Can Chronic Pain Cause Fatigue? Why Pain Leaves You Feeling Exhausted
Do you ever have those days that you wake up wondering “how do I still feel so tired after a full night of sleep?”
Or, maybe you’ve been out on a hike you’ve done with ease a million times before, but your body feels so heavy and you’re completely exhausted.
In those moments, you might be wondering “can chronic pain cause fatigue?”
The short answer is: yes.
Living with chronic pain can be frustrating and exhausting, and the pain itself can contribute to fatigue.
In this article, we’ll explore what chronic pain is, how it impacts our body, nervous system, stress responses, sleep, and mental well-being, and what can help you manage the fatigue that often comes with chronic pain.
Understanding chronic pain
For most acute injuries, soft tissues like muscle, tendon, and ligament typically heal within 3-12 weeks while bone usually heals within 8-10 weeks.
This acute pain is important because it’s like an alarm that signals immediate protective responses like pulling your hand off of the hot stove.
As we’re healing from injury, the alarm serves to help us know what activities we’re ready for and what activities we need to give more time before returning to them.
The sensitivity of the alarm system decreases as our tissues heal and we’re able to return to our usual activities without pain limiting us.
Chronic pain, however, is pain that lasts longer than the expected healing timelines.
When we have chronic or persistent pain, tissue healing is often no longer the primary driver of pain, but rather it is the nervous system continuing to signal a threat that keeps us in pain.
In other words, our alarm system is staying overly sensitive and continuing to go off even when it doesn’t need to. This can happen even without a new injury.
One of the challenges with chronic pain is that it is, in and of itself, a threat to our nervous system and can keep our nervous system on high alert. This constant hypervigilance is exhausting and one of the reasons chronic pain can cause fatigue.
How pain affects sleep
You’ve probably already noticed that when your pain is high, it’s really hard to fall asleep and stay asleep. It can be hard to find a comfortable position to fall asleep. And, if you wake in the middle of the night, it can be hard to get back to sleep, especially if you’re feeling pain or discomfort in your body.
What often happens is that sleep itself starts to become stressful. You might worry about whether:
You’re going to be able to fall asleep
You’ll be able to stay asleep
Your sleep will be restful or if you’ll toss and turn all night
The pain-fatigue cycle can be an incredibly frustrating cycle because poor sleep can increase pain sensitivity and increased pain can disrupt sleep.
It feels even worse to be just told “get more sleep.” I trust that if it were that simple, you would already be doing it.
That said, setting yourself up through some simple sleep hygiene practices can be helpful.
Create a simple bedtime routine. Our brain and nervous system love routine and consistency. When we do the same pre-bed activities in the same order every night, it signals to our brain and nervous system that it’s time for sleep.
Include a few nervous system resets in your night time routine to shift into rest-and-restore mode. You might try some deep breathing, a few gentle restorative yoga postures like child’s pose or legs up the wall, or a short guided meditation.
Go to bed and wake up at the same time every night. Again, routine and consistency.
Stop checking the time in the middle of the night! Have you ever noticed how quickly you start doing mental math about how many hours of sleep you’ll get if you fall asleep right now? Checking the clock often increases stress and makes it harder to fall back asleep. If your alarm isn’t going off, trust that it’s not time to get up…no need to check the clock.
Keep your bedroom cool and dark. A slightly cooler room with minimal light helps to signal your body that it’s time for sleep and can support deeper rest.
As hard as it might be, get your TV out of your bedroom. Remember, your bedroom should be reserved for sleep and intimacy so your brain begins to associate that space with rest rather than stimulation.
At the end of the day, know that sleep challenges are not because you’re not trying hard enough. They’re in response to a sensitive nervous system that’s trying to keep you safe.
The stress response and energy levels
Our autonomic nervous system is the control system in our body that unconsciously regulates our body functions like heart rate, respiratory rate, digestion, etc. It has 2 main modes: sympathetic and parasympathetic.
The sympathetic nervous system is responsible for our fight-flight responses, mobilizing energy and allowing us to respond to threats.
On the flip side, our parasympathetic nervous system activates our rest, digest, and restore responses and allows us to maintain presence, focus, and concentration.
