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Pain Neuroscience Education:
Neurological Disorders and Chronic Pain
For many years, chronic pain was viewed as a simple symptom of illness — an unfortunate side effect of a neurological condition. Today, research shows a different reality: in many cases, chronic pain becomes a disease state within the nervous system itself. This happens through a process called maladaptive neuroplasticity, where the brain, spinal cord, and nerves remain in an “overprotective” mode, amplifying pain signals long after the original trigger has passed. The nervous system and immune system also interact closely in this process, fueling ongoing sensitivity and inflammation.
The pain linked to neurological disorders is often multi-faceted, and understanding it requires looking at its different origins:
- Primary pain: pain that comes directly from the neurological condition itself (for example, nerve damage in multiple sclerosis).
-Secondary pain: pain that develops as a result of the condition’s progression, such as muscle weakness, immobility, or changes in posture. In neurological disorders, this type of pain is an indirect consequence of the condition's progression. It is often musculoskeletal, arising from problems in the bones, muscles, ligaments, and tendons but can also present as secondary pain is visceral pain, which originates from internal organs.
-Mixed pain: when pain gets complex and presents with combinations of: neuropathic, nociceptive and/or neuroplastic pain.
Recognizing chronic pain as more than “just a symptom” shifts the treatment focus. Instead of only trying to suppress discomfort, the goal becomes restoring balance and retraining the nervous system while supporting the body’s structural and biological needs.
Learn more about the basics of pain and 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.
Foundational Mechanisms: Neuroinflammation in Neurological Disorders
The Immune–Brain Axis: A Pain Conversation
In neurological disorders, chronic pain is not simply a side effect — it’s often driven by the ongoing dialogue between the immune system and the brain. This process, called neuroinflammation, plays a central role in conditions such as multiple sclerosis, Parkinson’s disease, ALS, and post-stroke pain.
Normally, the brain’s support cells (glial cells like microglia and astrocytes) maintain neural health. But in the presence of neurological disease or injury, these cells become over-activated. They release inflammatory chemicals (cytokines, chemokines) that amplify pain signals and keep the nervous system in a heightened state of sensitivity.
Key points:
- Glial cells (microglia, astrocytes, oligodendrocytes) act as the brain’s immune responders.
- When triggered, they release inflammatory chemicals (cytokines, chemokines) that amplify pain signals.
- his creates a “pain loop” that can continue even after the original injury has healed.
From Protection to Problem
Inflammation is meant to protect and heal — but when it doesn’t switch off, it becomes harmful. This chronic neuroinflammation causes the nervous system to become overly sensitive, a state called central sensitization, resulting in neuroplastic pain.
What happens in this shift:
- The nervous system stays in “high alert,” reacting strongly to even small triggers.
- Brain chemistry becomes imbalanced (too much excitatory glutamate, not enough calming GABA).
- Pain signals are exaggerated, spreading from the site of injury to wider areas of the nervous system.
A Shared Biological Foundation
Although diseases like MS, ALS, or Parkinson’s have different causes, they share a common pathway of inflammation-driven neuroimmune dysfunction. This explains why people with different neurological diagnoses often report similar pain experiences (burning, tingling, muscle pain, stiffness) and why treatments that calm the nervous system — from medications to mind-body therapies — can be effective across conditions.
How the FLOW Program Fits In:
Because neurological pain is multi-layered — involving immune activation, nerve damage, and nervous system sensitization — the FLOW Program provides a structured, one-on-one pathway that respects all these factors. Using tools such as movement pacing, flare planning, breathwork, emotional processing, and mindfulness, FLOW helps calm neuroinflammation, restore safe movement, and support both brain and body in conditions like MS, Parkinson’s, ALS, and post-stroke recovery.
A Clinical Overview of Common Neurological Conditions
ALS (Amyotrophic Lateral Sclerosis):
ALS damages motor neurons, leading to muscle weakness and atrophy. Interestingly, pain in ALS is usually secondary (nociceptive) rather than neuropathic.
Main pain sources:
- Muscle weakness → joint strain (neck, shoulders, back)
- Immobility → pressure pain, skin breakdown, wounds
- Muscle cramps, tightness, spasms (affecting ~⅔ of patients)
- Constipation-related discomfort
Parkinson’s Disease:
Over 66% of people with Parkinson’s live with chronic pain, but it’s often overlooked. Pain can take many forms, linked to both motor and non-motor symptoms.
