Why chronic pain persists, and what to do about it

Are you one of the 1 in 4 adults in the UK who live with chronic pain? And in this shockingly high number, women are even more disproportionately affected. Perhaps you have unexplained fatigue, or other mysterious symptoms. It’s frustrating, confusing, scary, disheartening and exhausting, isn’t it? Perhaps you’ve tried everything- the supplements, herbs, medications, scans, chiropractors, thinking positive, doing more exercise, meditation- and none of it has worked for long. Or maybe you’ve been told that there’s nothing more the doctors can do, and been sent home with antidepressants and painkillers.

The thing is, the entire medical profession, and many of the bodyworkers out there, are looking for answers in the wrong places. They are coming from a biomedical and biomechanical approach, when pain is a biopsychosocial phenomenon. What this means is that there are many factors influencing your perception of pain, and tissue damage is only one of them. Tissue damage actually has a surprisingly weak correlation to pain. In fact, most chronic pain (lasting 3 months or longer) isn’t caused by structural damage at all- it’s due to changes in the way your brain interprets signals from your body.

That said, all pain is real! If you have been told “it’s in your head” then this is your signal not to listen to that person again! Once you have expanded your understanding of what pain is, how it perpetuates, and what you can do about it, you’ll be in a much better position to feel hopeful, empowered, and like you have agency and choice over your situation-  and this essay aims to provide you with just that. So, read on!

So- if pain is not simply a sign of damage, then what is it?

Pain Is a Protective Output

Pain is a protective output. It is your nervous system’s best guess at how much danger you are in, based on the information available. Think of it like a guard dog. A well- trained guard dog barks when there is a genuine threat, and settles when the threat has passed. But if that dog has been repeatedly startled, stressed or confused, it may begin barking at everything- the wind, a passing shadow, a harmless visitor. The barking is real. The alarm is loud. The doggy thinks he’s doing a good job. But the danger is not always proportional.

Your nervous system is the same. It’s not broken- it’s doing its job, too well.

What Is Central Sensitisation?

Chronic pain is often the result of an inner guard dog that has become overprotective. Over time, stress, injury, trauma, inflammation, hormonal shifts, a harsh inner critic, lack of sleep, blood sugar swings, adverse childhood experiences, and repeated periods of overload can all sensitise your nervous system. This is where central sensitisation comes in- a state in which the nervous system becomes more responsive, more vigilant, and quicker to interpret sensation as threat. The threshold lowers. The volume turns up.

And once your nervous system has learned this pattern, it doesn’t simply switch off because you want it to. Many of these responses operate below conscious awareness. They are shaped by memory, by subconscious associations, by neural networks strengthened over time, by previous experiences of danger or overwhelm. Which means that trying to “think positively” your way out of chronic pain is a bit like asking the barking guard dog to read a self- help book.

When we talk about central sensitisation, we are describing a nervous system that has become too efficient at producing pain. Neural pathways get stronger with repetition. The more often a protective response is activated, the easier it becomes to trigger. This does not mean the pain is imagined. It means the system has adapted- just not in a way that feels helpful.

The Biopsychosocial Model of Chronic Pain

This is where an understanding of the biopsychosocial model becomes important. Pain is influenced not only by tissues, but by stress chemistry, immune activity, past experiences, how much support you have, beliefs, context, and whether the nervous system feels safe. The hypothalamic-pituitary-adrenal (HPA) axis (your stress response system) plays a central role here. Prolonged stress can alter cortisol rhythms, disrupt sleep, increase inflammation, and amplify pain sensitivity. Add hormonal shifts during perimenopause or menopause, and the system may become even more reactive.

You might recognise this in yourself. Perhaps your pain or symptoms flare when you are stressed, overwhelmed or haven’t slept enough. Perhaps they worsen before a difficult conversation, during hormonal shifts, or after pushing yourself too hard for too long. Maybe scans have shown nothing significant, yet the pain is very real. These patterns are clues. They tell us that the nervous system is involved.

Some researchers describe a related concept called the “cell danger response.” In simple terms, when the body perceives threat- whether physical, infectious, inflammatory or emotional- cells shift into a defensive mode. Resources are diverted toward protection rather than repair. If that protective state becomes chronic, symptoms can persist even when the original trigger has resolved. Again, this is not dysfunction. It is protection that has not yet received the message that it is safe to stand down.

