“How do I know if this pain means I’m injured or if my nervous system is just stuck on high alert?”

As a psychologist who works closely with clients who are living with chronic pain, one of the most common (and confusing) questions I hear is: “How do I know if this pain means I’m injured or if my nervous system is just stuck on high alert?”
Here’s a helpful way to think about the difference between injury pain and pain driven by central sensitisation.

Pain from injury is usually protective. It tends to:

• Be linked to a clear event (a fall, strain, surgery)
• Be localised and consistent with the injured tissue
• Improve gradually as healing occurs (typically over weeks to a few months)
• Increase predictably with specific movements that stress the tissue

In contrast, pain from central sensitisation happens when the nervous system becomes more sensitive and reactive over time. The “alarm system” stays turned up, even after tissues have healed. Signs pain may be driven more by sensitization than ongoing injury include:

• Pain lasting well beyond normal tissue healing time
• Symptoms that spread or move around the body
• Pain triggered by light touch, stress, fatigue, or even temperature changes
• Flare-ups that feel disproportionate to activity
• Coexisting issues like sleep disturbance, brain fog, or heightened stress response

A helpful metaphor is injury pain is like a smoke alarm responding to a real fire.
​Central sensitisation is like a smoke alarm that goes off when you make toast.
This doesn’t mean the pain is “in your head.” It’s very real but it’s being amplified by a sensitised nervous system rather than ongoing tissue damage. And the good news is that nervous systems can calm down. If pain has been persistent and confusing, it may be worth exploring not just what’s happening in the tissues, but also what’s happening in the nervous system.