Abstract

The interplay between stress, anxiety, and central pain mechanisms is a critical consideration in modern physiotherapy. Emerging evidence underscores the neurobiological convergence of stress-related systems, such as the hypothalamicpituitary-adrenal (HPA) axis and sympathetic nervous system, with pain processing pathways. Chronic stress induces neuroinflammatory responses, disrupts inhibitory neurotransmission (e.g., GABA), and heightens excitatory mediators, such as Substance P, collectively amplifying pain sensitivity. Anxiety further intensifies pain through mechanisms such as catastrophizing, attentional bias, and anticipatory fear, often leading to maladaptive avoidance behavior. These psychological states not only exacerbate pain, but may also contribute to the development and persistence of chronic pain. Effective assessment and intervention require a multidisciplinary approach that integrates physical and psychological strategies, including physiotherapy, cognitive-behavioral therapy, mindfulness, and patient education. Understanding this bidirectional relationship is essential for personalized treatment planning and improved clinical outcomes. Addressing both emotional and physiological contributors to pain offers a comprehensive path to recovery and long-term management.

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