Still in Pain With No Clear Diagnosis? It Might Be Neuroplastic Pain
- Colin O'Banion, DPT
- Nov 20, 2025
- 5 min read
Still in pain even though your tests are “normal”? It might not be your body — it might be your brain.
In my Boulder physical therapy practice, I often see clients who’ve tried everything from MRIs to massage, with no real solution to their pain, and no closer to the answer of what is causing it.
In many of these cases, the pain isn’t due to ongoing tissue damage — it’s coming from the nervous system itself. This is called neuroplastic pain — when the brain stays stuck in a danger mode, continuing to send pain signals even after the body has actually healed.
If you’ve been searching for chronic pain treatment in Boulder that looks beyond the physical, this guide can help you understand whether your pain is more about nervous system sensitivity than injury — and what you can do to change it.
What Is Neuroplastic Pain?
Pain is the brain’s way of protecting you. Pain is your brain’s way of signalling danger. Usually, that danger is tissue damage. Normally, it signals real damage in your tissues. But sometimes, even after your body has healed, the nervous system stays stuck in “danger mode” — and continues to send pain signals. This is called neuroplastic pain, also known as central sensitization or nervous system–driven pain.
In these cases, the problem isn’t in the body’s hardware — it’s in the software. Your muscles, joints, and tissues may be fine, but your brain is still misinterpreting normal signals as threats.
Research confirms that chronic pain can rewire the brain’s pain networks, making them more sensitive over time. That means you can still feel very real pain — even when there’s no ongoing injury.
In plain language: your brain may trigger pain without new injury — because it still thinks you’re in danger.
Could Your Symptoms Be Neuroplastic?
Here Are the Telltale Signs
If you’re experiencing chronic pain, but haven’t found a clear cause, these patterns may point to neuroplastic pain — pain driven by your nervous system, not ongoing injury.
Here are clues that your pain may be more brain‑based than purely structural or mechanical:
Pain began or worsened during emotional stress or without a clear injury
Pain persists past the normal healing time of the tissue (usually 3–6 months)
Symptoms shift location, move or spread (for instance from one side of the body to the other)
Pain is clearly influenced by stress, emotion, or your mental state
Relief occurs when you’re distracted or positively engaged
No clear structural diagnosis, or multiple inconsistent diagnoses
You identify with being self‑critical, anxious, a high‑achiever or people‑pleaser
Recognizing these signs helps steer away from “let’s fix the tissue only” and towards “let’s retrain the nervous system”.
In my Boulder-based physical therapy practice, I use this understanding to create a more accurate and hopeful path to recovery.
How We Accurately Identify the Source of Your Pain
With over 20 years of experience as a Doctor of Physical Therapy, I’ve developed a comprehensive evaluation process to determine whether your chronic pain is mechanical/structural, neuroplastic, or a combination of both.
This includes a detailed written and verbal intake correlated with a thorough hands-on physical exam.
This holistic approach ensures we don’t overlook the nervous system's role, or misattribute brain-based pain to tissue problems alone. For those in the Boulder area seeking chronic pain treatment that goes beyond the basics, this kind of root-cause clarity is often the turning point.
When you understand why your pain is persisting, you can finally take the right steps toward lasting relief.
Why the Brain Gets Stuck in a Pain Loop
Your nervous system is designed to protect you.The moment something threatens you (injury, stress, illness, fear), your brain activates the “danger alarm”. Pain is one of its loudest signals.
But sometimes, even after the original threat is gone, that alarm system stays on. Three key factors keep it stuck:
Fear or threat perception
Hypervigilance — constantly scanning for danger
Chronic stress — which amplifies the alarm signals
When that alarm persists after tissues heal, you end up in a pain‑fear cycle:
This creates a self-reinforcing cycle:
Pain → threat response → increased nervous system sensitivity → more pain.
Think of it this way: structural pain is like a fire alarm going off because there’s smoke. Neuroplastic pain is like the alarm going off because you made toast — no fire, but the system thinks there is.
For many people seeking stress-related pain treatment in Boulder, this pattern is the missing explanation — and understanding it is the first step toward interrupting the cycle.
Common Triggers That Keep the Pain Cycle Going
Even in Boulder’s active, health-conscious community, certain emotional and psychological patterns can unknowingly keep the brain’s danger system switched on, fueling neuroplastic pain even after the body has healed.
Some of the most common triggers include:
Worry: “What if this never goes away?”
Pressure: deadlines, performance, staying active despite pain.
Self-criticism: “There’s something wrong with me.”
Anger or frustration: At your body, your circumstances, or others
Each of these can activate the nervous system’s threat response — keeping you stuck in a pain cycle even when there’s no current injury.
The Hopeful Truth: You Can Retrain Your Brain
The good news: Because the nervous system is plastic (meaning it can change), you can recalibrate the brain’s threat system and help it learn that “you’re safe” again. When it does, the pain will subside.
A landmark trial of Pain Reprocessing Therapy (PRT) found that two‑thirds of people with chronic back pain were pain-free or nearly so after 4 weeks of treatment, compared with far fewer in control groups. Learn more about that study here.
In my Boulder-based holistic physical therapy practice, I integrate this neuroplastic perspective into everything I do. From movement therapy to stress regulation and nervous system retraining. It’s not about fixing “broken” tissue. It’s about addressing the deeper patterns that keep your pain alive, and helping your brain let go of the danger signal.
Ready to Approach Your Pain from a New Angle?
If you’re dealing with persistent pain in the Boulder or Denver metro area that isn’t improving despite treatments, it’s time to consider a different angle.
It's time to ask a new question: "Could this be driven by neuroplastic pain, and driven by my nervous system rather than ongoing injury?”
At my practice, I specialize in one-on-one, direct-pay physical therapy focused on mind-body physical therapy for chronic pain. If you’re ready to explore the path where the brain and nervous system are contributing to your chronic pain, contact me to schedule a consultation and take the first step toward healing.
How to Connect with Me:
Colin O’Banion, Doctor of Physical Therapy
Colin is a licensed Physical Therapist and founder of Colin O’Banion Physical Therapy in Boulder, Colorado. With 20 years of experience, he specializes in solving complex and chronic pain cases through a root-cause, integrative approach. Colin combines advanced manual therapy, shockwave therapy, dry needling, and movement re-education to help clients return to the activities they love. His one-on-one practice is dedicated to clients seeking lasting solutions when traditional PT has fallen short.
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