The Nervous System’s Role in Chronic Pain (And Why Treating Muscles Alone Often Fails)
One of the most confusing parts of chronic pain is this:
you can stretch, strengthen, massage, ice, heat, and “do everything right”—and still hurt.
For many people, this leads to a frustrating conclusion: “My muscles must just be permanently damaged.”
In reality, the issue is often elsewhere.
When pain becomes chronic, the nervous system—not the muscles or joints alone—becomes the primary driver of symptoms. Understanding this shift is one of the most important steps toward meaningful, lasting relief.
Pain Is a Signal, Not a Structure
Pain does not live in muscles, discs, or joints.
Pain is a signal produced by the nervous system.
Here’s the basic pathway:
- Sensory nerves detect stimuli (pressure, stretch, temperature)
- Signals travel through the spinal cord
- The brain interprets those signals as safe, uncomfortable, or painful
In acute injuries, this system works well. The signal reflects real tissue damage and fades as healing occurs.
In chronic pain, something different happens.
The nervous system becomes overprotective, amplifying signals even when tissue damage is minimal or resolved.
When Muscles Aren’t the Real Problem
Muscle tension, knots, spasms, and weakness are very real—and very uncomfortable.
But in chronic pain, they are often secondary effects, not the root cause.
Common patterns include:
- Muscles tightening to “guard” against perceived threat
- Persistent tension despite stretching or massage
- Pain returning quickly after physical therapy sessions
- Symptoms spreading beyond the original injury site
This is why treating muscles alone often produces short-term relief followed by relapse. The underlying nervous system pattern hasn’t changed.
Central Sensitization: When the Volume Knob Gets Turned Up
A key concept in chronic pain science is central sensitization.
In simple terms:
- The brain and spinal cord become more responsive to pain signals
- Normal sensations may be interpreted as painful
- Minor inputs produce outsized responses
This is not psychological weakness or imagination. It is a measurable neurological process.
Researchers describe it as the nervous system’s “volume knob” being turned up too high—and stuck there.
The International Association for the Study of Pain recognizes central sensitization as a core mechanism in many chronic pain conditions, including back pain, neck pain, headaches, fibromyalgia, and neuropathic pain.
You can read a deeper clinical explanation in our article
Understanding Chronic Pain Syndrome and Its Causes.
Why Structural Fixes Alone Don’t Resolve Chronic Pain
When pain persists, the natural assumption is that something structural must still be wrong.
That leads to:
- Repeated imaging
- Focusing on disc bulges or “degeneration”
- Chasing alignment, posture, or symmetry fixes
But here’s the uncomfortable truth:
many people without pain have the same MRI findings as people in pain.
By the time pain is chronic, the nervous system may be reacting to:
- Prior injury memory
- Stress load
- Poor sleep
- Repeated flare-ups
- Emotional or physiological stressors
The structure becomes less important than how the nervous system is responding to it.
This is why purely mechanical approaches often plateau.
The Stress–Pain Feedback Loop
The nervous system does not separate physical pain from stress.
When the body stays in a heightened state:
- Stress hormones increase pain sensitivity
- Muscles stay guarded
- Sleep quality declines
- Pain recovery slows
Pain increases stress. Stress increases pain.
This loop becomes self-sustaining.
Many people notice:
- Pain flares during stressful periods
- Worse symptoms after poor sleep
- Fluctuating pain without clear mechanical triggers
These are classic signs that nervous system regulation is part of the equation.
What It Means to “Treat the Nervous System”
Treating the nervous system does not mean ignoring the body.
It means addressing:
- How pain signals are processed
- How the autonomic nervous system responds to threat
- How easily the system shifts between tension and relaxation
Effective chronic pain care often combines:
- Movement and strength (physical therapy)
- Behavioral strategies (sleep, pacing, stress management)
- Nervous system–focused interventions
This is where acupuncture often fits—not as a muscle treatment, but as a neuromodulatory therapy.
How Acupuncture Influences Pain Signaling
From a biomedical perspective, acupuncture has been shown to:
- Modulate pain-related brain activity
- Influence neurotransmitters involved in pain inhibition
- Improve blood flow and reduce local ischemia
- Regulate autonomic nervous system balance
Rather than forcing muscles to relax, acupuncture works upstream—at the level of the nervous system that controls muscle tone and pain sensitivity.
A large-scale review published in The Journal of Pain found acupuncture to be effective for multiple chronic pain conditions by influencing central pain pathways rather than acting only locally:
https://www.jpain.org/article/S1526-5900(17)30780-0/fulltext
At PA-OM, treatments are individualized and often incorporate electro-acupuncture, which provides consistent stimulation shown to be especially helpful in long-standing pain patterns. You can learn more about our approach on our
How It Works page.
Why This Explains “Good Days and Bad Days”
One of the most telling signs of nervous system–driven pain is variability.
If pain were purely structural, symptoms would be consistent.
Instead, people experience:
- Fluctuating pain intensity
- Different pain locations
- Good days followed by unexplained flare-ups
This variability reflects changes in nervous system sensitivity—not sudden structural damage.
Understanding this often brings relief in itself. It reframes pain from something mysterious or worsening to something modifiable.
What This Means for Recovery
When chronic pain is approached as a nervous system issue:
- Progress is measured over weeks, not days
- Setbacks are expected but meaningful
- Treatment plans emphasize regulation, not force
This is also why chronic pain recovery usually requires consistency rather than intensity. The goal is not to “override” pain, but to gradually retrain the system producing it.
If you’re wondering what this typically looks like in practice, our
FAQ page covers common questions about treatment frequency and expectations.
The Bottom Line
If you’ve been treating muscles, joints, or alignment—and pain keeps returning—the missing piece may not be effort or diagnosis.
It may be that the nervous system itself needs to be addressed.
Chronic pain is rarely just a mechanical problem. It’s a regulatory one.
Understanding that distinction opens the door to approaches designed for long-standing pain—not just short-term symptom relief.
To explore how this perspective applies to specific conditions, visit our
Complete List of Conditions.
Steve Hoffman, L.Ac., Dipl. OM
Princeton Acupuncture & Oriental Medicine