5 reasons your chronic pain is sticking around (despite treatement)
Chronic pain is stubborn for good reason. Here are five common (but often overlooked) reasons it might be persisting, along with how the research supports them.
Lifestyle
A comprehensive review found that lifestyle factors such as physical inactivity, sedentary behaviours, stress, poor sleep, unhealthy diet, and smoking can perpetuate and worsen chronic pain (Nijs et al. 2021). There is some evidence that links low vitamin D levels and chronic pain - in fact, colder climates and lack of sunshine also contribute to higher pain sensitivity.
Smoking affects blood flow and nutrition to the spinal discs, accelerates degeneration, and increases inflammation — all of which worsen pain. A number of painful conditions have been linked to smoking (such as Rheumatoid Arthritis, cluster headache, fibromyalgia, menstrual pain etc..) and smokers are more likely to report multiple pain sites and higher pain intensity. Quitting smoking was associated with reductions in pain and reduced opioid use.
Inactivity and poor diet contribute to obesity, muscle weakness, and systemic inflammation, which all feed chronic pain. Exercise and nutrition can help: regular movement (even low-impact options like yoga, tai chi, or aquatic exercise) and balanced nutrition improve function, mood, and pain tolerance.
Both current and former smokers have a higher prevalence and incidence of low back pain than never smokers (Shiri et al. 2010)
Action Steps:
Quit or reduce smoking — even cutting down can help pain sensitivity.
Move a little more every day: take stairs, walk short distances, stretch at your desk.
Increase how much time you spend outside - a 30 min walk can improve your mood AND help your spine get stronger.
2. Poor sleep
Pain and sleep have a vicious, two-way relationship: pain disrupts sleep, and sleep deprivation makes pain worse.
Studies show that lack of quality sleep amplifies pain sensitivity by disturbing key systems that control inflammation and your body’s natural painkillers (like endorphins and dopamine).
Treating sleep issues is often a crucial — and overlooked — part of pain recovery.
Poor sleep predicts higher pain intensity the next day
Action steps:
Prioritise restful sleep and recovery. Start with basic sleep hygiene:
Keep a consistent sleep/wake time (including weekends).
Avoid screens 30–60 minutes before bed.
Limit daytime naps, especially long ones, as they can affect your ability to get a restful nights’ sleep.
3. Weakness, not just tightness
Many people with chronic pain actually lack strength, not just flexibility.
Weak muscles can make your body over-rely on joints and tendons, leading to strain and pain. Building strength supports posture, reduces stress on painful areas, and enhances resilience against flare-ups.
Physical activity has multiple benefits, including reducing sarcopenia (muscle wasting), improving posture and muscle activation, enhancing self-efficacy and moods, reducing pain catastrophizing, anxiety, and depression (Wong et al. 2022).
Action steps:
Start with body-weight moves: squats, wall push-ups, bridges, or resistance bands.
Do 2–3 short sessions per week (even 10 minutes helps).
Combine with mobility work — you need both strength and flexibility.
4. Stress and Mental Health
Your mind and body are deeply connected especially when it comes to pain.
Depression, anxiety, and fear of movement can heighten pain sensitivity and slow recovery. Anxiety and fear about pain are linked to a higher likelihood of developing chronic pain and a poorer prognosis of recovery from chronic pain. Negative beliefs (“rest is best,” “pain means damage”) are linked to higher disability and worse outcomes.
Conversely, active coping strategies like gentle exercise, pacing, and mindfulness can dramatically improve quality of life.
Action Steps:
Try activity pacing, to reduce negative beliefs and associations around movement.
Write down 3 things that went well each evening (reduces rumination).
Add “micro-breaks” during the day — a short walk, deep breathing, or stretching break.
5. Not moving enough
Movement really *is* medicine.
Fear of pain often leads to avoidance — but staying still can actually worsen pain over time. Movement improves circulation, reduces inflammation, and retrains your nervous system to feel safe again.
Even small, regular movements throughout the day (“your best posture is your next posture”) help desensitize the body and reduce chronic pain.
Action Steps:
Take short “movement breaks” every hour (even 2–3 minutes helps).
Change positions often — “your best posture is your next posture.”
Use music or an audiobook to make movement enjoyable.
Final thoughts
Chronic pain is rarely caused by one single issue. It’s the sum total of habits, beliefs, and biological changes that reinforce each other. The good news? Every small step helps turn the volume down on pain.
Struggling with ongoing pain? You don’t have to push through it alone. Book a consultation to uncover what’s keeping your pain stuck — and start moving forward again.
References:
NHS England. How to fall asleep faster and sleep better – Every Mind Matters. NHS UK. Available at: https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/how-to-fall-asleep-faster-and-sleep-better/ (Accessed: 24 October 2025).
Nijs J, D'Hondt E, Clarys P, Deliens T, Polli A, Malfliet A, Coppieters I, Willaert W, Tumkaya Yilmaz S, Elma Ö, Ickmans K. Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth? PM R. 2020 Apr;12(4):410-419. doi: 10.1002/pmrj.12244. Epub 2019 Oct 21. PMID: 31437355.
Wong CK, Mak RY, Kwok TS, Tsang JS, Leung MY, Funabashi M, Macedo LG, Dennett L, Wong AY. Prevalence, Incidence, and Factors Associated With Non-Specific Chronic Low Back Pain in Community-Dwelling Older Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis. J Pain. 2022 Apr;23(4):509-534. doi: 10.1016/j.jpain.2021.07.012. Epub 2021 Aug 24. PMID: 34450274.
John U, Hanke M, Meyer C, Völzke H, Baumeister SE, Alte D. Tobacco smoking in relation to pain in a national general population survey. Prev Med. 2006 Dec;43(6):477-81. doi: 10.1016/j.ypmed.2006.07.005. Epub 2006 Sep 1. PMID: 16949655.
Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between smoking and low back pain: a meta-analysis. Am J Med. 2010 Jan;123(1):87.e7-35. doi: 10.1016/j.amjmed.2009.05.028. PMID: 20102998.
Ditre JW, Brandon TH, Zale EL, Meagher MM. Pain, nicotine, and smoking: research findings and mechanistic considerations. Psychol Bull. 2011 Nov;137(6):1065-93. doi: 10.1037/a0025544. PMID: 21967450; PMCID: PMC3202023.
Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019 Aug;123(2):e273-e283. doi: 10.1016/j.bja.2019.03.023. Epub 2019 May 10. PMID: 31079836; PMCID: PMC6676152.
Haack M, Simpson N, Sethna N, Kaur S, Mullington J. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology. 2020 Jan;45(1):205-216. doi: 10.1038/s41386-019-0439-z. Epub 2019 Jun 17. PMID: 31207606; PMCID: PMC6879497.
