---
title: "Pain Volume Theory: Why Stress Can Turn Up the Volume on Chronic Pain"
description: Discover how stress, sleep, anxiety and emotional wellbeing can influence chronic pain, and learn practical ways to help turn down your pain volume.
image: https://www.centredcounselling.co.za/hubfs/Centred_Counselling_Pain_Volume_Theory_under_100kb.webp
---
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[Chronic Pain](https://www.centredcounselling.co.za/centred-counselling-blog/tag/chronic-pain)
# Pain Volume Theory: Why Stress Can Turn Up the Volume on Chronic Pain
Byron Werbeloff
Author
Oct 4, 2026, 5:44:27 AM
# Pain Volume Theory: Why Stress Can Turn Up the Volume on Chronic Pain
*From the Counsellor’s Chair*
## Stress Can Turn Up the Volume
Pain is not simply a measurement of physical damage. The International Association for the Study of Pain describes pain as a multifactorial experience involving biological, psychological and social factors.
Stress and emotional distress can therefore become part of the pain picture.
You can end up in a cycle:
**Pain increases → stress increases → you focus more on the pain → anxiety increases → the pain feels even more intense.**
This doesn't mean stress is necessarily causing the underlying condition. It means stress may be one factor influencing the intensity of the pain experience.
## Sleep Can Turn the Volume Up Too
Sleep is another important factor.
When you're sleeping badly, you may wake up exhausted, more irritable and less able to cope with discomfort.
So when someone tells me:
**“My pain was terrible today,”**
I don't only want to know what happened today.
I also want to ask:
**“How did you sleep last night?”**
Sleep, stress and pain can interact with one another, creating a cycle that can be difficult to break.
## Medication Can Sometimes Turn the Volume Down
This is where medication becomes an interesting part of the discussion.
Certain antidepressants are used not only for depression and anxiety, but also in the management of some forms of chronic pain.
NICE recommends that antidepressants such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine and sertraline can be considered for adults with chronic primary pain, following a discussion of their benefits and risks. NICE notes that these medications may improve pain, sleep, quality of life and psychological distress, even when the person does not have a diagnosis of depression.
The evidence base isn't uniform. For example, NICE's evidence review found that evidence for duloxetine came from seven studies and showed longer-term benefits particularly for quality of life, psychological distress and sleep, while evidence for SSRIs came from seven studies and showed clinically important benefits for pain and psychological distress.
So, using the pain-volume analogy:
**Less anxiety and psychological distress → potentially lower pain volume.**
But some antidepressants may also influence pain processing directly, meaning their potential benefit isn't simply because someone feels less anxious.
Importantly, this evidence relates specifically to chronic primary pain and shouldn't automatically be applied to every type of chronic pain.
Antidepressants aren't appropriate for everyone, either. The decision should be made with a doctor based on the individual's condition, other medications, potential benefits and side effects. They should also not be stopped suddenly without medical guidance.
## This Doesn't Mean Your Pain Is “All in Your Head”
This distinction is extremely important.
Stress influencing pain does not mean the pain isn't real.
It doesn't mean an underlying medical condition should be ignored.
It doesn't mean you should simply “think positively.”
Your physical condition matters.
But so can your sleep, stress, emotions, attention, activity and environment.
Understanding these factors gives you another potential lever to work with.
## Look Beyond the Pain Score
When your pain suddenly increases, don't only ask:
**“What's wrong with my body?”**
Also ask:
- How did I sleep?
- How stressed have I been?
- Am I anxious or emotionally exhausted?
- Have I been thinking about my pain constantly?
- Have I been unusually inactive?
- Have I done too much?
- Has something stressful happened recently?
- What was happening emotionally before the pain increased?
You may eventually discover that certain things consistently turn your pain volume up.
## The Goal Isn't to Turn the Pain Off
For many people living with chronic pain, completely eliminating pain may not be realistic.
The goal can instead become:
**“What can I do to turn the volume down?”**
That might involve:
- Better sleep
- Managing stress
- Appropriate movement
- Addressing anxiety
- Learning relaxation techniques
- Reducing fear around activity
- Maintaining meaningful activities
- Psychological therapy where appropriate
- Medication when clinically appropriate
These things don't necessarily remove the underlying pain.
But they may help prevent pain from becoming the loudest thing in your life.
## From the Counsellor’s Chair
When your pain suddenly gets worse, try asking:
**“What is turning the volume up?”**
You may not always find an answer.
But when you start recognising your patterns, pain can become something you understand and manage, rather than something that completely controls your day.
You may not be able to turn the pain completely off.
**But perhaps you can learn how to turn the volume down.**
**Let’s get you back on track!**
## Sources
**International Association for the Study of Pain (IASP)**
Pain Management Center — Biopsychosocial Approach
**NICE Guideline NG193**
Recommendations for Chronic Primary Pain
**NICE Evidence Review J**
Pharmacological Management for Chronic Primary Pain
## Medical Disclaimer
This article is for general educational purposes and does not replace medical assessment, diagnosis or treatment. New, severe or significantly changing pain should be assessed by an appropriate healthcare professional. Do not start, stop or change medication without discussing it with your prescribing clinician.
**Tagged with:** [Chronic Pain](https://www.centredcounselling.co.za/centred-counselling-blog/tag/chronic-pain)
#### Byron Werbeloff
KEEP READING
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