Medscape Medical NewsFeatures
Manuela Callari
May 07, 2025 
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Chronic pain affects 150 million people across Europe, according to the European Pain Federation. That is approximately the population of France and Germany combined. This burden drives countless patients to seek help first from general practitioners, incurring substantial costs to patients and healthcare systems, potentially reaching €12 billion annually. That includes direct medical expenses, out-of-pocket costs, and productivity losses due to absenteeism and reduced work capacity. Bigger still is the physical and mental cost patients endure. People with chronic pain experience a lower quality of life, an increased risk for mental health problems like depression and anxiety, and often face social isolation and a reduced ability to participate in daily activities.

While managing the physical symptoms of pain is essential, a critical, often overlooked, factor contributes to its persistence: The intricate and powerful link between stress and the experience of pain. Despite evolving scientific understanding and clinical guidelines advocating for a biopsychosocial approach to pain, this crucial connection may not be consistently addressed during early consultations with non-specialist healthcare professionals.
Pain specialists see the consequences firsthand.
“In my experience, this is incredibly common,” Ashley Simpson, MBChB, consultant orthopedic surgeon specializing in peripheral nerve injuries at the Royal National Orthopaedic Hospital, London, England, told Medscape Medical News. “A significant portion of the chronic pain patients I see had clear psychosocial stressors, such as high anxiety and unresolved emotional distress, early on that went unaddressed.”

Ashley Simpson, MBChB Research supports this observation, with one review finding that psychological factors were associated with pain becoming chronic in 83% of studies. This missed opportunity represents a critical junction where early intervention could potentially prevent acute pain from embedding into a chronic condition.

The Stress-Pain Connection: An Amplified Alarm System The scientific understanding of pain has moved beyond viewing it solely as a direct signal of tissue damage. Instead, researchers now understand the nervous system, particularly the brain and spinal cord, as a dynamic alarm system whose sensitivity can be modulated by various factors, including stress. In chronic pain, this system often becomes hypersensitive, reacting strongly even to minor stimuli.
Sandrine Géranton, PhD, principal research fellow at University College London, London, England, told Medscape Medical News that chronic stress, whether psychological (anxiety or trauma), physiological (poor sleep or inflammation), or environmental, can significantly amplify this sensitivity.

“There are shared neural substrates between pain and stress,” David Finn, PhD, professor of pharmacology and therapeutics at the University of Galway, Galway, Ireland, said. “Some of the same brain regions and circuitry within the central nervous system mediate both stress and pain, and so maladaptive alterations in that circuitry due to stress can give rise to sensitization within the somatosensory system, which ultimately can lead to chronic pain,” he told Medscape Medical News.
David Finn, PhD The opposite is also true. Persistent pain itself acts as a potent stressor, disrupting sleep, mood, work, and relationships, feeding this cycle of sensitization.
What Primary Care Doctors Should Know Despite the compelling evidence, the integration of this biopsychosocial understanding into initial patient encounters remains often overlooked. Frontline healthcare professionals face significant time constraints, often prioritizing immediate symptom management or investigation of obvious structural issues.

Patients with chronic pain frequently present having received purely biomedical assessments and treatments, such as repeated scans or a focus solely on strengthening exercises, without ever having the stress or psychological component discussed. This is not necessarily a failing of the individual clinician but a reflection of systemic pressures, historical training biases toward biomedical models, and patient expectations often centered on a physical “fix.”
The consequence, as highlighted by both the clinical and scientific experts, is a missed opportunity. Patients may leave consultations without understanding why their pain persists despite a lack of clear physical findings, potentially feeling dismissed or believing their pain is purely physical when stress is a major contributor. This lack of early psychoeducation and acknowledgement of the stress-pain link can hinder their ability to adopt effective self-management strategies and make the pain much harder to treat later.
Simpson shared some key concepts healthcare professionals should help their patients understand early.

• Pain does not equal harm. While pain is real, its intensity is not always proportional to tissue damage. The brain and nervous system interpret signals, and this interpretation is heavily influenced by state of mind, stress, and prior experiences.
• The nervous system can learn pain. Persistent pain can lead to lasting changes (“sensitization” or “priming”) in the nervous system, making it more reactive. The longer pain persists, the better the brain becomes at producing it.
• Stress is a major amplifier and contributor. Chronic stress, anxiety, depression, poor sleep, and fear significantly affect pain processing and can contribute to chronification.
• Movement is generally safe and therapeutic. Reassure patients that moving within limits, even if it causes temporary discomfort, is vital for recovery and helps calm a sensitized nervous system. Pain flares don’t necessarily mean damage.

