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Pain Neuroscience Education:
Autoimmunity and the Hidden Landscape of Chronic Pain
For millions of individuals, particularly women, living with an autoimmune disease, chronic pain is not merely a side effect; it is often the first, most persistent, and most disabling symptom. This pain frequently presents as a "shifting landscape" of sensations, defying easy explanation and measurement. From unexplained fatigue and muscle aches to burning nerve sensations and joint pain, these "hidden layers" of discomfort can be vague and overlapping, leading to a profound mismatch between a person's lived experience and the medical system's response. The fact that pain can be the initial sign of an underlying autoimmune condition further complicates the diagnostic process, contributing to years of uncertainty and a sense of being unheard.
Learn more about the basics of pain neuroscience education as a foundation for the following information below.
Disclaimer:
I am not a medical doctor. My work is in the field of chronic pain psychology and mind-body coaching. The information provided on this site is educational and for general informational purposes only. It is not intended to diagnose, treat, cure, or prevent any medical condition, nor should it replace the advice of your physician or healthcare team. Please consult your doctor or qualified healthcare provider before making any changes to your medical treatment, medications, or healthcare routine.
The Immune System's Double-Edged Sword
The immune system is the body’s natural defense and repair network. But in autoimmune conditions, this system becomes confused and starts attacking the body’s own healthy tissues. This misdirected response can create inflammation, tissue damage, and pain — often affecting both the body and the nervous system.
Key points:
The immune system normally protects against infection and helps repair the body after injury.
In autoimmunity, the immune system mistakenly attacks healthy cells (e.g., joints in rheumatoid arthritis, gut in IBD).
Chronic immune activation fuels neuroinflammation, disrupting brain and nervous system function.
Damage to nerve coatings (myelin) can impair communication between brain, spinal cord, and body.
This explains not only physical pain but also fatigue, brain fog, and mood changes often linked with autoimmune disease
The Multifaceted Nature of Pain:
Understanding Mixed Pain Types
Inflammation is the body’s natural healing response, but in autoimmune disease it often becomes chronic, driving ongoing pain and tissue damage. This long-term inflammation affects not only the body but also the nervous system, making pain more intense and widespread.
How inflammation drives pain:
- Chemical mediators: Immune cells release pro-inflammatory cytokines (e.g., IL-1, IL-6, IL-17) that sensitize nerves, increasing pain sensitivity.
- Mechanical pressure: Swelling from inflammation compresses nearby nerves, amplifying pain signals.
- Nervous system changes: Ongoing inflammation can cause central sensitization, where the brain and spinal cord stay on “high alert,” amplifying pain even after the original trigger has passed.
The spectrum of pain in autoimmunity:
- Inflammatory pain: Caused by immune activity and swelling in affected tissues (e.g., joints in rheumatoid arthritis).
-Neuropathic pain: Nerve damage leads to burning, tingling, or stabbing sensations (e.g., multiple sclerosis)
- Structural/nociceptive pain: From muscle, bone, or joint changes such as spasms, deformities, or stiffness.
- Neuroplastic pain: From a sensitized nervous system, often overlapping with conditions like fibromyalgia.
Understanding this mixed spectrum of pain is key: focusing on just one type of pain often leaves other drivers unaddressed. That’s why comprehensive, multi-layered approaches — like FLOW — are essential.
Common Autoimmune Conditions & Mixed Pain
Autoimmune diseases can create complex pain profiles, often blending inflammatory, structural, neuropathic, and neuroplastic components. Understanding these patterns is essential for safe, effective management — and is central to the FLOW approach.
Rheumatoid Arthritis (RA):Chronic inflammation of the joint lining (synovium) causes pain, swelling, and stiffness.
Pain is typically mixed presenting as inflammatory and structural/nociceptive.
Common features: warm, swollen joints (often hands and feet), morning stiffness lasting >45 minutes, and symmetry across both sides of the body.
Long-term inflammation can erode bone and damage other systems (eyes, lungs, heart).
Systemic Lupus Erythematosus (SLE): A systemic autoimmune disease affecting skin, joints, kidneys, lungs, and more.
Pain is a mixed state:
Inflammatory/Structural: Joint and muscle pain, arthritis, tendonitis.
Neuropathic: Burning, shooting, or tingling from nerve involvement.
Neuroplastic: ~30% of patients also have fibromyalgia, requiring careful distinction between inflammatory vs. neuroplastic-driven pain.
Sjögren’s Syndrome: Best known for dry eyes and mouth, but also systemic.
Pain is typically mixed presenting as inflammatory and neuropathic:
Inflammatory: Symmetric joint flares, swelling, and tenderness.
Neuropathic: Burning, stabbing, or skin-on-fire sensations from nerve involvement.
Neuroplastic: Fibromyalgia overlap adds widespread, muscle-related pain.
Multiple Sclerosis (MS): Immune attack on the brain and spinal cord leads to demyelination (nerve coating loss).
Pain presents as:
-Neuropathic (direct): Trigeminal neuralgia (sharp facial pain), Lhermitte’s sign (electric shock sensation), burning/tingling dysesthesias.
-Structural/Nociceptive (secondary): Muscle and back pain from spasticity
-Neuroplastic: nervous system hypersensitivity can result from long-term medical and movement fear
Other Autoimmune Conditions with Pain:
Ankylosing Spondylitis: Inflammatory pain in the spine.
Psoriatic Arthritis: Joint inflammation linked with psoriasis.
Myositis: Muscle inflammation causing pain and weakness.
IBD (Crohn’s, Ulcerative Colitis): Chronic gut inflammation with systemic pain.
Guillain-Barré Syndrome (GBS): Immune attack on peripheral nerves, causing weakness and sensory pain.
Type 1 Diabetes: Autoimmune attack on insulin-producing cells, with secondary pain complications.
Scleroderma: Tissue hardening; can cause painful neuralgia.
Managing Autoimmune Pain:
A Holistic Framework
Autoimmune pain is complex — often involving structural changes, immune activity, and nervous system sensitization. That’s why no single solution works for everyone. The most effective care is personalized and multidisciplinary, addressing the full spectrum of pain drivers.
This is where the FLOW Program adds real value. Through one-on-one sessions, FLOW combines evidence-based strategies — from movement pacing, nutrition, and flare planning to brain retraining, emotional processing, and mindfulness — into a plan tailored to your condition. By caring for both the body and the nervous system, FLOW helps reduce symptoms, restore confidence, and build long-term resilience.
Other key components of autoimmune pain management may include:
- Pharmacological interventions: Anti-inflammatory medications (NSAIDs, corticosteroids), immunosuppressants, or biologic drugs to calm immune activity. Neuromodulators and certain antidepressants may help with neuropathic pain.
- Lifestyle modifications: Anti-inflammatory nutrition, regular low-impact exercise (e.g., walking, swimming, yoga, tai chi), and good sleep habits can lower inflammation and support overall well-being.
- Mind-body therapies: Approaches like PRT, brain-retraining, emotional processing, mindfulness, and trauma-informed practices calm an overactive nervous system, reduce fear, and ease symptom amplification — working alongside medical care to create a stronger foundation for healing.
