The Nervous System’s Role in Chronic Pain

Simplified insights into central sensitisation and neuroplasticity for manual therapists , Chronic Pain

As manual therapists, we’re used to treating clients with lingering pain that doesn’t quite match up with tissue damage or injury timelines. Understanding the nervous system’s role in chronic pain—particularly the concepts of central sensitisation and neuroplasticity—can transform the way we assess and support clients in persistent pain states.

A woman in a white shirt appears distressed against a soft gradient backdrop, highlighting the discussion on "The Nervous System’s Role in Chronic Pain."

What is central sensitisation?

Central sensitisation occurs when the central nervous system becomes hypersensitive, amplifying pain signals. It’s not about injury anymore—it’s about a nervous system that has become overprotective. Clients experiencing this often report widespread or exaggerated pain, often without any clear injury or identifiable pathology. This shift from peripheral to central mechanisms means pain becomes less about tissue damage and more about nervous system processing.

Neuroplasticity: The brain’s ability to adapt

Neuroplasticity is the nervous system’s remarkable ability to change its structure and function in response to repeated stimuli. While this adaptability is what allows us to learn and recover, it can also reinforce chronic pain. The longer pain is present, the more entrenched those neural pathways can become—leading to persistent, self-reinforcing pain cycles.

Why this matters in manual therapy

For manual therapy practitioners, these insights shift the focus from "fixing" tissues to supporting the nervous system. Touch-based therapies may help calm the system, create a sense of safety, and promote downregulation. It also reinforces the importance of language, pacing, and education in clinical settings—our words and presence can either reinforce threat or support recovery.

Helping clients understand their pain

One of the most powerful tools we have is education. Explaining the nervous system’s role in chronic pain in simple, non-threatening ways can help clients reframe their experience. This can reduce fear, increase engagement, and ultimately improve outcomes.

If you're a massage therapist, myotherapist or Bowen therapist wanting to learn more about chronic pain, nervous system function and evidence-informed practice, browse our range of flexible, online professional development courses.