Chronic Pain Getting Worse? Here's Why

Published March 3, 2026 · 7 min read

By Tauri Urbanik, Pain Science Researcher

It wasn't this bad before

You remember when the pain was manageable. Annoying, sure. But you could get through the day. You could still do most things.

Now it's different. The pain is louder. Sharper. More constant. It's taken over more of your day, more of your thoughts, more of your life. Maybe it's spread to new areas. Maybe things that never used to hurt now do.

And the scariest part? Nobody can tell you why it's getting worse. No new injury. No clear explanation. Just more pain.

First: rule out the important stuff

Before anything else. If your chronic pain is getting worse, see your doctor to make sure nothing new is going on. This is especially important if you have new neurological symptoms like weakness, numbness, or changes in bladder or bowel function. Those need medical attention.

But if your doctor has checked and there's no new injury, no progressive disease, no red flags? Then what you're experiencing has a name. And it's far more common than you think.

Central sensitization: the volume knob theory

Your nervous system has something like a volume knob for pain. In a healthy system, this knob adjusts normally. Injury turns it up. Healing turns it back down.

But in chronic pain, the knob gets stuck on high. And over time, it can creep even higher. This is called central sensitization (Woolf, PAIN, 2011↗).

Your brain becomes increasingly reactive to normal signals from your body. Touch that should feel neutral starts to feel painful. Movements that used to be fine now trigger flares. The pain spreads to areas that were never injured.

None of this requires new damage. Your tissue can be perfectly healthy while your nervous system screams louder and louder.

The fear-pain cycle makes it worse

Here's the part that's hardest to hear. Fear about your pain is probably making it worse.

Not because the pain is imaginary. It's not. Your pain is completely real. But fear and worry send danger signals to your brain. And a brain that already has its volume knob cranked up interprets those danger signals as more reason to produce pain.

It works like this. Pain gets worse. You worry. The worry tells your brain something is wrong. Your brain responds by amplifying pain. More pain means more worry. More worry means more amplification.

Research shows that brain connectivity, not injury severity, predicts who develops worsening chronic pain (Apkarian et al., Journal of Neuroscience, 2004↗). The brain is driving the escalation.

Recognizing the pattern

Does your pain get worse during stressful periods? Has it spread to new areas over time? Do you find yourself checking and monitoring your pain throughout the day?

How to reverse the trend

Here's the good news. Central sensitization isn't permanent. The volume knob can be turned back down. But it requires a completely different approach than what you've probably been doing.

Instead of treating the body (more PT, more injections, more scans), you treat the brain. You teach your nervous system that the danger signals are false alarms. You break the fear-pain cycle. And the pain starts to quiet.

In a clinical trial published in JAMA Psychiatry, Pain Reprocessing Therapy did exactly this. 66% of chronic back pain patients became pain-free or nearly pain-free after 4 weeks (Ashar et al., JAMA Psychiatry, 2022↗). The treatment worked by changing how the brain processed pain signals. Not by fixing anything in the body.

And even understanding this science helps. Research shows that simply learning how pain works reduces pain, fear, and disability (Louw et al., Physiotherapy, 2016↗). You're doing part of that right now.

K

Kevin, 45

back and neck pain for 8 years

Kevin's pain started in his lower back. Over the years, it spread to his neck, then his shoulders. Each year was worse than the last. He was terrified something was degenerating. But three MRIs showed nothing new. His doctor couldn't explain the progression. When Kevin learned about central sensitization, the pattern made perfect sense. His pain always spiked when he was anxious. It spread when work got stressful. His fear of the pain was literally feeding it. Brain retraining helped him break the cycle. Within two months, his pain was back to manageable levels. Within four months, most days were pain-free.

Composite story based on common patient patterns. Not a specific individual.

The worsening is the evidence

Your pain getting worse without explanation isn't a mystery. It's the evidence. It's your nervous system's volume knob, stuck and climbing. And that volume knob lives in your brain, not in your body.

Which means it can be turned back down.

Frequently asked questions

Why does my chronic pain keep getting worse?

When chronic pain worsens without a new injury, it's often due to central sensitization. Your nervous system becomes increasingly sensitive over time, amplifying normal signals into pain. Fear and worry about the pain can accelerate this process, creating a cycle of worsening symptoms.

Can chronic pain get worse even without a new injury?

Yes. This is one of the hallmarks of neuroplastic pain. The brain's pain pathways become more sensitized over time, producing stronger signals without any new tissue damage. Research shows the brain itself can amplify pain independently of what's happening in the body.

Does worsening pain mean something is getting more damaged?

Not necessarily. Worsening pain without a new injury often points to central sensitization rather than progressive damage. A doctor should rule out serious conditions. But in many cases, the pain increase comes from your nervous system becoming more reactive, not from worsening tissue damage.

How do I stop chronic pain from getting worse?

Understanding that your pain may be neuroplastic (brain-generated) is the first step. Research shows that pain education alone can reduce pain and fear. Brain-based treatments like Pain Reprocessing Therapy have achieved 66% pain-free rates by retraining these sensitized pathways.

References

1. Ashar YK, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial.DOI: 10.1001/jamapsychiatry.2021.2669
2. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain.DOI: 10.1016/j.pain.2010.09.030
3. Apkarian AV, et al. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density.DOI: 10.1523/JNEUROSCI.3623-04.2004
4. Louw A, et al. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature.DOI: 10.1016/j.physio.2015.10.007