• Anxiety
• Fear-avoidance of pain
• Depression
• Trauma
• Opioid pain medication dependence
• Being unemployed
• Financial stressors due to being out of work or unpaid medical bills
• Insomnia
• Fatigue
• Poor concentration and short-term memory
• Stress-related health problems, such as headaches, reflux & indigestion, diarrhea, increased blood pressure
• People not believing you or invalidating the legitimacy of your pain
• Perfectionism
• Having to decline participation in family functions because of being in too much pain or because it would cause too much pain
• Being unable to help out and others not understanding
• Lack of daily structure & feeling aimless
• A lack of meaning or direction to life

The list could continue, but these problems are often the most common.

Healthcare providers categorize these problems into what are called psychosocial problems. The term refers to issues that are psychological, interpersonal, or social in nature. It is well known that chronic pain can lead to psychosocial problems or make them worse if they occurred prior to the onset of chronic pain.

All these problems are stressful. They are inherently difficult to experience. They are taxing and make those who experience them tense. As stressful problems, they make you physically and emotionally nervous.

Stress on the nervous system makes pain worse. Whatever the initial cause of the chronic pain might have been, pain is ultimately a function of the nervous system. There would be no pain were it not for the nervous system. Stress makes the nervous system more reactive, leading to tension and nervousness. This heightened state of reactivity of the nervous system, or nervousness, makes pre-existing pain worse.

The above-noted psychosocial problems can thus create a vicious cycle of chronic pain. Chronic pain leads to these problems, but once they are occurring they are also stressful. The stress that they create leads to increased pain because of their effect on the nervous system.

Healthcare providers call this constellation of chronic pain, psychosocial problems, and stress a complicated chronic pain syndrome.

It also explains one of the central tenets of chronic pain rehabilitation: that what initially caused the pain is not the only thing that now maintains it on a chronic course. Chronic pain leads to vicious cycles of stressful complications that, in turn, make chronic pain worse. What might start off as having a single, solitary cause comes to have multiple secondary causes.

Date of publication: March 25, 2013

Date of last modification: January 13, 2019