Why Does Chronic Pain Flare When Life Gets Stressful?

Yes, stress can make chronic pain worse, and from what I've experienced in my own life and from what my clients have told me - it's one of the most common reasons pain flares without any trauma or injury to your body. If we keep things simple: stress, poor sleep and worry move your nervous system into a more protective state, and a more protective nervous system tends to produce more pain. That's what I would consider a normal (if unhelpful) response. It's usually temporary, and there are practical ways to work through it and get back on track.

Your nervous system's job at a primal level is to protect you. When life deals a stressful set of cards, whether that's illness, money worries, caring for a loved one, potential job uncertainty or weeks of broken sleep - your stress systems ramp up. Stress hormones rise, muscles become more tense, sleep tends to suffer and these things influence your nervous system's threat centres in an unhelpful way.

A more primed nervous system is more likely to read ordinary sensations as threatening. So your lower back that was "grand" last month might start to feel sore again, even if you have zero recollection of tweaking it or injuring it at all. And depending on how worried or afraid I am about the symptoms that I experience, I may feel a little or a lot of pain. Your tissues usually haven't changed much at all, but the unconsciously perceived level of threat has.

Flare-ups are unfortunately common in persistent pain. Research in people with long-term back pain found flares are a regular part of the picture for many pain sufferers.

It's accurate and real to say that recovery is rarely a straight and smooth line from pain to pain-free. If you are lucky enough to eventually overcome your symptoms and the effect they have on your life and you were able to look at your recovery like a linear graph - you'd see that it looks more like a jagged line with peaks and troughs, improvement, some setbacks, then a bit more improvement, with a gradual overall upward direction that you might only see when you zoom out a bit. Instead of it being a straight upward line, imagine it like a swarm of bees buzzing here, there and everywhere, and eventually the swarm reaches the target.

A "familiar flare" is a term I use from time to time. One of those feels like your normal pain except everything is a bit more "turned up" - the same area, the same kind of pain, often after a stressful spell, poor sleep or doing more than usual, and it tends to settle down again over a few days.

An "unfamiliar flare" is where it gets tricky. A new pain experience, maybe it's a different type of pain and potentially in a different area of your body. Especially if it's happening without any potential reason or triggering event. I've been through these myself and although most of them settled down within a few days to a few weeks - you cannot help but be concerned about these. I often found myself overthinking about these flares, doomscrolling Dr Google's finest horror stories and half convincing myself that I was going to be stuck with this new pain forever. One thing that often helped was focusing myself on taking it a bit easier, actively relaxing and regulating myself and when I needed it - booking an appointment with a trusted health care professional to get myself checked out. I know you are reading this on the Bigger Than Pain website, and whilst what we have built is extremely powerful for someone in pain, we do not and cannot diagnose you - having a trusted health pro to turn to when needed is simply another tool in your tool belt on the journey of persistent pain recovery.

On that note, it's worth dropping this in here.

See your GP promptly if you notice:

• pain that is significantly different from your usual pattern, or keeps getting worse instead of settling
• new numbness, pins and needles or weakness, or weakness that is getting worse
• fever, feeling generally unwell, or unexplained weight loss alongside the pain

Get urgent medical help (your nearest emergency department, or call 112 or 999) if you have:

• new numbness around your backside, genitals or inner thighs
• new difficulty passing urine, or loss of bladder or bowel control
• weakness in your legs that is getting worse quickly

If you're not sure, get it checked. Peace of mind and some reassurance are potent pain killers.

When I first started practising, I'd get frustrated when people couldn't stick to their exercises or flared up easily. I thought, "If they'd just do exactly what I gave them, they'd get better faster." Years of working with real people living real, messy lives taught me I was wrong. The people who do best long term aren't the ones who follow a plan perfectly. They're the ones who get good at getting back on track.

When shit hits the fan in life, all of the rehab exercises, sleep routines, breathing practices and appointments are usually the first things to bounce off said shit covered fan and fly straight out the window. Nearly every client I've spoken to about this has felt guilty about it:

"Ah David, I've been terrible at doing my exercises. I haven't done them in a week and I can feel my back tightening up again. It had been so good. I'm actually useless..."

