Your client walks in tense, guarded, and exhausted. They’ve tried everything—chiropractic care, physical therapy, pain medication—and nothing has stuck. Sound familiar? If you work with clients in chronic pain, there’s a good chance trauma physiology is part of the picture.
Research shows that 70% of adults in the United States have experienced at least one traumatic event in their lives. Two in three patients who experience a traumatic injury develop chronic pain for at least a year afterward. These numbers aren’t just statistics. They’re the people on your table.
Understanding the connection between trauma, stress, and pain doesn’t just make you a better-informed therapist. It fundamentally changes how you show up for your most complex clients.
The trauma–stress–pain trifecta
Pain isn’t simply a damage meter. It’s a message, an action signal asking the body to change something.
The biopsychosocial model helps explain why. Rather than treating pain as a purely physical problem, this model recognizes that biological, psychological, and social factors all influence how a person experiences pain. Mood, personality, social support, financial stress, past experiences: all of it plays a role.
As trauma researcher Jess Mather explains, trauma isn’t necessarily the event itself. It’s what happens inside the body, brain, and nervous system as a result of that event. When the stress response doesn’t complete—when there’s no resolution or return to safety—the body stays in a state of threat. Chronically. Unconsciously.
This is the foundation of the trauma–stress–pain trifecta: unresolved stress creates a hypersensitive nervous system, and a hypersensitive nervous system amplifies pain.
Related CE for massage therapists: Enhancing Pain Relief: Understanding Trauma Physiology
How pain is actually processed
To work effectively with clients in chronic pain, it helps to understand what’s happening beneath the surface.
Nociception is the detection of painful stimuli. Nociceptors, or nerve endings throughout the body, begin the process. Pain then moves through four phases:
- Transduction: A tissue-damaging stimulus activates nerve endings
- Transmission: The message travels up the spinal cord to the brain
- Modulation: Neural processes reduce or amplify activity in the transmission system
- Perception: The brain makes a subjective decision about what you feel
That last phase matters most. Pain is, ultimately, an opinion of the brain. Attention, expectation, past experiences, and the limbic system all shape how pain is perceived. This is why it’s harder to feel hurt when you feel safe, happy, and supported.
The role of the vagus nerve
Chronic stress reduces vagal tone, and reduced vagal tone increases pain sensitivity.
The vagus nerve, the 10th cranial nerve, is part of the parasympathetic branch of the autonomic nervous system. It connects to brain regions associated with pain processing and carries anti-inflammatory properties that may provide pain-inhibitory effects. It innervates nearly all internal organs in the abdominal cavity and plays a key role in regulating the body’s stress response.
Studies have shown that vagus nerve stimulation can:
- Decrease fibromyalgia pain
- Reduce pain in osteoarthritis
- Limit fatigue in autoimmune conditions like Sjögren’s syndrome
- Relieve symptoms of depression
For massage therapists, this is significant. Touch, relaxation, and slow breathing are all tools that support vagal tone, and they’re already part of your practice.
Related CE for massage therapists: Fostering Safety and Trust through Trauma-Informed Practices
What is neuroplastic pain?
Not all chronic pain points to structural damage. In fact, 52% of pain-free individuals have at least one MRI abnormality. Structural findings and pain levels often don’t correlate the way we assume.
Neuroplastic pain occurs when the brain and nervous system generate pain without an ongoing physical cause. The nervous system has essentially learned to produce pain as a conditioned protective response.
A client might have neuroplastic pain if:
- Medical treatments have been ineffective or only provided temporary relief
- Their pain came on during a stressful period of their life
- Symptoms are inconsistent: moving around, varying in intensity
- Their pain persists well beyond the expected healing window
- They have a history of childhood trauma or chronic feelings of being unsafe
Clients with perfectionist or people-pleasing personalities may also have higher pain sensitivity. Understanding these patterns and gently educating clients about them can open a new window of hope.
The psychology behind why clients don’t get better
Here’s something most therapy training doesn’t cover: your client might not be following through on their home care not because they don’t care, but because their subconscious mind is working against them.
People living with chronic pain or unresolved trauma are often operating in a survival state. Their nervous system is consuming enormous resources just to get through the day. Capacity for new behavior is genuinely limited.
The subconscious mind prioritizes safety and familiarity. When a client’s behavior seems self-sabotaging, they’re often doing what feels familiar, or meeting a need they may not even be aware of. Connection, certainty, significance: these are powerful drivers. Staying in pain can sometimes satisfy subconscious needs in ways recovery doesn’t yet offer.
Rather than frustration, this calls for compassion. Ask what motivates your client. Learn what a “win” looks like to them. Helping them feel heard and safe is, in itself, therapeutic.
Somatic practices as a tool for regulation
Somatic practices work by bringing a person into greater awareness of their body in the present moment. For clients with trauma or chronic pain, this matters deeply. Many have become disconnected from, or even hostile toward, their own bodies.
Somatics helps by:
- Expanding the window of tolerance so clients can handle more input without triggering a stress response
- Increasing parasympathetic activation, which quiets the nervous system
- Creating new anchors to safety that gradually replace patterns of protection and pain
- Building resilience—the ability to return to baseline after activation
Practical somatic tools you can incorporate or recommend include slow breathing techniques, grounding meditations, and mindful movement practices. These don’t require elaborate equipment—just consistency and safety.
It’s worth noting that somatic practices aren’t just for clients. Compassion fatigue and vicarious trauma are real risks in bodywork. Tending to your own nervous system regulation makes you a more present, effective, and sustainable practitioner.
Five principles for working with movement and pain
When helping clients move again, guiding principles matter more than rigid protocols.
- Learn the language of the body. Support your client’s autonomy and help them reconnect with their own internal signals.
- The body seeks safety. Pain is a protection response. Repatterning it requires creating genuine felt safety, not just telling someone to relax.
- The body knows best. Watch for green lights—spontaneous sighs, relaxed hands, greater ease of movement—and pace accordingly.
- Mindset shapes experience. If a client expects pain, they’ll find it. Help them shift from “pain-identified” to curious and open.
- Strength heals. Building physical strength creates stability, improves movement confidence, and reduces feelings of fragility—all of which support recovery.
Start seeing the whole person
Trauma physiology isn’t a niche topic for specialists. It’s foundational knowledge for anyone working with chronic pain, which includes massage therapists.
When you understand that pain is shaped by stress, emotion, belief, and nervous system history, you stop looking for what’s broken and start asking what the body needs to feel