The Bathtub Analogy

You may not feel consciously stressed. In fact, many of the women I work with are competent, capable, used to coping. But the body keeps score of cumulative load- deadlines, parenting, caregiving, childhood adversity, illness, relational strain, internal pressure to hold everything together. Like a bath with the tap still running, eventually it overflows- and the overflow can look like pain, fatigue, migraines, gut symptoms, in fact any symptoms (skin complaints, dizziness, brain fog to mention a few), or anxiety.

The important thing to understand is that it isn’t just the steady drip drip drip of daily stress that causes the overflow. That drip is to be expected; after all, we can’t get through life with zero stress. (And nor would we want to- some stress is a good thing.) It’s everything that was already in the bath to begin with. Old injuries. Unprocessed experiences. Unexpressed emotions. Hormonal shifts. Years of pushing through. Patterns learned in childhood about staying vigilant, staying responsible, staying strong. The water level may have been high long before the most recent stressor arrived.

And this is where many approaches go wrong. They focus only on turning off the tap- reducing stress, thinking differently, managing workload. That can help. But if the bath is already near the brim, even a small additional drip will cause overflow. Sustainable change comes from gradually emptying what has accumulated and, at the same time, increasing the capacity of the bath itself- expanding what is called your Window of Tolerance. In nervous system terms, this means building flexibility, so that the same inputs no longer trigger the same protective output.

What Is the Window of Tolerance?

The “Window of Tolerance” is a term used to describe the range within which your nervous system can respond to life without becoming overwhelmed or shutting down. When you are within your window, you can think clearly, feel your emotions without being consumed by them, and respond rather than react. When you are outside of it, your nervous system shifts into survival mode- fight, flight, fawn, freeze, or collapse. Pain often intensifies in those states because the body is on high alert.

For some people, that window is naturally wider. For others, especially those who have experienced repeated stress or early adversity, it can be narrower. Research into Adverse Childhood Experiences (ACEs) has shown a strong association between early chronic stress and later health challenges, including persistent pain. This does not mean that your past determines your future. It means that the nervous system is shaped by experience- and can also be reshaped by experience.

How Subconscious Patterns Influence Chronic Pain

Many of these adaptations happen below conscious awareness. If you grew up needing to stay vigilant, to anticipate other people’s moods, to be responsible beyond your years, your nervous system may have learned that the world is unpredictable. That learning does not disappear just because you are now an adult with insight and intelligence. It becomes encoded in patterns under the surface- in muscle tone, posture, breath patterns, stress chemistry, expectation, and subconscious associations.

This is where the role of the subconscious becomes important. Alarm pathways are influenced not only by structural input, but by prediction. The brain is constantly asking: “Is this safe?” (This spidey sense is called neuroception.) If past experiences have taught it that certain sensations, movements, contexts or emotions are dangerous, it may generate pain in anticipation. Not as punishment, or weakness. As protection.

If pain is influenced by prediction, it also means it is influenced by learning. The nervous system is not just reacting in the moment. It is constantly drawing on past experience to anticipate what might happen next. If bending once led to injury, if stress once coincided with a pain flare, if a particular time of the month has repeatedly been difficult, the brain begins to prepare in advance.

This is called predictive processing. We don’t get to choose this, and its not a flaw- its an inbuilt shortcut in the human brain. That unconscious preparation can include increasing muscle tension, amplifying sensitivity, and, sometimes, producing pain itself.

You may have noticed this in subtle ways. The ache that begins before you even start a task you expect to aggravate it. The flare that arrives the night before an important event. The migraine that appears at the end of a long period of coping. These patterns are not imagined. They are learned associations- protective shortcuts the nervous system has built over time.

And here is the hopeful part: what is learned can be unlearned. Your inner guard dog can be retrained and soothed.

Neural pathways strengthen with repetition, but they also weaken when new experiences are introduced. When the system repeatedly encounters the same movement, sensation or emotion and discovers that it is safe, prediction begins to shift. The guard dog learns that not every sound requires barking. The bath slowly drains. The window widens.

This is not about forcing yourself to push through pain. It is about creating enough safety- physiologically and psychologically- that your system no longer needs to shout.

And this is why understanding pain changes your experience of pain.

When you begin to see symptoms as protective rather than catastrophic, you no longer need to be scared of your symptoms. When fear reduces, you can work on sending safety signals to your nervous system. When safety increases, sensitivity can begin to lower. Education is not just information- it is a practical intervention that can lead to positive results.

Why Chronic Pain Can Worsen During Perimenopause

And let’s talk about hormones for a minute. Hormones can play a significant role in how pain is experienced. Oestrogen, for example, influences pain sensitivity, inflammation, sleep regulation and mood. During perimenopause and menopause, fluctuating oestrogen levels can lower pain thresholds and increase nervous system reactivity. Many women notice that old injuries resurface, migraines become more frequent, or new aches appear without clear cause.