Types of pain in PD:
- Musculoskeletal: From rigidity, posture changes, scoliosis, frozen shoulder
- Neuropathic/Radicular: From nerve compression or entrapment
- Dystonic: Painful spasms and twisting contractions
- Akathisia: Restlessness, inability to stay still
- Neuroplastic pain: From altered brain pain pathways
Important note: Pain in PD often interacts with mood and sleep problems, creating a cycle where pain worsens depression/anxiety, which then worsens pain.
Central Post-Stroke Pain (CPSP):
CPSP is a neuropathic pain syndrome caused by damage to central pain pathways after a stroke. The thalamus and spinothalamic tract are often involved.
Mechanisms:
- Nerve pathway damage → misfiring pain signals
- Neuroinflammation (microglial activation, cytokine release) → hyper-excitable pain circuits
- Imbalance of brain chemicals (↑ glutamate, ↓ GABA) → exaggerated pain
- Emotional comorbidities (anxiety, depression, fatigue) create a reinforcing loop and heightening pain
Symptoms: Burning, stabbing, tingling, or heightened sensitivity even without injury.
Spinal Cord Injury (SCI):
Pain after SCI is common and varies by level of injury. It can be neuropathic, nociceptive, or visceral.
Pain types:
- At level of injury: Neuropathic pain from hyper-excitable neurons at the lesion site
- Below injury: Misfiring pathways → burning, shooting, or spontaneous pain
- Above injury: Secondary musculoskeletal pain (shoulders, elbows, neck, back) from wheelchair use and overuse strain
- Visceral: Pain from constipation or organ involvement
Multiple Sclerosis (MS): A Prototype Autoimmune Condition
In MS, the immune system attacks the myelin sheath, disrupting nerve signaling. Pain affects up to 80% of patients and is often mixed (neuropathic + secondary).
Primary neuropathic pain syndromes:
- Trigeminal neuralgia: Electric shock-like facial pain
- MS Hug: Tight, squeezing sensation around the torso
Lhermitte’s sign: Electric-shock pain down the spine with neck flexion
Secondary pain sources:
- Muscle stiffness (spasticity)
- Weakness and gait issues → joint and back pain
- Neuroplastic pain
A Holistic Framework for Management
Managing the complex and multi-layered components of pain of neurological disorders means that no single treatment works for everyone. Because pain often arises from a mix of structural changes, immune activity, and nervous system sensitization, the most effective approach is both multidisciplinary and personalized. The best outcomes come from a personalized, multi-modal approach — combining medical treatment with non-drug strategies that support the whole person.
This is where the FLOW Program can be especially valuable. Through one-on-one guidance, FLOW integrates evidence-based strategies — from movement pacing, nutrition, and flare management to brain retraining, emotional processing, and mindfulness — into a plan tailored to your unique condition. By addressing both the body and the nervous system, FLOW provides a whole-person pathway to reduce symptom burden, restore confidence, and support long-term resilience in the face of autoimmune and mixed pain challenges.
Pharmacological Interventions: Medication can play an important role in managing neurological pain, but it needs to be personalized to each individual and their condition. Options may include drugs such as anti-seizure medications, certain antidepressants, muscle relaxants, or anti-inflammatories. These are best prescribed and closely monitored by your healthcare specialist, who can ensure safety and tailor the treatment to your unique needs.
Lifestyle Modifications: Lifestyle changes play a crucial role in reducing systemic inflammation. Adopting an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids can help. Regular exercise, including low-impact activities like swimming, walking, yoga, and Tai Chi, has been shown to reduce both systemic inflammation and improve pain, especially in conditions like arthritis and fibromyalgia.
Mind-Body Therapies: Mind-body therapies can be powerful allies in managing mixed pain conditions and autoimmune challenges. While structural changes and immune activity may play a role, the nervous system often becomes sensitized and amplifies symptoms. Approaches such as Pain Reprocessing Therapy (PRT), brain-retraining exercises, emotional processing, mindfulness, and trauma-informed practices help calm this overactivation. By reducing fear, releasing stored tension, and supporting nervous system balance, these therapies complement medical care and create a more resilient foundation for healing — allowing the body, brain, and immune system to work together with greater ease.
