Most people think pain is purely structural.
Bad back? Must be an injury. Achy joints? Probably “wear and tear.” Stiff and sore all the time? Maybe I’m just getting older.
But pain is often more complicated than that. Over the last few years, research has increasingly shown that pain is not just influenced by muscles, joints, and posture. It’s also shaped by the immune system, inflammation, the nervous system, and surprisingly… the gut.
So what is inflammation?
Inflammation is the immune system’s natural response to a perceived threat. This could be an infection, injury, toxin, or irritation.
If you cut your finger or catch a virus, immune cells release chemical messengers that increase blood flow, recruit defences to the area, and begin the clean-up and repair process. You experience this as heat, redness, swelling, pain and perhaps temporary loss of function. In this situation, inflammation is not the enemy, it’s essential.
The problem comes when inflammation never fully switches off. Instead of being a short-term repair response, it becomes a low-grade background process that quietly keeps the body on high alert. This chronic inflammation is influenced by many of the things we do every day – what we eat, how we sleep, how we move, stress, medications and crucially, gut health. And importantly, chronic inflammation can amplify pain.
Pain is not just structural
I recently worked with a client who had chronic back pain for years. She’d done everything you’re “supposed” to do – physio, pilates, an ergonomic chair, a standing desk. All of it helped a bit… but the pain never fully went away.
Then during our conversations, another pattern emerged. She also had bloating, unpredictable digestion, food sensitivities, fatigue and just a feeling that her get up and go had got up and gone.
So instead of focusing only on her back, we focused on calming her system. We worked on improving her diet quality, supporting her digestive process, reducing ultra-processed foods, stress management and balancing her blood sugar levels.
Nothing extreme. But over time, something interesting happened – her pain became less constant. Did we magically “fix” her spine? No. But we likely changed how sensitive her nervous system and immune system were behaving. For people living with chronic pain, that change matters enormously.
What has the gut got to do with pain?
A lot more than most people realise. Around 70% of the immune system is located in the gut.
Think of the gut as a control centre: if it’s calm, the body whispers. If it’s inflamed, the body uses a megaphone.
When the gut lining becomes irritated through stress, poor diet, alcohol, infections, medications, or lack of sleep, the immune system can become more reactive. This increases inflammatory chemicals in the body, which can make nerves more sensitive. In simple terms the “volume” on pain gets turned up.
Research now suggests that people with chronic pain often have:
- Reduced diversity of beneficial gut bacteria
- Increased inflammatory activity
- Altered gut-brain communication
- Greater nervous system sensitivity
The gut and brain are in constant communication through what’s known as the gut-brain axis. That means pain is not only influenced by what’s happening in your joints or muscles, but also by how the brain and nervous system are interpreting those signals.
Stress changes pain too
Stress is not “just in your head.” Stress changes gut bacterial diversity, gut lining integrity, immune reactions, nervous system sensitivity, sleep quality and even pain perception. This is one reason pain often flares during stressful periods, even when scans or injuries haven’t changed.
The nervous system also communicates directly with immune cells through pathways such as the vagus nerve – one of the body’s major calming systems. When that calming system is under-functioning, inflammation and sensitivity may increase and symptoms fluctuate more easily.
Practical ways to calm the system
The good news is that many of the drivers of chronic inflammation are modifiable. You do not need perfection – but you do need consistency.
1. Feed your gut like it matters
Aim for variety, not restriction. Every week try to include a wide variety of fruit, vegetables, beans/legumes, nuts/seeds, herbs/spices and omega-3 rich foods like oily fish.
This is because your most friendly and useful gut bacteria thrive on diversity. They can only survive if you feed them. The easiest way to do that is to have a variety of plant foods across the week.
2. Reduce the daily “background noise” contributing to inflammation
It’s rarely one takeaway or one biscuit that causes problems. It’s the constant drip-feed of ultra-processed snacks, excess sugar or sugary drinks, artificial sweeteners, alcohol, poor sleep and chronic stress. These all keep inflammation simmering in the background partly because they kill off your useful gut bacteria and allow your less friendly ones to rule the show.
3. Prioritise sleep
Pain and poor sleep have a two-way relationship – poor sleep increases pain sensitivity and of course, pain can disrupt sleep. Sleep also influences blood sugar control, cravings, hormonal balance and inflammation levels throughout the body, partly through its impact on cortisol levels and gut microbes.
If you are struggling with sleep, work on this with a practitioner who can help you get to the bottom of why and help you improve it.
4. Pay attention to digestion
Your digestion gives useful feedback about what’s happening internally. If you have frequent bloating, constipation, diarrhoea, acid reflux or urgency, get to the bottom of what is going on for you and fix your “digestive domino run” to help improve your immune function and calm over-reactivity.
5. Be mindful of hidden gut disruptors
Some medications are absolutely necessary but they can affect gut health and nutrient absorption long term. These include frequent antibiotics, anti-inflammatory painkillers, proton-pump inhibitors and even the oral contraceptive pill.
Sometimes the things helping short-term symptoms can quietly contribute to longer-term irritation. If you are on long-term medication, understand how they work and which nutrients they may be impacting. Mitigating for these losses can sometimes be very helpful with targeted supplementation. Please check any medication/supplement interactions.
Make your physical therapies work harder
None of this means posture, movement, strength, or biomechanics don’t matter. They absolutely do. But hands-on treatment, movement therapy, rehabilitation, and ergonomics often work better when the body is less inflamed and the nervous system is calmer.
You have more control over pain than you think
Pain is not just structural. It’s also chemical, neurological, and immunological. Your gut, immune system, stress levels, sleep, and lifestyle habits all help influence how loudly pain is experienced.
Small daily changes can genuinely help turn the volume down. You do not need a perfect diet. You need a calmer system.
