Pain: Complex but Protective
Pain, according to the updated 2020 IASP definition, is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." This tells us that pain isn’t just about damage, it’s about perception.
Pain serves as a protective mechanism. It grabs our attention in the face of potential harm, but the way our nervous system processes this information is influenced by our thoughts, beliefs, and emotional state. For example, a patient’s back pain may flare up during periods of stress at work, not because their spine has structurally changed overnight, but because their body is operating in a heightened state of threat and protection.
The Emotional Factors Behind MSK Pain
Emotions such as fear, anxiety, anger, or sadness activate our nervous system in very real ways. Chronic stress leads to elevated cortisol and inflammatory markers, sensitising the nervous system and amplifying pain signals — even when there is no new tissue damage. This can result in symptoms that feel severe and persistent, yet don't correlate with the severity of physical findings on examination or imaging.
As chiropractors, we often meet patients where emotional factors are a key driver of their symptoms. Tension in the shoulders, recurring headaches, and low back pain that worsens with emotional stress are common presentations. These patients may feel frustrated, dismissed, or confused when told there's "nothing wrong" structurally — which is why education and empathy are so critical in our approach.
Chiropractic Care
The role of the chiropractor is evolving. We're no longer seen purely as manual therapists but as educators, movement guides, and advocates for a holistic approach to care. We assess and support the patient’s physical, emotional, and social wellbeing, not just their joints and muscles.
Here’s how we approach this:
Thorough history and context – we ask about life stressors, mood, sleep, and lifestyle, not just pain location.
Reframing beliefs – many patients equate pain with damage. We explain how pain is a nervous system response, not always a sign of injury.
Movement – gentle, progressive movement and rehab are powerful tools that help restore confidence and reduce fear-avoidance.
Manual therapy– hands-on care helps patients feel safe, supported, and may help calm the nervous system when paired with positive reassurance.
Empowerment through education – we explain pain science in patient-friendly terms, using metaphors and analogies to reframe fear-based narratives.
Referral when appropriate - when emotional health is significantly impacting recovery, we collaborate with mental health professionals or recommend psychological support.
Helping patients understand that their pain is real, even when not caused by visible damage, validates their experience and opens the door to change. Understanding the emotional contributors to MSK pain allows us to offer more effective, compassionate, and long-lasting care.