Understanding Persistent Pain: Causes and Mechanisms

Introduction to Persistent Pain

Pain is an essential signal from our body, alerting us to potential harm or injury. However, for some individuals, this signal becomes persistent, transitioning from acute to chronic pain. Understanding how this transformation occurs is crucial in addressing the underlying causes and finding suitable treatments.

The Transition from Acute to Chronic Pain

Acute pain usually results from a specific injury or illness and typically subsides as the body heals. In contrast, chronic pain persists beyond the typical healing period, often lasting for months or even years. The transition from acute to chronic pain involves several complex mechanisms. Initially, injury or inflammation may trigger pain signals through the nervous system. However, if these signals continue without an ongoing injury, the nervous system can become sensitized. This means that even the normal stimuli will be perceived as painful, leading to a cycle of pain that can be difficult to break.

Underlying Causes of Persistent Pain

The underlying causes of persistent pain can be multifaceted, ranging from physical to psychological factors. Physically, conditions like arthritis, fibromyalgia, and neuropathy can contribute to chronic pain. These conditions may involve ongoing inflammation or damage to the nervous system, which keeps the pain signal active.

Psychological aspects also play a significant role. Emotional stress, anxiety, and depression can amplify the perception of pain, making it feel more intense and unmanageable. Moreover, individuals with a history of traumatic experiences may be more susceptible to developing chronic pain, as their nervous systems are already programmed to react strongly to perceived threats.

Additionally, lifestyle factors such as lack of physical activity, poor diet, and insufficient sleep can create a vicious cycle that exacerbates chronic pain. The absence of movement can lead to muscle weakness and stiffness, further fueling the pain experience and impacting daily living.

Central Sensitisation - why is this crucial to understand?

Central sensitisation means that your nervous system becomes extra sensitive.
Normally, your brain and nerves work together to alert you when something is wrong — like when you touch something hot or twist your ankle. But when central sensitisation happens, your nervous system starts to turn up the volume on pain signals, even when there’s no new injury or damage.

In other words, your body’s “pain alarm” becomes too loud and too easily triggered.

Sometimes, after a long period of pain, stress, or injury, your nervous system becomes overprotective.
It’s like your body has learned to expect pain — and now it keeps sending pain messages even when the tissues are healing or safe.

This can happen due to:

• Ongoing or repeated pain (like arthritis, back pain, or fibromyalgia)

• A past injury or surgery

• Emotional stress or trauma

• Poor sleep or fatigue

• Illness that affects the immune or nervous system

Common signs include:

• Pain that lasts longer than expected after an injury heals

• Pain spreading to new areas

• Pain from things that shouldn’t hurt (like light touch or clothing)

• Feeling more sensitive to noise, light, or temperature

• Fatigue, poor sleep, or “brain fog”

• Fluctuating pain — some days worse than others

These symptoms are real, and they don’t mean you’re imagining things. They mean your nervous system is working overtime.

What can we do about central sensitisation?

The brain and nerves are changeable — they can learn new, healthier patterns.
Just like the system became over-sensitive, it can also relearn how to quiet down.
This process takes time and the right strategies, but it’s absolutely possible.

1. Understanding Your Pain

Learning about how pain works can actually reduce pain sensitivity. Knowledge helps the brain feel safer.

2. Gentle, Gradual Movement

Movement helps retrain your nervous system that activity is safe. Start small — walking, stretching, swimming, yoga — and build up slowly.

3. Good Sleep and Relaxation

Poor sleep makes the nervous system more sensitive.
Try to keep a regular sleep routine and use calming techniques like deep breathing, meditation, or mindfulness.

4. Managing Stress

Stress keeps your body in “alert mode.” Activities like slow breathing, journaling, or spending time in nature can help calm the system.

5. Pacing Yourself

Balance activity and rest. Doing too much on a “good day” can flare symptoms, so find a steady rhythm that works for you.

6. Support and Guidance

Pain specialists, physiotherapists, occupational therapists, and psychologists familiar with chronic pain can guide you through recovery.

A Reassuring Message

Central sensitisation doesn’t mean your body is broken — it means your nervous system is trying too hard to protect you.
With time, movement, understanding, and support, your system can learn to feel safe again and turn the pain volume back down.