Practical Strategies for Busy Clinicians (Within ~10 Minutes)
Integrating a stress-informed approach is feasible even in short consultations:

• Listen and ask (minutes 1-3): Weave in brief, open-ended questions: “How has stress been affecting you lately?” “How has your sleep been?” “Have there been any major life changes recently?” Listen for cues about mood, anxiety, or fear related to their pain. Simpson noted that “catastrophizing or fear of movement during an acute injury are much more likely to develop into persistent pain,” suggesting that observing or asking about these responses is important.
• Simple explanation (minutes 4-6): Briefly explain the stress-pain link using the “alarm system” analogy. Reassure the patient that this is a real biologic process involving the nervous system, not an indication that their pain is “all in their head.” Explain that understanding this offers them tools to influence their pain.
• Actionable first steps (minutes 7-9): Provide one to two concrete, simple, and accessible suggestions:
  • Brief relaxation: Suggest simple, controlled breathing techniques.
  • Sleep hygiene: Offer one key tip, like maintaining a consistent sleep schedule.
  • Gentle movement: Encourage starting small with movement, for example, a short walk and pacing activity, focusing on consistency rather than pushing through severe pain. Reframe movement as “calming the nervous system” and regaining function.
  • Signpost resources: Mention reliable patient-facing websites or apps for pain education and stress management if known.
• Validate and refer (minute 10): Acknowledge the patient’s pain and struggles are real. Explain when a referral might be necessary and mention relevant services like pain psychology or pain-informed physiotherapy.

These steps, though seemingly basic, are “profoundly important,” Simpson said. “They help the patient not only physically but psychologically by preventing fear and despair from taking hold.”
“It is important to listen carefully to a patient who is saying that they feel stressed or anxious and to take that seriously,” Finn said. “Be aware of the possibility that if that’s not addressed early, it can exacerbate pain-related conditions or contribute to the development of chronic pain.”

Géranton reinforced the importance of the integrated approach. “You really need to look at it as one package and never separate the sensory aspect from the emotional aspect of the pain experience.”
Simpson, Géranton, and Finn reported having no relevant financial relationships.
Manuela Callari is a freelance science journalist specializing in human and planetary health. Her work has been published in The Medical Republic, Rare Disease Advisor, The Guardian, MIT Technology Review, and others.

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#PainReprocessing #HealthcareInnovation #IntegrativeHealth
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When we think about aging, most people focus on lifespan—the total number of years we live. But what may matter even more is healthspan—the number of years we live in good health, free from serious illness, cognitive decline, or physical disability. The goal of healthy aging isn’t just to live longer, but to live better for longer.
What Is the Difference Between Lifespan and Healthspan?

• Lifespan refers to how long you live.
• Healthspan refers to how long you stay healthy—physically, mentally, and emotionally.

While modern medicine has extended lifespan, many people still spend their later years managing chronic conditions, mobility issues, or cognitive impairment. This has prompted a growing interest in strategies that extend healthspan—often through lifestyle changes and supportive care.
The Role of Lifestyle in Healthy Aging
​Emerging research shows that lifestyle factors have a powerful impact on how we age. The following habits are especially important:

• Nutrition: A whole-food, plant-forward diet rich in fiber, healthy fats, and antioxidants supports brain and body health.
• Movement: Regular physical activity (especially strength training and walking) helps maintain mobility, cardiovascular health, and cognitive function.
• Sleep: Consistent, high-quality sleep supports immune health, memory consolidation, and emotional regulation.
• Social Connection: Meaningful relationships and community reduce inflammation, protect against cognitive decline, and promote longevity.
• Stress Management: Chronic stress accelerates aging. Practices like mindfulness, breathwork, and guided relaxation can reduce wear and tear on the body.

How Therapy Can Support Healthy Aging
While we often think of aging in physical terms, emotional and psychological wellbeing play an equally vital role in healthspan. Psychotherapy can support healthy aging in several ways:

• Processing Life Transitions: Retirement, health changes, caregiving, and grief can all impact identity and emotional health. Therapy offers a space to process these shifts.
• Behavior Change Support: Therapists can help you work through resistance, self-sabotage, or trauma-related barriers that block healthy lifestyle changes.
• Mental Flexibility: Cognitive and emotional flexibility is linked with better aging outcomes. Therapy supports this by helping clients explore new perspectives and build resilience.
• Meaning and Purpose: A sense of purpose is a strong predictor of healthspan. Therapy can help clients reconnect with meaning in their lives, even during times of transition or loss.

