How Stress, Sleep & the Nervous System Influence Ongoing Pain

Pain is not always determined by tissue damage alone. While an injury or physical irritation can initially trigger pain, the experience of pain is influenced by a range of factors, including stress, sleep, movement and the way the nervous system processes information. This becomes particularly relevant when pain continues beyond the expected healing period or fluctuates without an obvious change in the original injury. Ongoing pain is real, but it does not necessarily mean that there is ongoing tissue damage. Research increasingly recognises pain as a complex experience influenced by biological, psychological and lifestyle factors (Adams et al., 2023).

Why Can Pain Continue After an Injury?

Acute pain is protective. It encourages us to protect an injured area while the body recovers. However, when pain persists, the nervous system can become more responsive to signals coming from the body. This increased sensitivity can contribute to symptoms that continue or fluctuate, even without new or worsening tissue damage. One way to think about this is like a volume control: when the nervous system becomes more sensitive, signals from the body may be experienced more strongly. Factors such as prolonged stress, poor sleep, inactivity or repeatedly aggravating an area may contribute to turning this “volume” up.

Stress, Sleep & Pain

Stress and sleep can both influence how the nervous system processes pain. Prolonged stress activates systems including the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. When stress is ongoing and recovery is limited, these systems may influence pain processing and sensitivity (Vyverman et al., 2026).

Sleep and pain can also influence each other. Research has found that people experiencing sleep problems have a greater future risk of developing chronic musculoskeletal pain, while ongoing pain can make it harder to sleep well (Runge et al., 2024). Sleep disturbance may also affect the body's natural pain-modulating mechanisms, potentially increasing sensitivity (Herrero Babiloni et al., 2024). This can create a cycle:

Pain → disrupted sleep → increased sensitivity → more pain → further sleep disruption

Supporting Recovery

Because ongoing pain can be influenced by multiple factors, recovery may involve more than treating the painful area. Depending on the individual, this may include gradually rebuilding movement and strength, improving sleep habits, managing stress, modifying excessive physical loads and developing confidence with movement. Research also suggests that non-pharmacological sleep interventions can improve sleep quality in people experiencing chronic pain (Whale et al., 2022).

How Chiropractic Care May Help

Chiropractic care can form part of this broader approach. Spinal manipulation provides sensory input to the nervous system and has been shown to produce short-term neurophysiological responses (Sampath et al., 2024). Combined with appropriate movement advice, exercise and education, chiropractic care can support mobility, function and confidence.

If ongoing or recurring pain is affecting your day-to-day life, book an appointment with our team to discuss how we can support your recovery.

References

Adams, G.R. et al. (2023) ‘Do “central sensitization” questionnaires reflect measures of nociceptive sensitization or psychological constructs? A systematic review and meta-analyses’, Pain, 164(6), pp. 1222–1239.

Herrero Babiloni, A. et al. (2024) ‘The impact of sleep disturbances on endogenous pain modulation: A systematic review and meta-analysis’, The Journal of Pain, 25(4), pp. 875–901.

Runge, N. et al. (2024) ‘The bidirectional relationship between sleep problems and chronic musculoskeletal pain: A systematic review with meta-analysis’, Pain, 165(11), pp. 2455–2467.

Sampath, K.K. et al. (2024) ‘Effectiveness of spinal manipulation in influencing the autonomic nervous system: A systematic review and meta-analysis’, Journal of Manual & Manipulative Therapy, 32(1), pp. 10–27.

Vyverman, J. et al. (2026) ‘The stress-pain connection in chronic primary pain: A systematic review and meta-analysis of physiological stress markers in relation to experimental pain responses’, Neuroscience & Biobehavioral Reviews.

Whale, K. et al. (2022) ‘The effectiveness of non-pharmacological sleep interventions for people with chronic pain: A systematic review and meta-analysis’, BMC Musculoskeletal Disorders, 23, 440.