Why Do I Ask Chronic Pain Clients About Their Life Story?
Chronic pain affects around 20–30% of the global population, and it’s now the leading cause of disability worldwide. Yet one of the biggest mysteries in medicine is this:
Pain often continues long after the original injury has healed.
So, what keeps it going?
Over the last two decades, research has increasingly shown that chronic pain is often influenced not only by the body, but also by the nervous system and how it has learned to respond to stress over time.
That’s why, when someone comes to see me for persistent pain, I sometimes ask questions that might seem a little unexpected.
Questions like:
“What was happening in your life when the pain began?”
At first this can feel surprising. Most people expect a physiotherapy appointment to focus on joints, muscles and posture—not life events.
But modern pain science tells us something important:
The nervous system does not separate physical stress from emotional stress.
Both shape how the brain processes pain.
Because of this, I sometimes explore what was happening in someone’s life around the time their pain began, or whether there were periods of significant stress or challenge.
We often spend the first appointment understanding the physical symptoms, medical history and how the pain behaves. But pain rarely develops in isolation.
So, after our first session, I usually send clients a short questionnaire by email.
This isn’t ‘homework’ in the traditional sense. Instead, the questionnaire helps me understand your life story and the major events that may have shaped your nervous system over time.
The questionnaire gives me a broader picture of things like:
· significant life stressors
· difficult or overwhelming events
· major losses or transitions
· periods where life felt unsafe or uncertain
Many people initially think, “Nothing much happened in my life.”
But when they pause and reflect, they often realise there were periods of stress or responsibility that their nervous system quietly carried for years.
You could think of the questionnaire as giving me the map before we start the journey.
Without that map, we’re sometimes trying to understand a pain problem with only a small piece of the puzzle.
“But I Had a Good Childhood”
One of the most common responses I hear is:
“But I had a good childhood.”
“My parents loved us.”
“We just got on with things.”
And that may absolutely be true.
Exploring life history is not about blaming parents or searching for dramatic events. In fact, many people with chronic pain had very caring families and stable homes.
Sometimes the patterns that keep pain going are very subtle.
In fact, many people with chronic pain are exactly the people who have spent a lifetime being capable, resilient and getting on with things.
Unfortunately, the nervous system sometimes keeps the score.
But there is another factor that is easy to overlook:
A person only knows their own childhood.
Whatever environment we grow up in becomes our “normal”, and we naturally tend to look back through rose-coloured glasses.
Often it isn’t the big dramatic events that shape the nervous system. It can be the smaller, quieter experiences that accumulate over time:
feeling unheard or misunderstood
learning to seek approval or avoid conflict
taking on responsibility too early
feeling pressure to be “the good one”
experiencing repeated disappointment or uncertainty
witnessing conflict
None of these experiences mean someone had a bad childhood. But they can quietly shape the beliefs a child develops about themselves and the world.
Beliefs such as:
I need to keep everyone happy.
My needs are less important.
I must stay in control.
It’s not safe to express certain emotions.
These patterns usually develop completely unconsciously, yet they can influence every relationship, every emotional response to challenge, and how the nervous system reacts to stress throughout adult life.
A surprising moment in the clinic
Occasionally the connection becomes clear very quickly.
I recently had a client with persistent neck and shoulder pain. When I asked what was happening in his life when the pain started, (then with a gentle reframing by me), he paused—and suddenly realised something significant about a stressful dynamic in his family life.
That moment of insight changed everything.
His nervous system settled and the pain resolved surprisingly quickly. It was remarkable.
Now, I wish I could say it always happens that fast.
(It doesn’t. Sadly, there is no “one-question miracle cure”.)
But understanding the emotional drivers behind pain can often be the turning point in recovery.
An Often Unspoken Part of Recovery
There is one more aspect of chronic pain that is rarely talked about—but can be very important.
Sometimes I gently ask clients another slightly unusual question:
“What might be different if your pain was no longer there?”
At first, this can seem like a strange question. Most people understandably just want the pain gone.
But when we explore it a little more, some people notice that being unwell can (completely unintentionally) bring certain things into their lives, such as:
care or attention from others
permission to rest or step back
relief from overwhelming responsibilities
a sense of being supported or looked after
This is not conscious, and it is never a choice.
It is simply the nervous system doing what it has always done—trying to meet unmet needs in the safest way it knows how.
For some people, especially those who have spent years being strong, independent, or putting others first, this can be the first time their needs are acknowledged.
So, part of the work is gently bringing awareness to this, without judgement.
Not to take anything away—but to help find healthier, more sustainable ways to have those needs met.
Because true recovery isn’t just about reducing pain.
It’s also about making sure that when the pain no longer needs to be there, nothing important is lost with it.
When the Nervous System Stays on Alert
If the nervous system spends years adapting to stress, responsibility or emotional pressure, the body can remain in a kind of background protective mode.
Over time this may lead to:
persistent muscle tension
heightened sensitivity to pain
inflammation and immune activation
a nervous system that overreacts to normal sensations
Pain researchers now refer to this type of pain as nociplastic pain — pain driven by changes in how the brain processes signals rather than by ongoing tissue damage.
A simple way to think about it is like a car alarm that goes off when a leaf falls on the bonnet.
The alarm isn’t broken.
It has simply become too sensitive.
The Encouraging News
The most hopeful part of modern pain science is this:
The brain and nervous system are highly changeable (rewiring can occur).
New therapeutic approaches can help the brain update old emotional learning and calm an overprotective nervous system. As the nervous system settles, pain often reduces as well.
This is why understanding the story behind the pain can sometimes be just as important as understanding the pain itself.
Curious to Learn More?
This article is a very simplified overview of the connection between chronic pain and life experiences.
If you would like to read a deeper explanation of the science and therapeutic approaches involved, you can find my full article here:
A Trauma Perspective on Chronic Pain, Written for Pain Australia in 2024
And if you’re currently living with chronic pain, please know this:
Your pain is real, your nervous system is trying to protect you, and in many cases change is possible.
Sometimes the key lies not only in the body—but in the stories the nervous system has been holding for years.
And occasionally, those stories just need the right moment to be understood.
(No rose-coloured glasses required.)
Carole is available Monday’s (and occasionally Wednesday afternoon) at Live Well.