Learn More

• Podcast: The Drive with Dr. Peter Attia – A science-driven exploration of longevity and healthspan, featuring expert interviews on nutrition, exercise, sleep, and mental health.
• Book: Outlive: The Science and Art of Longevity by Dr. Peter Attia – A comprehensive guide to living longer and better, including a deep dive into the emotional and psychological components of aging.
• Research: Vaillant, G. E. (2002). Aging Well: Surprising Guideposts to a Happier Life from the Landmark Harvard Study of Adult Development – Long-term findings on what predicts successful aging (spoiler: emotional warmth and coping skills matter more than cholesterol).

Healthy aging isn't just about adding years to your life—it’s about adding life to your years. Through intentional lifestyle changes and supportive therapy, you can build a longer, healthier, and more fulfilling life. Whether you're in midlife or already navigating older adulthood, it's never too late to invest in your healthspan.
If you’re interested in working through emotional or behavioral roadblocks to healthy aging, reach out to Debra for support.

#HealthspanNotJustLifespan #HealthyAging #AgingWell #TherapyForAging #EmotionalHealth #LongevityMindset #ResilientAging #LifestyleMedicine #MentalHealthMatters #MindBodyWellness #LiveBetterLonger #PurposefulAging #DebraSupportsHealing

When you’re not feeling well—whether physically or emotionally—it can be hard to imagine that something as simple as feeling good on purpose could help. But research shows that intentionally increasing positive emotions, called positive affect induction, can reduce both physical and mental health symptoms.
What is Positive Affect Induction?
Positive affect induction means doing things that help you feel good, on purpose and with intention. It’s not about ignoring your problems or forcing happiness. Instead, it’s about practicing small moments of joy, gratitude, or calm that can gently shift your mood and help your body heal.
How Can Positive Emotions Help Your Health?

• Physical Symptoms Improve:
  Positive emotions can lower stress hormones, reduce pain, and even help with chronic conditions like headaches, digestive issues, and fatigue.
• Mental Health Benefits:
  Feeling positive—even briefly—can improve mood, reduce anxiety, and build resilience over time.
• The Body-Mind Connection:
  Studies show that when we experience positive feelings, our heart rate slows, our muscles relax, and our immune system can function better.

Simple Ways to Increase Positive Emotions

• Gratitude Practice: Write down 1-3 things you’re grateful for each day.
• Mindful Moments: Take time to savor something pleasant—a cup of tea, the sun on your skin, or music you enjoy.
• Acts of Kindness: Doing something nice for someone else can quickly boost positive feelings.
• Imagery Exercises: Visualizing happy or peaceful memories can help bring positive emotions into the present.

Learn More

• Book: Hardwiring Happiness by Dr. Rick Hanson
  This book explains how to help your brain “hold onto” good experiences to build resilience and long-term emotional strength.
• Research: A 2017 study by Nelson-Coffey et al. found that practicing gratitude and kindness helped people experience more positive emotions and improved both mental and physical well-being.

Final Thoughts
You don’t have to wait until life is perfect to start feeling better. Small, intentional moments of joy, gratitude, and kindness can slowly shift your mood and improve your health. Over time, these positive feelings can become a valuable part of your healing process.
If you’d like support in building these practices into your life, contact Debra.
​
​#PositiveAffect #EmotionalWellness #MindBodyHealing #IntentionalJoy #GratitudePractice #MentalHealthSupport #PositivePsychology #ChronicPainRelief #StressReduction #HealingThroughJoy #ResilienceBuilding #FeelGoodOnPurpose #SelfCompassion #MindfulLiving #NeuroplasticityHealing

When we think about mental health, we often focus on emotions, thoughts, and brain chemistry. But there’s another important piece of the puzzle: mitochondria. These tiny parts inside our cells are responsible for making energy. When mitochondria don’t work well, it can affect how we feel, think, and function.
Why Mitochondria Matter for Mental Health

• Low Energy in the Brain:
  When mitochondria don’t produce enough energy, the brain can feel foggy, tired, or slow. This can show up as low mood, trouble concentrating, or feeling emotionally flat.
• Stress and Inflammation:
  Damaged mitochondria can increase inflammation in the brain and body. This is now linked to depression, anxiety, and even brain fog.
• Links to Mental Health Conditions:
  Research shows that mitochondrial problems may play a role in depression, anxiety, bipolar disorder, autism, and ADHD. Supporting mitochondrial health may help improve these conditions.

