How Nervous System Dysregulation Leads to Chronic Pain

Chronic pain is one of the most common symptoms of nervous system dysregulation. You activate the same network in the brain whether you experience emotional, physical, or social pain like rejection.

Understandably, chronic pain can cause strong emotional responses like fear, anger, or despair. These emotions are associated with increased activity in the amygdala, the anterior cingulate cortex, and the insula. These areas are important not just in pain perception, but also in regulating your stress arousal and your emotions.

Whether a sensation is seen as threatening by the amygdala depends on whether you believe you have enough coping resources. Although the sensation may be unpleasant if you feel like you have agency & choice, stress arousal decreases, and the nervous system re-regulates. Pain that’s seen as overwhelming & uncontrollable brings strong anxiety, anger, or despair leading to greater pain intensity despite the extent of physical impairment. 

Chronic stress and dysregulation can increase the activity in the anterior cingulate cortex and the insula. This heightened neural activity can amplify pain because they’re involved in both pain perception & emotional regulation. Chronic and traumatic stress not only influences the nervous system, but also the endocrine (hormonal) & immune responses, which may amplify pain through several mind-body system pathways, such as inflammation.

Beliefs have a powerful top-down effect on your mind-body system and can make pain worse. Having the belief: “It’s not fair that I have to live with this pain and nobody else does,” can lead to anger and can mobilise the sympathetic nervous system into the fight branch of fight or flight.

Fear can also increase sympathetic activation and the flight response. For example, this could include beliefs such as: “something really bad is happening,” or “my back is broken” or “I’ll lose my job”. On the other hand, “this will last forever and there’s no use trying anything to get better” can drive despair making you feel flat, helpless, and depressed.

Resources that re-regulate your nervous system can help you experience less distress and fear about chronic pain. As emotional & physical pain use the same neural networks, it’s possible that improved emotional regulation will reduce pain. Although pain is not just “in your head”, if chronic or traumatic stress left a footprint on your nervous system that makes it more efficient at moving into survival mode, this dysregulation can intensify pain.

Examining the underlying beliefs that you (or your patients) have can change the top-down beliefs that affect your nervous system and may be amplifying pain pathways and dysregulation. Consider your beliefs about the pain. For example, “my back is unstable” can make you fearful of movement & amplify pain. You could consider the following questions to reflect on the beliefs related to your pain:

• What belief do I have about the pain?

• Is that belief 100% true?

• Where did that belief come from?

• What would my pain be like if I was no longer living with this belief?

Bottom-up regulation practices help to re-calibrate the nervous system so that it doesn’t automatically interpret unpleasant sensations as a threat. This means there will be less activity in the areas of the brain like the amygdala, insula, and anterior cingulate cortex, allowing pain levels to decrease. You’ll also experience less anxiety, distress, and helplessness.