Chronic Pain: Stuck in Survival Mode
Our acute stress response (fight-or-flight) is a survival response that activates in the presence of threat and then returns to baseline once the stressor resolves. When this response fails to quieten down, it becomes maladaptive. The stress system remains switched on or primed, leading to heightened reactivity even to minor triggers. Persistently switched on fight or flight activation and dysregulated HPA (hypothalamic, pituitary, adrenal) axis activity contribute to the overall stress load which has far ranging effects.
Chronic stress isn’t just a subjective experience; it has measurable effects on our bodies. Exposure to sustained mental, social or workplace stress is linked with a higher incidence of a wide range of stress-related conditions and can “reset” stress circuitry, including the HPA axis, autonomic nervous system and immune signalling, towards a state of chronic activation.
Maladaptive Stress Responses in Chronic Pain
When the stress system stops switching off, it becomes a major driver of chronic pain. A body stuck in survival mode becomes hypersensitive. The same stress circuitry that keeps the “alarm” blaring also amplifies pain signals.
Chronic activation of the HPA axis and nervous system (fight or flight) ramps up inflammation, tightens muscles, heightens vigilance, and disrupts normal pain-modulating pathways in the brain and spinal cord. Over time, this constant load recalibrates how the nervous system processes threat. Pain pathways become easier to activate, and harder to calm down. In this state, even minor inputs such as pressure, movement, emotional stress or poor sleep can provoke amplified pain responses.
Research shows that people exposed to ongoing stress have higher rates of chronic pain disorders. Stress hormones like cortisol, when persistently elevated (or, paradoxically, depleted after long-term stress), interfere with tissue healing and immune balance. They also impair the brain’s own analgesic systems, reducing your natural ability to dampen pain.
Once the system is dysregulated, a triggering event, a small injury, surgery, infection, hormonal shift, or emotionally stressful period, can set off a prolonged pain condition in someone whose physiology is already primed. The nervous system isn’t just reacting to tissue damage; it’s reacting to the internal state of threat.
In this way, chronic pain becomes less about what’s happening in the tissues and more about what’s happening in the system that interprets those signals. The body has essentially learned a pain response, just as it learned to keep the stress alarm on. This isn’t imagined or psychological, it’s neurobiological conditioning.
Over time, survival-mode physiology creates a feedback loop: stress amplifies pain, pain increases stress, and the system stays locked in a pattern it thinks is protective. This is why effective chronic pain care has to work on recalibrating the nervous system and threat responses, not just treating the painful body part.
Rewiring Pain
The brain and nervous system are neuroplastic, meaning it has a remarkable capacity to adapt. When pain becomes persistent, the brain doesn’t simply keep reacting to the original injury; it reorganises. Neural circuits involved in threat detection, pain processing and emotional regulation become more active, more interconnected and more efficient at producing pain. This is maladaptive plasticity: the brain has essentially become better at generating pain signals, even when the tissues have healed.
Rewiring Pain
Our brains are neuroplastic. They can adapt and rewire to change our responses to input.
Chronic pain is associated with measurable changes in both brain structure and function. Pain-processing regions become hypersensitised, while the brain’s natural inhibitory systems, the circuits that would normally dampen pain, become less effective. The system interprets normal sensory input as dangerous, and the person experiences pain that feels every bit as real as any injury-driven pain. The longer this pattern persists, the more entrenched these pathways can become.
The good news is that these changes are not fixed. Neuroplasticity works in both directions. Just as the brain can learn maladaptive responses, it can also unlearn them and rewire pathways. Studies show that targeted interventions such as movement therapy, graded exposure, somatic practices, vagal regulation, cognitive approaches, pain science education and other neuroplasticity-based methods can reduce hypersensitivity and restore neural pathways recognising normal function, regulation and safety over threat.
This means chronic pain can be rewired. Even if the nervous system has been operating in amplification mode for years, it can be trained toward a safer, more regulated baseline. The brain and nervous system are dynamic, responsive and capable of recalibrating responses to threat. This is not instant and not passive. To make change requires consistent input that signals safety, reduces threat, and interrupts learned patterns. In essence, the same system that once wired the body into persistent pain can be guided to wire its way out.
Resources to start rewiring chronic pain
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