Some challenges that arise in the case of chronic pain are:
Pain keeps our nervous system on guard, always on the lookout for a threat we may need to respond to at a moment’s notice
This high alert system uses energy reserves and we end up relying on adrenaline and cortisol to keep us going
All the energy being used up contributes to fatigue and feeling “tired-but-wired”
As an active individual, you might notice that recovery from long hikes or ski days becomes harder. You might feel more sore than usual, it might take you more days to recover, or you might notice you’re struggling to make progress toward your activity goals or you might even be regressing.
There’s no judgement here. It’s not a reflection that you’re not trying hard enough. It might simply be that your nervous system needs some support.
Mental health and exhaustion
Let me be honest. Living with chronic or persistent pain is exhausting and takes a toll emotionally.
You might notice yourself monitoring symptoms more closely, not from a place of curiosity, but from a place of hypervigilance.
You notice all the movements that cause any of your symptoms to show up, worry about how you will tolerate any activity outside of what feels “safe” for you, and often end up progressively decreasing your participation in workouts, time on the trails, and social engagement outside of what’s required by work and life.
It’s at this point that, as an active individual, you might experience feelings of frustration and grief as your identity shifts from strong and capable to deconditioned and fragile.
Self-compassion and seeking care from providers who understand that your pain is not “all in your head” can be incredibly beneficial.
Inflammation and the nervous system
Chronic or persistent pain is in and of itself a threat to your nervous system.
That threat response releases adrenaline and cortisol in an effort to mobilize you to act, to fight or flee.
Over time, the persistent threat posed by chronic pain can lead to increased inflammatory responses, muscle guarding or bracing, and an increase in nerve sensitivity so that things that once did not cause pain, even something as simple as the texture of your clothing, now do.
When your system is extra vigilant, constantly scanning for threats, it uses more energy, contributing to fatigue.
Managing fatigue with chronic pain
To reduce fatigue associated with chronic pain, it’s important to approach this process from a place of curiosity and non-urgency.
I know, easier said than done.
But, when you try to force a change from a place of urgency, you can end up frustrated and continuing to loop in stress responses.
Some gentle and sustainable nervous system supports include:
Breathwork: a great way to shift the state of your nervous system is with a 4-7-8 breath. Don’t get hung up on perfect execution or timing of the breath, simply holding at the top of your inhale and aiming for a longer exhale is beneficial.
Gentle mobility: sometimes you do need to mobilize energy through movement. You might experiment with cat-cows, child’s pose, trunk rotation in sitting or sidelying, or gentle self-massage practices using soft tools like the Franklin Ball, Courageous Ball, or Tune-Up Fitness Therapy Balls.
Pacing: this is NOT about all or nothing. Pacing allows you to engage in activities while minimizing overextending your capacity, which can lead to a pain flare. Initially, your system may need more frequent rest breaks, that’s totally normal! Over time, you’ll likely notice you can go longer between rest periods.
Graded strength and rebuilding capacity: as an active person, you’re likely feeling a little impatient to get back out on the trails or on your skis. Before you go all in, it’s important to build your strength and endurance to support your activity goals. Commitment to the sometimes slow and steady process is what makes all the difference.
Lastly, remember that recovery is a process. There’s no magic pill, but showing up for yourself with as much consistency, compassion, and curiosity as you can will lead to changes over time.
For some people, they even start to see little setbacks or flare-ups as opportunities because they get a chance to practice their chronic pain recovery skills.
Where to find physical therapy in Bend, OR for chronic pain related fatigue
If you take nothing else away from this article, let it be this:
You are not broken.
Your body is not broken; it is doing what it knows to do to keep you safe.
You are doing the best you can with the information you have.
Your fatigue is a signal from your nervous system, not a flaw.
Fatigue in chronic pain isn’t a personal failure or a lack of motivation. It’s a physiological response to a nervous system that has been working overtime for a long time. The good news is that with the right support, your system can learn to feel safer again.
If you’re in or near Bend, Oregon and curious about chronic pain PT, working with a provider who understands how chronic pain causes fatigue and approaches your care both holistically and with compassion can be an important part of your pain recovery process.
You can get started by learning more about chronic pain physical therapy in Bend, OR, or by getting in touch with me.
If you have questions, I’d love to connect, hear how chronic pain is affecting your lifestyle and well-being, answer your questions, and explore how I can help.
You can schedule a free consultation here.
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Disclaimer: this post is intended for informational purposes only and is not medical advice. If you are experiencing pain, it is always in your best interest to consult with your medical doctor and/or your physical therapist.
