May 9, 2022 by spencerjean_do

Chances are very good that if you have pain or discomfort, inflammation is to blame; if not wholly, then at least in large part.

Inflammation is directly involved in the pain conditions ranging from sciatica to arthritis, whiplash to tennis elbow, and from migraines to postexercise muscle soreness. So how exactly does inflammation trigger pain?

Pain (like inflammation itself) is biologically and behaviorally necessary. Pain protects against tissue damage by shaping our behavior, while inflammation protects against tissue damage by mobilizing our immune system’s physiological safeguarding and repair functions. Both of these kinds of protection—behavioral and immunological—make sense when danger or damage are actually present; but both pain and inflammation can become problematic when they chronically persist after the threat is no longer around.

Also, keep in mind that pain and nociception are not the same thing. Nociception is a nerve signal indicating potential mechanical, thermal, or chemical threat to tissues; pain is the experience the nervous system generates in response.

Many times, when your pain is prolonged, it can be because there is continued nociceptive input (for example, from ongoing mechanical or inflammatory irritation). But pain can persist even with little or no tissue damage; or, even when there is obvious damage or degeneration, there can be little or no pain experience at all. And while your pain may not be as related to physical tissue damage as we might have thought, there turns out to be a strong relationship between pain and expectations, fears, context, memory, and social influences.

These psychosocial factors play a role in inflammation, as well as in pain. For example, high hostility scores have been correlated with increased inflammation, while openness (hostility’s flip-side) has been associated with decreased inflammatory markers. But the relationship between pain, inflammation, and psychosocial factors is nuanced and complex: while depressed people often have stronger inflammatory responses, turning down inflammation with immunosuppressive drugs can also trigger depressive mood changes. So even though pain, inflammation, and reactive emotions are deeply interconnected, they don’t move in lockstep with one another. Instead, they could be thought of as different modes of physical, psychological, and behavioral adaptation that we use in varying ways in the face of perceived threat.

In inflammation, the nervous and immune systems work together. Tissue injury or irritation triggers the release of pro-inflammatory molecules into the surrounding interstitial environment (Image 1). Very quickly, the resulting “inflammatory soup” chemically excites and sensitizes nearby peripheral nerves, triggering behavior-altering soreness and pain (as well as initiating the cascade of the inflammatory progression, discussed in “Understanding Inflammation’s Progression”). Pain sensitization is a key link between the immune and nervous systems: sensitization amplifies the actual nociceptive signals (not just the experience of pain), either peripherally at the tissue receptors themselves, or centrally, within the spinal cord and brain.

Interestingly, inflammation-related sensitization isn’t limited to the directly injured areas. Inflammatory markers have also been found within related dorsal root ganglia along the spine (associated with processing chronic pain), neural pathways within the spinal cord, and perhaps most intriguingly, even in immune cells in parts of the brain associated with both sensation and movement of the painful area (glial cells in the sensorimotor cortex, Image 2). In the short term, this neural coinflammation protectively inhibits muscular activity related to a painful (and potentially injured) area. But if prolonged, inflammatory sensitization can lead to numerous neurological and myofascial changes, including muscle size reduction (within days), reduced fatigue resistance, contraction speed change, and infiltration of fibrous and fatty tissues (within weeks or months, Image 3).

Curiously, these inflammatory changes have been observed in muscles and fascia far from an injury, such as in spinal multifidus not adjacent to the site of a disk injury. In other words, inflammation doesn’t just affect the fascia and connective tissues of the locally painful area. Over time, local pain can also inflame:

    • Other myofascial structures far from the injury site;
    • The neurons that connect the injured areas with the brain;
    • And strangely, the ankle area of your brain’s body map.

As bad as this sounds, the body and brain have a tremendous capacity for adaptation. This means that all these things can also get better, and hands-on work has repeatedly been shown to help. There is a lot more to say about handson work’s relevance to the inflammation/ pain relationship before we get into actual techniques. Other important concepts include the ways local pain and inflammation are affected by systemic (whole-body) inflammation, the role of the vagus nerve and autonomics, stress, the controversies around ice, diet, and much more.


Musculoskeletal pain inflames both local tissues and the brain. In a recent study of sciatic pain (Loggia et al., 2015), inflammation wasn’t limited to the locally painful tissues of the low back and leg. Glial cells (inset), which play a key role in both immunity and chronic pain, also respond with inflammatory activation (orange) in the corresponding regions of the brain’s sensory and motor cortexes. This has implications for the use of both therapeutic sensation (such as produced by touch) and active client movement when working with musculoskeletal inflammation.


