From Exam to Explanation: Helping Patients See the Science of Neuroplastic Pain

How to integrate neuroplastic principles into frontline care to build understanding and reduce reliance on invasive treatments and opioids

Authored by Dr. Jill VanWyk

Medical Director at Lin Health and Board-Certified Family Medicine Physician and Assistant Professor, UC Health

Why this matters

Explaining to a patient that their chronic pain is being amplified by their brain and nervous system can be extremely challenging for physicians and other caregivers. Geoffrey Keenan, MD, a board-certified Physical Medicine & Rehabilitation physician (Physiatrist) and Co-Director of the Neck and Back Pain Clinic at Sentara Orthopedics, has refined a method that helps patients visualize how the nervous system learns pain – and, importantly, how it can unlearn it.

Dr. Keenan’s approach brings logic and compassion to that discussion by helping patients see that physical and cognitive connection for themselves. Whether through a hands-on sensory exam or thoughtful dialogue, clinicians can make the invisible visible and open the door to low-risk, first-line treatments ahead of opioids or invasive procedures.

What clinicians need to know

Up to 80% of chronic pain conditions have underlying neuroplastic or nervous system-driven elements.
Physicians often see chronic pain patients after they have undergone a multitude of tests and treatments (imaging, injections, medications, PT), yet their pain persists because their pain signaling system is over-firing.
All pain is real, even when imaging is normal. The issue is an overly sensitized pain system that sends a disproportionate amount of pain signals; this is not imagined distress.
Fear and pain reinforce each other: anxiety heightens pain and pain fuels anxiety.
Overreliance on imaging can mislead: "MRI findings have very poor correlation with pain and function,” noted Dr. Keenan. “Abnormal findings are the norm in asymptomatic populations. Chasing treatments or assessing prognosis based on 'false positives' is often frustrating and dangerous for the patient."

The physical exam as a patient education tool

Dr. Keenan’s exam technique demonstrates hypersensitivity patterns, offering both diagnosis and education to patients living with pain or discomfort. By comparing normal and painful areas using pinprick, vibration, and cold stimuli, he helps patients observe how the same sensation feels amplified in sensitive regions. This clear comparison turns an abstract neurological concept into something patients can tangibly feel and understand.

Here are three tools Dr. Keenan employs in his physical exams:

Pinprick
Use a moderately sharp object such as an uncurled paperclip or even a fork to test different areas of the body. Compare painful areas with non painful areas, and ask the patient to “price the sensation” (ex: “If this is $1 of pain here, what is it there?”).
Cold
Apply a disposable cold pack on a neutral area first (“call this $1 cold”), and then to the pain site (“what is the dollar value of pain here?”). Increased feeling of cold or, in more significant cases, pain with application of the cold is suggestive of sensory hypersensitivity.
Vibration
Use a small vibrating toothbrush to compare sides; differences suggest nervous system amplification.

"When you have an injury, cold should feel soothing, not painful. If mild cold hurts more at the pain site, that’s a sign your nervous system is sensitized - not damaged.”

Dr. Keenan

When you can’t perform a physical exam

Additionally, use of available pain science resources (such as the "Tame the Beast" educational video by pain scientist Lorimer Moseley, PhD) “can fairly quickly introduce these concepts without the patient becoming defensive,” Dr. Keenan suggested.

How to explain neuroplastic pain while maintaining patient trust

Patients may initially resist the idea that pain can be learned, but clear, logical explanations and simple demonstrations help build understanding and trust.

Emphasize that the pain is real but driven by an overactive nervous system rather than ongoing tissue damage.
Explain that sometimes the nervous system stays “on alert” long after an injury heals, continuing to send amplified pain signals.
Clarify that this is not psychological; it’s a biological response that can be retrained through practice and reassurance.
Note that the same brain circuits involved in physical pain also react to stress and emotion, which is why mental and physical factors influence each other.
Reinforce that the nervous system can calm down over time, and that safe movement, relaxation, and education help “reset” its sensitivity.

After the exam - or conversation: Reinforce the logic

Once a patient experiences or discusses their hypersensitivity, the clinician can help them connect what they felt to what’s happening in their nervous system. The goal is to replace fear with understanding.

Name what’s happening: Describe what you both observed, such as a stronger response to mild cold or touch, and explain that this reflects an overprotective nervous system rather than tissue damage.
Highlight variability: Point out how pain intensity often fluctuates with stress, emotion, or environment to reinforce that these shifts are signs of sensitivity, not structural failure.
Encourage curiosity: Invite patients to reflect on patterns – what else was happening on days their pain was worse – to help them notice links between stress, emotion, and physical sensations (Ex: “have you ever noticed your symptoms seem to flare up consistently when you visit a specific family member, but not when you’re enjoying your hobby?”).
Reinforce safety: Remind them that each time they move safely and experience less fear, they’re helping the nervous system recalibrate and quiet those amplified signals.

“Statistics show that people have different levels of mental flexibility,” noted Dr. Keenan. “There are some who are very concrete and will never believe in the concept of neuroplastic pain no matter how much convincing and how much evidence there is to the contrary. That’s probably about 10% of the population. In my practice, I can get buy-in from patients about 80-85% of the time.”

Integrating neuroplastic care into frontline treatment

Introducing these concepts early - before surgery or long-term medication use - positions neuroplastic-informed care as a first-line, evidence-based option. By validating pain as real and explainable, clinicians can help patients understand the nervous system’s role in recovery, reducing fear and building readiness for change. Healthcare leaders and payers can view this approach as a scalable, low-risk pathway to improving chronic pain outcomes and reducing avoidable interventions.

Dr. Keenan’s closing advice:

“Many providers get empathy fatigue when caring for patients with neuroplastic pain because the work we do is hard. Therefore, it’s important to not only have empathy for your patients but also empathy for yourself.”

Dr. Kennan presented these insights at the 2025 Association for the Treatment of Neuroplastic Symptoms Conference. Don’t miss the 2026 event for the latest updates and expanded discussion.

How Lin helps

Turning skepticism into understanding:

A brief sensory comparison (such as showing how mild cold feels different on the painful versus non-painful area) can help patients see that their nervous system, not tissue damage, is driving pain. Lin Health reinforces this logic through ongoing education and coaching.

Reinforcing the science of safety:

Each time a patient moves safely and experiences less fear, the nervous system begins to calm. Lin Health’s structured programs build on these moments, helping patients retrain their pain response and regain confidence in movement.

Extend the conversation beyond the clinic:

Through personalized coaching and digital tools, Lin Health helps patients practice the same nervous system retraining strategies introduced in your office.