How Can You Support Your Mitochondria?

• Healthy Eating:
  A balanced diet with healthy fats, proteins, and low processed sugar can fuel your mitochondria.
• Movement:
  Regular exercise helps your body make new, stronger mitochondria.
• Quality Sleep:
  Rest gives your mitochondria time to repair and recharge.
• Supplements (if recommended by your provider):
  Some people benefit from nutrients like CoQ10 or N-acetyl cysteine, which help mitochondria function better.

Learn More

• Book: Brain Energy by Dr. Chris Palmer
  A powerful look at how improving mitochondrial health can help with depression and other mental health challenges.
• Research: Liu et al. (2023) found that some genetic changes in mitochondria may increase the risk of depression and anxiety through inflammation.
• Podcast: Dhru Purohit’s show (Episode 269) with Dr. Chris Palmer
  They discuss how brain inflammation and mitochondrial health affect mood and focus.​

Final Thoughts
If you’ve been struggling with mood, brain fog, or low energy, supporting your mitochondrial health might help. Talk with your healthcare provider about personalized steps that could work for you.

How to blend mindfulness with safety re-appraisal:  Pain Reprocessing Therapy in everyday language
Chronic primary pain (back pain, tension headaches, fibromyalgia, IBS and more) often lingers because the brain keeps mis-labelling normal body messages as threats—like mistaking a garden hose for a rattlesnake. Somatic tracking shows your nervous system—moment by moment—that the signal is uncomfortable but not dangerous. In a landmark clinical trial, two-thirds of participants were pain-free or nearly pain-free four weeks after a Pain Reprocessing Therapy (PRT) program that centered on this skill. (JAMA Network)

The 3-Step “Safety” Version
Time needed: 2–3 minutes, 3–5 times a day. Short & frequent exercises beat long & infrequent.
1  Get curious: Find a comfy position, breathe slowly, and zoom in on the sensation. Label its size, shape, texture, edges. For example: “Golf-ball spot, warm pulse, right of my spine.”
2  Re-appraise for safety: Remind yourself—out loud or silently—why the signal is safe. Ground your words in evidence you trust (clear scan, doctor’s check-up, everyday activities you can still do). For example: “My MRI was clean. Muscles & nerves are healthy. This is just my brain’s false alarm.”
3  Keep it light: Watch what the feeling does—shift, swell, drift—without trying to fix it. Sprinkle in humor, calming imagery or a smile to keep the mood relaxed. For example: “Look at that… it’s floating upward like a soap bubble.”
Notice variability. If the sensation moves or changes intensity, that’s live proof it isn’t stuck tissue damage—celebrate it!

Pro-Tips for Sticking Power

• Evidence first. Review any normal imaging or exams so your safety words feel true.
• Tone > words. A calm, matter-of-fact voice reassures the brain more than pep-talk volume. Let go of criticism and judgment toward self, body, pain sensations.
• Drop the goal. The point is to observe, not to “make pain leave.” Relief often follows once the alarm de-escalates.
• Use micro-sessions. Waiting in line, sitting in traffic, commercial breaks—perfect two-minute practice slots.

Hear & Practice🎧 Podcast guide – Tell Me About Your Pain episode “What Is Somatic Tracking—and How Can It Help My Pain?” offers a free, 15-minute audio you can replay anytime. (Spotify)

Want to Dive Deeper? 
Journal article Ashar YK et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain. JAMA Psychiatry, 2022. (JAMA Network)
Book Alan Gordon & Alon Ziv. The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain. Penguin Random House, 2021. (PenguinRandomhouse.com)
PodcastTell Me About Your Pain (Curable Health). Start with the episode linked above. (Spotify)

Key Takeaway: Every time you pair curious attention with a clear safety message (and a dash of light-heartedness), you teach your brain, “This hurts, but it isn’t harmful.” Do that often enough and the over-protective alarm quiets down—opening the door to real, lasting relief.

Reach out to Debra for one on one healing from chronic pain with Pain Reprocessing Therapy. 

#PainReprocessingTherapy #ChronicPainRelief #Mindfulness #SafetyReappraisal #SomaticTracking #PainScience #NervousSystemHealing #MindBodyConnection #PainManagement #PRT #ChronicPainSupport #Neuroplasticity  #DebraEngLCSW #TraumaInformedCare