If this has happened to you, it does not mean your body is deteriorating. It means the buffering systems that once helped regulate stress and inflammation are shifting. When hormonal change coincides with accumulated stress load, previous adversity, sleep disruption or long- standing overextension, the nervous system can become more vigilant. The guard dog was already alert; now it is quicker to bark.

Immune signalling adds another layer. Inflammation is not inherently harmful- it is part of the body’s protective response. Short- term inflammation is a good thing. But chronic low- grade inflammation, often driven by stress, poor sleep, blood sugar instability or unresolved threat patterns, can amplify pain sensitivity. The system becomes primed. Signals are interpreted through a lens of caution.

Again, this is not dysfunction. It is protection layered upon protection.

When you step back and view chronic pain through this wider lens- nervous system learning, stress physiology, immune activity, hormonal shifts, subconscious prediction-  the experience often begins to feel less random. It may still be uncomfortable, frustrating and annoying. But it is no longer mysterious, or something to be feared.

And when something is no longer mysterious, or feared, it becomes workable.

This is where many women experience their first real sense of relief- not because the pain has magically vanished overnight, but because the story has changed. Instead of “my body is broken,” the narrative becomes “my system has been protecting me.”

And making that shift matters.

What You Can Do About It

Because if chronic pain is an overprotective response, then the work is not about fighting the body. It is about retraining it.

That retraining happens on multiple levels.

First, education reduces the feeling of threat. When the brain understands that pain does not automatically equal damage, the alarm system can begin to soften. Research consistently shows that pain neuroscience education alone can reduce fear, catastrophising and sensitivity. Knowledge, when properly integrated, changes physiology.

Second, the nervous system needs repeated experiences of safety. This is not forced exposure or pushing through symptoms. It is gradual, intelligent reintroduction of movement, sensation and emotion within a regulated window. Each safe experience slightly updates prediction. Each moment of tolerable challenge expands capacity. This can take time, and be a non-linear process, but given the right inputs, the outputs will naturally change. And safety is one of the most important inputs.

Breath patterns also deserve a mention here. Often, improper breathing is the missing link. Chronic over-breathing or erratic breathing can maintain sympathetic arousal (fight/flight) and amplify sensitivity. Chest breathing keeps shoulder, chest and neck muscles tight, and tells the body that there is imminent danger- even when there isn’t. Breath re-education, including the Buteyko method, improves carbon dioxide tolerance (a good thing), improves autonomic balance and flexibility (meaning you can relax more easily) and stabilises the stress response. When breathing becomes steadier, the system receives a powerful message- we are safe enough to slow down.

Somatic awareness also plays a role. The body often holds patterns of tension that reflect long-standing vigilance. Learning to notice and gently shift these patterns increases flexibility. Trauma-informed approaches such as TRE and impulse completion can help complete stress cycles and complete gestures that were never fully resolved. The goal is not dramatic release. It is gradual recalibration.

Subconscious work is equally important. If pain has become associated with specific movements, environments or emotions, those associations need updating. Cognitive Hypnotherapy allows us to work directly with predictive patterns held below conscious awareness. In a safe, structured state of focused yet relaxed attention, the brain can begin to rewrite outdated threat responses.

Over time, these layers combine. Education reduces fear. Breath stabilises physiology. Somatic work restores flexibility. Subconscious patterns update prediction. Lifestyle factors- sleep, blood sugar stability, pacing, relational boundaries- support the system as a whole.

What this means is: the bath drains. The guard dog settles. The window widens.

This is not an overnight process. But it is a reliable one. Change the inputs, and the outputs change. This is a long-term solution- going upstream to address the root causes, rather than just treating the symptoms.

I have witnessed women who felt trapped by persistent pain begin to move more freely, sleep more deeply, and trust their bodies again. Not because they forced symptoms away, but because we addressed the protective patterns underneath them.

If you recognise yourself in this article- the frustration, the confusion, the sense that something deeper is driving your symptoms- then you are not alone. And I’d like to reassure you that you are not broken.

Chronic pain is complex. It deserves a framework that is equally nuanced. I’m here to make it simple, and workable.

When you are ready, working together means approaching your symptoms with curiosity rather than fear, intelligence rather than force, and compassion rather than criticism. We build capacity. We expand tolerance. We restore flexibility.

And from there, positive change becomes not only possible- but sustainable.