Tissue injury releases inflammatory molecules and cells into the surrounding interstitial environment. The resulting “inflammatory soup” chemically excites and sensitizes nearby sensory nerves, generating a nociceptive (pain-triggering) signal.


Over time, inflammation and pain can cause myofascial infiltration of fibrous and fatty tissues. A: Healthy skeletal muscle (rat tibialis anterior) with ~5 percent extracellular material. B: Fibrotic changes six months after inflammatory injury, showing extracellular increase to 20 percent of cross section. In another recent study (Bove et al., 2018), rats with repetitive strain injuries receiving modeled manual therapy (bilateral mobilization, skin rolling, and stretching) showed a reduction in nociceptor activity, neural inflammation, and fibrosis compared to unmassaged rats.


  1. Girard et al., “Trait Hostility and Acute Infl ammatory Responses to Stress in the Laboratory,” PLoS One 11, no. 6 (2016); M. Luchetti et al., “Five-Factor Model Personality Traits and Infl ammatory Markers: New Data and a Meta-Analysis,” Psychoneuroendocrinology 50 (2014): 181–93.
  2. L. Loggia et al., “Evidence for Brain Glial Activation in Chronic Pain Patients,” Brain 138, no. 3 (March 2015): 604–15.
  3. James et al., “Dysregulation of the Infl ammatory Mediators in the Multifi dus Muscle After Spontaneous Intervertebral Disc Degeneration PARC-null Mice is Ameliorated by Physical Activity,” Spine 43, no. 20 (2018): E1,184–94. doi:10.1097/BRS.0000000000002656.
  4. M. Bove et al., “Manual Therapy Prevents Onset of Nociceptor Activity, Sensorimotor Dysfunction, and Neural Fibrosis Induced by a Volitional Repetitive Task, Pain (November 16, 2018): doi: 10.1097/j.pain.0000000000001443 [Epub ahead of print].

If you have any questions or concerns about your inflammation or condition, please reach out to us at


13:48 28 Feb 22
The guy is a wizard. I’ve been looking for a long time for someone that knows what they’re doing when it comes to backs. I will only see Spencer now going forward. If you decide to see someone else for back pain I’m not sure if you really want to get better. Whole clinic is great.
Mallika SomayajuluMallika Somayajulu
16:26 22 Feb 22
Dr. Spencer is awesome. Because of him, My back pain is gone and I can do the things I like again. His staff are very professional and polite.
mariette renaudmariette renaud
19:56 11 Feb 22
After many years of cervical spine discomfort and osteoarthritis most likely as a result of sitting at a desk for a good number of years, I found myself wanting to find an alternative means towards improving my spine health!My Naturopath Doctor recommended I see an Oesteopath namely Spencer Jean who came highly recommended.Spencer welcomed me into his office and the conversation began as to how to go about the process of correcting my posture! A plan of attack was formulated as to how to begin the process which was amazingly positive based on his confidence in doing so along with my part in wanting to do so!Today my posture has improved tremendously and I cannot thank Spencer enough for getting me to this point! The exercises are not difficult and As I see the progress, I am so much more encouraged in doing so! Thank you so much Spencer and the wonderful welcoming staff at Community Chiropractic Centre! I am truly blessed!
Spencer has been a great benefit to me, as he listens to what is wrong and works to help with that problem; so that I get some relief & can do more of my ADL. Before meeting Spencer & being under his care; I had very limited relief of discomfort. I would recommend anyone with chronic pain & skeletal ailments to give Spencer a try. He maybe just what you need in your life.
Tea MalbasicTea Malbasic
13:23 13 Jul 21
Spencer is great! Very professional and caring. After years of chronic back pain, I can honestly say I feel better after every visit. The office staff is friendly and very easy to deal with!
Nik DobrichNik Dobrich
03:18 17 Jul 20
Dr. Jean has helped me tremendously. Appointments are always on time and very professional. Would highly recommend !
Olivia RivardOlivia Rivard
16:43 21 Oct 19
Spencer is an amazing osteopath. I brought my 3 week old to see him for colic and he has helped her immensely! She is now 3 months and doing so well. Spencer is fantastic with babies. He is so caring and my little just adores him! Highly recommend his service.
Steven GombaiSteven Gombai
18:10 06 Aug 19
I actually love going to see Spencer. He addresses my problems and I'm not sitting around for hours past my appointment time waiting to see him. In and out within 30 minutes. He takes care of my kids as well. I would recommend him to anyone without hesitation.Thanks for keeping us all in one piece and keeping us at our 100% for our tournaments.

Copyright by Spencer Jean, DO & Associates. All rights reserved.