There’s a moment that shows up in certain clinical conversations.
The workup is done. The imaging is clean. The labs are normal.
Everything that should explain the symptoms doesn’t.
And instead of relief, the patient feels worse.
Because now there’s no answer.
Or at least, not one that feels real.
Neuroplasticity Part 2: Fixing Physical Pain with Treatment of the Mind with Dr. Dave Clarke
When “Normal” Doesn’t Mean “Fine”
We trust medicine to find something.
A lab value. A scan. A diagnosis you can point to and say, there it is.
Something visible. Measurable. Nameable.
That’s the contract.
So what happens when there isn’t?
In most areas of medicine, we’re trained to identify what’s wrong. Find the lesion. Locate the pathology. Name the disease.
But in some cases, the path forward requires something much stranger: you have to prove what isn’t there.
In my conversation with Dr. Dave Clarke, this tension comes up immediately.
To even introduce a neuroplastic explanation for pain, you first have to earn the right to say it. Which means doing what medicine does best: testing, scanning, ruling things out.
Not because nothing is happening.
But because the mechanism isn’t structural.
That distinction matters more than it seems.
The Gap Between Explanation and Belief
From the patient’s perspective, this process doesn’t feel like clarity. It feels like uncertainty.
They came in with symptoms that are real. Often severe. Sometimes debilitating.
And after a series of tests, they’re told: “We don’t see anything wrong.”
That sentence lands differently depending on who’s hearing it.
To a clinician, it can mean reassurance.
To a patient, it can sound like dismissal.
This is the gap. Not between symptoms and diagnosis. But between explanation and belief.
Pain Doesn’t Require Structural Damage
Neuroplastic pain challenges one of the most deeply held assumptions in medicine: that pain requires structural damage.
That something must be physically broken, inflamed, compressed, or diseased.
But the brain doesn’t work that way.
It doesn’t just respond to injury. It responds to perception, stress, memory, and threat.
And when it can’t process something consciously, it can express it physically.
Not as a metaphor. As physiology.
This is where the language starts to break down.
Because if you say, “There’s nothing wrong,” you’re not wrong structurally. But you’re completely wrong experientially.
Something is happening.
The nervous system is activated. Signals are firing. Pain is being generated.
The problem is not the absence of a process. It’s a misunderstanding of which process is active.
And that’s a much harder conversation to have.
Asking Someone to Reconsider Their Own Body
Now you’re asking someone to reconsider what they believe about their own body.
To move from “something is damaged” to “something is being signaled.”
That shift is not just clinical. It’s psychological. It’s emotional. It’s identity-level.
People build stories around their symptoms. Not irrationally. But because it’s the only framework they’ve been given.
Pain equals injury. Symptoms equal disease.
So when you remove that structure without replacing it with something equally concrete, you don’t create relief. You create instability.
This is why the diagnostic process matters so much in these cases. Not just to rule things out. But to build trust.
To show, step by step, that the structural explanation doesn’t hold. That nothing has been missed. That the absence of findings is not negligence.
It’s information.
How the Model Actually Works
Only then can a different explanation begin to take shape.
And when it does, it often starts in a way that feels almost counterintuitive.
You reduce fear around the symptom. You shift attention away from the body. You begin to explore what’s happening in the mind, in the present, and in the past.
Not because the symptom is “in your head.”
But because the brain is part of the body. And it’s actively participating in what you feel.
This is where something interesting happens.
As fear decreases, the nervous system begins to settle. Sympathetic activation lowers. The intensity of signals starts to change.
A feedback loop that once amplified symptoms begins to reverse.
Not instantly. Not universally. But measurably.
Why the Model Still Struggles
And yet, despite this, the model still struggles to gain traction.
Not because it lacks evidence. But because it challenges the way we’ve been trained to think.
Medicine is built on what we can see. Neuroplastic pain exists in what we can’t.
And until we get more comfortable with that space, patients will continue to fall into this gap. Where everything looks normal. But nothing feels fine.
The Hardest Sentence in Medicine
Maybe the hardest sentence in medicine isn’t delivering bad news.
It’s saying: “We’ve ruled everything out, and that’s actually important.”
Because in that moment, you’re not just offering reassurance. You’re asking someone to see their body differently.
To consider that the absence of a finding is not the absence of a cause. Just a different kind of one.
If you’ve ever encountered symptoms that don’t follow the rules, or patients who don’t fit the model, my full conversation with Dr. Dave Clarke goes deeper into what this actually looks like in practice.