CIM

Neuroplastic Symptom Questionnaire

Look over the following list of questions about the nature of your symptoms. If you answer "yes" to more than a few, that's good news because there is a strong possibility your symptoms are due to neuroplastic changes in the brain and can be reversed with the Insight Medicine approach. Add up your "yesses" and click [Submit] at the end to learn more.

Do you have multiple symptoms that are different in type (back pain AND fatigue; or headaches AND digestive problems AND insomnia; or neck pain, anxiety, bladder urgency, AND tinnitus)?

Have your doctors or other practitioners completed diagnostic testing without finding a definite cause for your symptoms (beyond age-related changes like arthritis/disc bulges, being overweight, “wear and tear”; or vague explanations like gluten intolerance, mold sensitivity, a weak core, too much inflammation, or “just bad genes”)?

Do you have a history of prior symptoms in your childhood/college/your 30’s/etc (any chronic pain, anxiety or depression, digestive or bladder problems, ADHD, an eating disorder, headaches, any addiction, significant insomnia, OCD, fatigue)?

Do your symptoms vary in severity without obvious physical changes (some days 3 out of 10 and other days 7 out of 10; or you can walk 2 miles some days and other days only 2 blocks before symptom onset; or at times you can have some gluten and others you can’t have any before it upsets your GI tract; or they’re worse during the week, but reliably better on weekends)?

Would you be upset if you discovered that a child you care about is experiencing everything you did as a child?

Do you tend to frequently check on, worry about, research, think of ways to escape, feel very frustrated by, or dread your symptoms and their triggers throughout the day?

Are your symptoms triggered by things that don’t have to do with the body or area in question, like changes in the weather, foods, strong smells, specific sounds, certain lights, time of day, screens, or menses?

Did your symptoms begin around a time of intense stress, trauma, great frustration, or loss – or after an event that triggered intense memories of the above?

Do you tend to be very self-critical, a perfectionist, overly conscientious, a worrier, a people-pleaser, often insecure/doubtful of yourself, or get easily overwhelmed/angered?

Have your symptoms changed over time, migrating to different locations in the body (usually in right leg, but it has moved to the left; low back pain in the morning, but it moves to upper-back or neck pain in the afternoon; formerly painful intercourse, but now crampy, irritable bowels), or are your symptoms symmetrical (both wrists; entire right side of body)?

Did your symptoms begin without an injury or long after one (you “woke up with it" or "must have slept wrong”; it gradually developed “out of nowhere”; the suspected acute injury was more than 3 days prior to symptom onset; or you attribute it to an “old” injury like in high school or a car accident from years ago)?

Are your symptoms triggered/worsened by stressful situations (prior to school or work; “the holidays”; a social gathering), or are they less severe/frequent when you are engaged in something enjoyable or distracting (events w/ friends; weekends/vacation; some situation that feels safe or fun for you)?

Have you tried numerous treatments including traditional (medications, PT, injections, surgical procedures), alternative (massage, chiropractic, acupuncture, Reiki, herbal or vitamin supplement), or a NOVEL treatment (a famous practitioner, renowned modality, high-tech intervention), and only achieved temporary or minimal benefit?

First and Last Name

Email Address (to join our mailing list)

How did you find us? (e.g. web search, referred by friend or clinician, business card, etc.)

⚠ Form responses limit reached. Upgrade now.