Is it neuroplastic? Neuroplastic symptoms checklist

This questionnaire helps explore whether your symptoms may be influenced by nervous system sensitization or learned pain and symptom patterns. It is not a diagnosis.

Instructions

For each statement, circle how true this feels for you over the past several months.

0 = Not at all true

1 = Slightly true

2 = Moderately true

3 = Very true

A. Symptom onset and medical findings

• My symptoms began without a clear injury or have lasted longer than expected after an illness or injury: 0 1 2 3

• Medical tests or scans have not fully explained my symptoms: 0 1 2 3

• I have received multiple or changing explanations for my symptoms: 0 1 2 3

Subtotal A: ___ /9

B. Inconsistency and variability

• My symptoms change in intensity, location, or type: 0 1 2 3

• Symptoms are different depending on time of day, stress level, or environment: 0 1 2 3

• Symptoms worsen with stress but improve during rest, vacations, or enjoyable periods: 0 1 2 3

• Symptoms often appear after activity rather than during it: 0 1 2 3

Subtotal B: ___ /12

C. Triggers, conditioning, and attention

• Certain cues trigger symptoms (sounds, lights, weather, time of day, movements, activities): 0 1 2 3

• Anticipating symptoms or imagining movement can increase symptoms: 0 1 2 3

• Symptoms worsen when I closely monitor my body: 0 1 2 3

Subtotal C: ___ /9

D. Nervous system load and history

• Symptoms began during or after prolonged stress, illness, burnout, or emotional overwhelm: 0 1 2 3

• I feel stuck in alertness, shutdown, or exhaustion: 0 1 2 3

• Rest is not consistently restorative: 0 1 2 3

• I have a history of childhood adversity, chronic stress, or co-occurring mental health conditions: 0 1 2 3

Subtotal D: ___ /12

Personality and family patterns

• identify with traits such as perfectionism, people pleasing, high responsibility, or self-criticism: 0 1 2 3

• There is a family history of chronic pain, fatigue, migraine, anxiety, or similar conditions: 0 1 2 3

Subtotal E: ___ /6

F. Relief with safety and engagement

• My symptoms lessen when I am distracted, engaged, socially connected, or doing something meaningful: 0 1 2 3

• Reassurance, validation, or new explanations temporarily reduce symptoms:

0 1 2 3

Subtotal F: ___ /6

Scoring and interpretation

Total score: ___ /54

Overall interpretation

• 0–18: Neuroplastic contribution less likely

• 19–34: Mixed or partial nervous system contribution

• 35+: Strong likelihood of central sensitization or neuroplastic symptoms

A higher score does not mean symptoms are “in your head.” It suggests the nervous system may be stuck in a learned danger pattern that can be retrained.