Persistent Pain: How the Nervous System Gets Stuck (and How It Can Change)
Pain is your brain’s way of trying to protect you. But sometimes those warning signals keep firing even after tissues have healed—or in some cases, when healing has plateaued but a subtle mechanical irritation hasn’t yet been identified. In other words, pain can become persistent for different reasons. Sometimes it reflects an ongoing stress to the body that hasn’t been uncovered yet. Other times, it reflects changes in how the nervous system is processing danger, stress, or past injury.
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When pain lasts longer than expected—typically beyond three months—it’s known as persistent or chronic pain. This page explores one important dimension: what modern pain neuroscience has uncovered about how and why the nervous system may stay in a protective state, and how that can shape your experience of pain.
Imagine there’s a construction zone on a road due to a pothole. Cones, barriers, and warning signs are set up to keep people safe while the pothole is being fixed. Once the pothole is repaired, in most cases, the cones and signs are taken away, and the road returns to normal. But sometimes, the cones and warning signs are left behind, even though the road is fixed. Drivers will still act like the road is broken due to these signs, even though the danger is gone.
Here’s leading pain neuroscience expert Adriaan Louw, discussing the complexities of chronic pain.
https://www.bobandbrad.com/experts/adriaan--louw
🔎 Important:
Before considering the nervous system’s role in persistent pain, it’s essential to first rule out serious medical conditions (like fractures, infections, or structural injuries).

If you've already been assessed and no ongoing damage was found, that's when we can start exploring how the nervous system may be keeping pain signals active. Understanding and working with this perspective can be powerful, but it’s often a process. It may involve education, hands-on support, and time to help the nervous system settle, relearn safety, and reduce overprotection.
What We Mean by “Nervous System”
When we talk about the nervous system in persistent pain, we mean the deeper parts of your body’s protective wiring--the systems that constantly monitor for danger and help keep you safe.

This includes:
  • The spinal cord and areas of the brain that detect danger and trigger protective responses
  • The autonomic nervous system, which manages background processes like heart rate, muscle tone, and pain sensitivity

Most of this happens below conscious awareness.
You're not choosing it--and you're not doing anything wrong.
It’s your body’s alarm system trying to keep you safe… even when the actual danger has passed.

All Pain is Real
Pain is always a real experience--even when there’s no visible tissue damage. Sometimes it reflects changes in the nervous system (the kind we’re talking about here), and other times it may involve subtle tissue restrictions, irritations, or peripheral drivers scans can't find or science doesn't fully understand yet.
Hurt Does Not Equal Harm
Just because something hurts doesn’t always mean something is being harmed, or that something is damaged.

When the nervous system stays on high alert, it can begin to amplify pain signals. Non-threatening things—like light touch or gentle movement—may start to feel painful. It’s like a microphone turned up too loud, picking up every little sound and distorting it.
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For example, if you hit your thumb with a hammer, it will obviously hurt. But if you keep hitting it again and again, the area becomes sensitized. Eventually, even a light touch on that thumb can feel painful—not because of new damage, but because the system is on high alert.
Sometimes the brain and nervous system act like an overprotective guard dog--barking at anything that seems even slightly off, even if it’s not dangerous.
🐶 Barking Dog (Overprotective):
Sometimes, our nervous system acts like an overprotective dog—barking at harmless things, just in case.
🐶 Calm Dog (Regulated):
With support and safety, that same nervous system can learn to sit peacefully—alert, but not alarmed.
Treatment often focuses on helping the nervous system feel safe again, through:
  • Discovering pain-free movement, gradually reintroducing safe activity, winding down sensitivity
  • Breath, rhythm, and body awareness
  • Hands-on support that speaks quietly to the nervous system
  • Education that reduces fear and builds understanding
Here are some of the key factors that can influence how pain is felt:
  • What your body is sensing – Signals like pressure, movement, or inflammation travel to the brain.
  • Past experiences – Previous injuries or pain memories can shape how your brain responds now.
  • Emotions – Feeling stressed, low, or anxious can turn the volume up on pain.
  • The situation you're in – If your brain senses danger, it may increase pain to protect you. If it feels safe, pain may ease.
  • Beliefs and expectations – Thoughts like “this must mean something is seriously wrong” can make pain feel more intense.
Different parts of your brain work together to create the experience of pain:
  • Sensing (e.g. somatosensory cortex, thalamus): Where is the pain? What does it feel like?
  • Emotions (e.g. insula, cingulate cortex): How distressing is this?
  • Thoughts (e.g. prefrontal cortex): What do I believe this pain means?
  • Memory & threat detection (e.g. amygdala, hippocampus): Have I felt this before? Is this dangerous?
  • Pain modulation (e.g. periaqueductal gray (PAG), spinal cord, brainstem pathways): These deeper brain areas help turn the pain volume up or down depending on context, stress, or safety.
Movement is Medicine
One of the ways to retrain the nervous system is through slowly and gently reintroducing pain-free movement so that the system can learn it’s safe. Think of it like dipping your toe into cold water—at first, there may be apprehension, but the more you ease into it, the more your body adjusts.
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Pain can also act as a teacher—not just a warning siren, but a guide. It can help you notice which movements or postures may be irritating your system, and which ones feel more supported. By gradually building a repertoire of pain-free movement, you not only help your brain rewire, but you also give irritated tissues the chance to heal without ongoing stress. This process can be empowering, giving you more clarity about how to move, rest, and recover.
Watch this short talk by another prominent researcher in this field, Lorimer Moseley, discussing Why Things Hurt:
Lorimer Moseley DSc PhD FACP is Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy at the University of South Australia. He is Senior Principal Research Fellow at Neuroscience Research Australia and an NHMRC Principal Research Fellow.
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Compiled by Joe Liguori