If I had a Bigger Than Pain subscription for every time I was told that, I'd never have to work again! But seriously, that self-critical inner voice is only helpful if it motivates you to begin again. If it's not helping you get back on track, there is literally NOTHING good that comes from self-criticism. In fact, it's come up so many times that people slide into a doom loop of self-criticism > more pain > further reduced activity > more self-criticism > feeling helpless > more pain > more self-criticism, etc. It never helps. When you find yourself riding those train tracks, do your best to get off at the next available stop.

Change is hard. Keeping it going while life piles it on your plate is even harder again. Expect diversions. Planning for perfect is the perfect way for a plan to fail.

Stressful periods often bring a boom-and-bust pattern. On a good day you feel great and you might try to do everything: the gardening, the grocery shopping, the exercises you missed yesterday plus today's exercises... Then you end up paying for the increase in activity with a few bad days, rest until it settles, and the cycle starts again.

Over time, boom and bust actually tends to shrink what you can do - because we often spend a lot more time busted than booming. Steadier is harder to get used to initially, but it's a sounder long-term strategy. I will take the person who does fewer reps and sets per day but manages to accumulate consistently across their weeks and months over someone who's stuck in the boom and bust cycle.

20/80, then 80/20

Forget aiming for 100%. I offer the following principle to pretty much every client at some point during their clinic appointments with me:

"What can we do for 20% of your effort that gives you 80% of the benefit/result you're looking for and can you do that 80% of the time, without beating yourself up for the other 20% that you might miss."

That approach bakes in that you're going to mess it up. If you allow for that, and when the 20% you miss comes - if you can treat yourself with some self-compassion instead of criticism, you will be on an incredibly solid trajectory.

And just to make it a bit more concrete let's put some numbers behind this: 5 minutes of movement doesn't sound like much. But 5 minutes x five days per week = over 20 hours a year of moving that's aimed at improving something for you. That's how a little becomes a lot.

Never miss twice

The other little piece I like to add in is for when all hell breaks loose. Because those times do happen and when they do they can potentially derail even the most motivated person's progress. If one of those weeks gets painted into your calendar - again treat yourself with some kindness and chalk it off as one of those weeks. The advice here is simple. Never miss the second week. Get back on track next week, so you never miss two weeks in a row. It gives everything room to disintegrate for a while, and for that to be OK.

The trend you are on is more important than any one event. One bad week won't matter if you can string good weeks together over months.

A five-minute reset

It can be really useful to build a short personal routine that you use to centre yourself and re-orient towards the targets you are working towards. That might be a few minutes of slow, relaxed breathing, a gentle movement you like, or rereading why you started. Slow breathing has been studied as a way to take the edge off pain, and many people (myself included) find it extremely helpful.

Adapt, don't abandon

Ask yourself: "Am I adjusting my approach to fit what's happening, or am I using what's happening as a reason to stop?" Adapting is a skill. Every time you adjust and keep going, you prove to yourself that you can.

Talk to someone

Tell your partner, a friend, your GP or your physio how you're actually doing. Getting it out of your head often makes it feel more manageable, and you might get a perspective you couldn't see on your own. If there's no one to talk to right now, write it down.

Sometimes pain, stress and self-criticism feed each other until everything feels like too much. It can feel like you're being pushed further and further away from where you want to be, and like you're the only one going through it. You're not.

When you're there:

• Accept that it's really hard right now. How you feel in this moment isn't the whole story. Your nervous system is under pressure, and states like this can shift, especially with support.
• Pick 2 or 3 small things that help you feel even slightly better, and do them for the next few days. A walk outside. A hot bath. Putting the phone down. Your favourite album. Making your bed. Talking to someone.
• Don't go it alone. Lean on the people around you, and let your GP or healthcare team know how you're feeling.

1. What one thing can I keep going, even at 10% of normal?
2. What would I say to a friend in my position?
3. Am I adapting, or avoiding?
4. Can I see this week as part of the journey, rather than the end of it?

Flares are much less frightening when you know in advance what you'll do. That's why Flare Support is built into Bigger Than Pain: steps for calming things down, and 33 flare-safe exercises for the harder days, so you're not making decisions in the middle of the storm.

Want to understand more about why pain behaves this way? Read Chronic pain but a normal MRI or scan, and Does focusing on pain make it worse?

This article is general education, not a diagnosis or a substitute for care from your GP or healthcare team. If your pain is new, getting worse, or comes with symptoms that worry you, please get it checked.