into the body in quantifiable ways.
• Interoceptive stuff: a body that feels anxious without anything to be anxious about, chemicals that blunt instead of activate, food sensitivities that come and go with nervous system state.
• Multiple chemical sensitivity, some chronic fatigue presentations, some functional neurological stuff, some of what used to get called "psychosomatic" and dismissed.
• The family pattern from Session 2 (hypermobility, neurodivergence, autoimmune, MCAS, autonomic issues, gender variance) shows up here too. These systems are higher-gain, and higher-gain systems are more prone to this kind of learned amplification.

Some merciful "nots"

• It's not "in your head" in the dismissive sense. The pain and sensitivity are just as real as from any other cause. The generator just isn't where you'd expect it if you hadn't learned about predictive processing and allostasis.
• It's not a diagnosis of exclusion like "I don't know what's going on, so I'll diagnose you with IBS". It has its own clinical features (widespread or regional distribution, hyperalgesia and allodynia, the associated symptom cluster).
• It's not hopeless or even all bad. The plasticity that created the pattern is the same plasticity that can undo it. These patterns also seem to be correlated with creative thinking and perceptive ability. Two sides of the same coin, suffering more with bad input but able to do more with good input.

Rule out substrate first

• Same caveat as Session 2. Thyroid, sleep apnea, B12, iron, hormones, gut stuff. These can drive or worsen nociplastic patterns, and you won't get as much traction on the processing layer if the hardware is off.
• They can also coexist. You can have both a substrate problem and a nociplastic pattern stacked on top. Fixing the substrate often makes the rest more workable but doesn't always resolve it by itself.

What might help

• The somatic and contemplative side: everything in Sessions 3 and 4. Signal work to give the system new data. Attention work to let it update. Feel-good practice to broaden the window of tolerance.
• Pain Reprocessing Therapy (Alan Gordon's work, Boulder back pain study in JAMA Psychiatry 2021). Howard Schubiner's stuff. More mechanistically careful than the older TMS material. Pain neuroscience education.
• The ritual and somatic modalities that look weird from outside (setting intentions, writing and destroying things, parts work, EMDR, breath practices) are doing real work at the processing layer. The traditional explanations may or may not be literally true. The mechanism is that they give a stuck predictive system a multi-modal update signal it can't easily dismiss.
• The medical side: look into duloxetine, low-dose TCAs or naltrexone, sometimes pregabalin.
• Graded aerobic exercise. Purely anecdotally - something specifically for fun that is also mildly activating, like mini golf or axe throwing with friends or family, is medicine for me.
• Cultivating a felt sense of safety. Programs like Annie Hopper's DNRS are specifically targeted toward this angle. My article Strange Stuff Your Body Does When Relaxing Or Stressing Out can help you identify when your nervous system is relaxing, so you can learn to do those things more. A relaxed nervous system can learn to feel safe more easily.
• Working with triggers (this is largely from my own experience and conversations rather than a literature review). In my view the point of this process is to reduce sensitivity to triggers rather than to get better at avoiding them, but the work is best done from a place where the body is able to receive positive sensations and feel safety. My own triggers tend to be dietary like caffeine, chocolate, and black tea specifically - but for some it's fragrances or any number of other things. I still need to go near-zero on them sometimes when I'm not doing great. Identifying what circumstances make things worse for you can be difficult especially if it's not an immediate reaction, but the knowledge you gain is a hugely useful tool.

A connection with the shamanic archetype

• There's a pattern in the anthropology and contemplative literature where the people who become healers in traditional societies often had an initiatory illness. A period of sensitivity, altered states, other strange and debilitating symptoms. They came out of it oriented toward working with those territories.
• May be a helpful way to frame this whole cluster of phenomena once you've got some stability. This framing may not help much with acute suffering, and definitely not if it becomes an identity that keeps you stuck. But learning to deal with issues like the ones talked about here can also confer useful skills that you can use to help others.

References and further reading

• I did a Twitter thread on this, and a followup with some stuff I missed
• Howard Schubiner, Unlearn Your Pain
• Alan Gordon, The Way Out, and the Boulder back pain study
• Jessica Eccles on the hypermobility / anxiety / neurodivergence cluster
• Sarah Garfinkel and the interoception and predictive processing literature
• Lisa Feldman Barrett, How Emotions Are Made. She's also been on some good podcasts.
• Kosek et al. (2021) on grading nociplastic pain clinically
• Daniel Clauw on central sensitization
• John Sarno's work on healing back pain was foundational in this area, even if his proposed mechanisms aren't quite right. Some people's back pain has significantly improved just from reading part of one of his books
• For the shamanic angle:
  • Mircea Eliade, Shamanism. More as ethnography than a manual
  • Drew Schorno's Null Call is what showed me the "shaman" connection in the first place

If this resonates

If you recognize yourself or someone you love in this, the practices in the course are a reasonable place to start. Go gently. The same sensitivity that made you susceptible to the pattern makes you susceptible to the intervention, in both directions. I'm working on integrating this into an article, so please reach out if you have something to add.