3 Main Factors Affecting Chronic Pain

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In our previous article, the topic of chronic pain was introduced. We talked about what pain was, the types of pain and how chronic pain is a real problem that needs to be addressed. In this article, we will discuss about factors that affect chronic pain.

chronic pain

What behaviours or triggers contribute to chronic pain?

Chronic pain is a complex issue as factors from various domains can contribute to each person’s individual pain experience. Typically only biomedical factors are considered, but the factors from the psychological, social and lifestyle domains are also relevant and important to consider. Factors from all these different domains can interact with each other and affect one’s pain experience to varying degrees at different points in time, often unique to each individual.

Biomedical factors

Immunity Levels

Lower immunity levels have been shown to play an active role in chronic pain. This link between lowered immunity levels and pain can often be observed in the case of a viral infection or flu, where we tend to experience body aches and pains though we are not exercising. We also tend to feel weak and physically unwell despite the lack of injury.

This increase in pain experienced occurs due to the release of chemicals caused by a lowered immunity level. These chemicals not only increases our sensitivity to send pain signals but also amplifies the severity of the pain. This is just like a fire alarm system, that was originally built to warn you of a fire, but is tripped and now triggered by steam instead of thick smoke. In addition, the fire alarm is ringing much louder than before, as if the danger was extremely great.

Similarly, pain was originally an alarm signal that was meant to warn us of a possible physical damage like an ankle sprain. However, in the presence of a lowered immunity system, even something as innocuous as the brush of the skin, can inflict pain. Hence, lower immunity levels can contribute to chronic pain by causing us to experience a decreased threshold to pain signals usually also accompanied with an amplified pain signal.

Lifestyle factors

Diet, sleep, level of physical activity and amount of stress, amongst other lifestyle habits and behaviours, can each play a direct role in persistent pain. They can also contribute to your chronic pain indirectly, by affecting the immune system. An assessment of which factors could be contributing to your pain and an appropriate management plan can help to strengthen your immune levels and reduce pain. However, it is difficult to do so on your own without the help of a medical professional, as the optimal level of physical activity, rest and stress will vary between individuals and with different life circumstances. Hence, it would be best to have a physiotherapist to help decipher what the right balance is, and to guide you in achieving it.

Psychological factors

Beliefs and Attitudes

The way you respond to your pain is often dependent on what you believe or understand the pain to be. For example, whether you think a fire alarm is due to a fire drill or a real fire will affect whether you stay in your seat or run out of the building. Similarly, how a person thinks about and perceives their pain can affect their pain experience. Inaccurate beliefs can amplify as well as increase the persistency of pain.

For example, believing that your pain is due to a physical injury can cause you to avoid any form of exercise or activity that will cause pain. However, this fear avoidance behaviour will often result in repercussions such as a sedentary lifestyle, loss of muscle mass, poorer heart health, lower immunity, weight gain and so on. These effects can then feed into the persistent pain cycle. Hence, it is crucial to consult a physiotherapist to ascertain if the pain we feel warrants rest and avoidance of certain physical activities or whether there are other steps that we can take to achieve better function and eventually, reduce our pain.

Mood and emotions

Frustration, anger, irritability, hopelessness and even depression can lead to chronic pain. Negative emotions can turn up the ‘volume button’ on pain, by increasing the intensity of pain experienced. Chemicals associated with negative thoughts and feelings can depress the inhibition of pain and excite the nervous system, which is responsible for sending pain signals to the brain. This in turn, heightens the sensation of pain and discomfort produced by the brain by amplifying the pain signals and reducing the body’s natural ability to tamp down the pain signals. In addition, negative emotions contribute to chronic pain by causing an increased focus on pain and altering behaviours, resulting in fear avoidance, for example. A tailored behavior modification program and exercises by a physiotherapist can help manage these factors and behaviours which contribute to chronic pain.

Social factors

Social factors such as your relationships with family and friends, work, compensation policies and even culture, can influence your recovery time frame and care-seeking options. As it would be challenging having a single healthcare professional to manage all these factors, it is advisable to seek help from a multi-disciplinary team instead. Specialities such as social workers and clinical psychologists would be adept in dealing with the variety of social factors encountered.


The nature of each person’s chronic pain experience is ever-changing and dynamic; it is often affected by different contributing factors from various domains all at the same time. What we have covered today are just some of the major contributing factors to chronic pain and it is critical to have them identified early and accurately by your physiotherapist. If you are suffering from chronic pain, do approach a physiotherapist, who can then guide you through a personalised journey towards better health and resolution of pain. In our next article, we will be discussing more on how chronic pain can be managed.