Why Some People Develop Chronic Pain After Injury—And Others Don’t
Why Some People Develop Chronic Pain After Injury—And Others Don’t
The “Pain Alarm” That Won’t Turn Off
In my previous post, I discussed how approximately one in four individuals develops chronic pain following an injury. In these cases, the original tissue injury may have healed, yet the nervous system remains in a heightened state of sensitivity, continuing to produce pain signals long after the body has recovered.
This raises an important question: why does this happen to some people but not others?
The answer often extends beyond the physical injury itself. One of the most influential factors is the context in which the injury occurs, including the emotional, psychological, and environmental circumstances surrounding the event.
How the Environment of an Injury Can Shape Pain
When we experience an injury, our brain does not simply evaluate tissue damage. Instead, it interprets the entire situation. The brain assesses whether the event feels threatening, stressful, or overwhelming, and this evaluation can influence how strongly the nervous system responds.
Consider reflecting on a time when you were injured.
Was the injury associated with a traumatic experience, such as a car accident, a serious fall, or a moment when life already felt overwhelming?
Did the injury come with significant consequences, such as time away from work, financial strain, loss of independence, or disruption to daily routines?
Or was the injury relatively minor—something that occurred during a time when your life felt stable, predictable, and manageable?
These contextual factors matter. Research shows that the circumstances surrounding an injury can significantly influence how pain is processed by the nervous system, how long symptoms persist, and whether pain becomes chronic.
What Research on Crash Victims and Demolition Derby Drivers Revealed
One particularly interesting study compared two groups of individuals who experience frequent collisions and physical trauma.
Demolition Derby Drivers
Demolition derby drivers intentionally collide with other vehicles during competitions. In some events, drivers crash into each other as many as 50 times per hour at speeds reaching 24 miles per hour, accumulating an estimated 1,500 collisions over the course of their careers.
Despite repeated high-impact collisions and frequent whiplash-like forces, studies show that only about 2 percent of demolition derby drivers (approximately 1 in 40) go on to develop chronic pain.
Single-Car Accident Victims
Now compare this to individuals involved in a single-car accident, an event that is often unexpected, frightening, and outside of their control.
In these situations, research suggests that up to 50 percent of individuals develop persistent or chronic pain, even when the physical injuries sustained are less severe than those experienced by demolition derby drivers.
What This Teaches Us About Chronic Pain
At first glance, these findings may seem surprising. If pain were determined solely by tissue damage, we would expect demolition derby drivers—who experience thousands of collisions—to develop chronic pain at much higher rates.
Instead, this research highlights several important principles about pain:
Pain is influenced by more than just structural injury.
The brain’s interpretation of threat plays a major role in determining how pain is experienced.
Unexpected or traumatic injuries, particularly when combined with stress or uncertainty, are more likely to lead to persistent pain.
Context, perception, and emotional response can influence how sensitive the nervous system becomes following an injury.
This helps explain why two individuals with very similar physical injuries may have completely different pain experiences and recovery trajectories.
Understanding the Nervous System’s Role in Chronic Pain
When an injury occurs in a stressful or traumatic environment, the nervous system may become more protective. In some cases, the brain continues to interpret normal movement or physical activity as a potential threat, even after the body has healed.
Over time, this heightened sensitivity can lead to a persistent “pain alarm” that continues to signal danger even when no tissue damage is present. This phenomenon is often referred to as central sensitization, and it is a common contributor to chronic pain conditions.
Understanding that pain can be driven by nervous system sensitivity rather than ongoing injury can be an important step toward recovery.
Breaking the Cycle of Chronic Pain
Effective treatment for chronic pain often requires addressing not only the physical body but also the nervous system and the brain’s perception of threat.
At Summerland Physical Therapy, we take a neuroscience-informed approach to pain management. Our goal is to help patients better understand how pain works and to provide strategies that help calm an overprotective nervous system.
Treatment may include:
Education about how pain is processed by the brain and nervous system
Individualized movement and strengthening programs
Gradual exposure to movement to rebuild confidence in activity
Techniques that help regulate the nervous system and reduce pain sensitivity
By addressing both the physical and neurological components of pain, we help patients restore function, improve movement tolerance, and regain confidence in their bodies.
Chronic Pain Treatment in Summerland, Santa Barbara, and Montecito
Summerland Physical Therapy provides personalized, one-on-one care for individuals experiencing persistent pain, injury recovery challenges, and nervous system–driven pain conditions.
Our clinic is located in Summerland, and we proudly serve patients throughout Santa Barbara and Montecito. For individuals who prefer care in their own environment, we also offer mobile physical therapy services.
If you or someone you care about is struggling with ongoing pain, it is important to know that recovery is possible. Understanding how the nervous system contributes to pain can open the door to effective treatment and meaningful improvement.
