Exploring Chronic Pain Through Evolution: Change Across Four Dimensions (3 of 3 Pain Series)

Exploring Chronic Pain Through Evolution: Change Across Four Dimensions (3 of 3 Pain Series)

As we wrap up our series on understanding pain, we shift our focus to how changes within a lifetime and across generations contribute to the development of chronic pain. Building on concepts from our previous posts (part 1 & part 2)—looking at pain through an evolutionary and complexity science lens—this new perspective highlights the connected complexity of pain and offers hope for better approaches to managing it in the future.

In this post, we’ll offer a general summary of how changes over a lifetime and across generations affect the development of chronic pain. This will serve as a foundation for deeper exploration of the four dimensions of evolution: genetic, epigenetic, behavioral, and symbolic. Don’t worry, we’ll define all of these terms! While today’s post introduces these dimensions, we will dive much further into each one in future blogs, previewing how they shape health outcomes and influence the transmission of traits across generations.

To begin, let’s expand on evolution as the science of change, moving beyond the traditional view of genetics as a primary understanding of evolution. Most of us are familiar with genetics, the blueprint that determines our potential for physical traits and changes. Some of you may also be aware of epigenetics, which refers to changes that occur over a lifetime due to behavior and environmental influences. However, limiting evolution to just these two dimensions doesn’t fully explain the rapid changes in human development observed over humankind’s relatively short history.

Two prominent geneticists, Eva Jablonka and Marion J. Lamb, propose a broader view of human evolution. They highlight two additional dimensions: behavioral and symbolic inheritance. Human beings evolve not only through genetic and epigenetic changes but also through behavioral patterns and the use of symbols. Behavioral inheritance refers to how actions and habits are learned and passed down through generations. Symbolic learning has traditionally been seen as primarily related to language. However, these dimensions also shape our internal world and decision-making processes.

Symbolic inheritance, for instance, shapes internal stress responses and behaviors that influence how the body reacts to harm. Over a lifetime, our symbolic learning influences behaviors like physical activity, coping strategies, diet, and substance use. These behaviors, in turn, change how the body responds to stress, injury, and environmental challenges, potentially making us more prone to chronic pain. Additionally, the stressors we experience—and how we respond—can lead to epigenetic and genetic changes that can be passed down to future generations.

Evolutionary Changes Across a Lifetime and Generations in Chronic Pain

Evolutionary science helps us understand how the body changes to fit its environment over a lifetime—and how these changes can be passed down through generations. How we grow and respond to challenges, including chronic pain, is partly influenced by our genetic makeup (genotype) and the environment. Together, they shape our individual traits, known as our phenotype. A phenotype includes many characteristics a person can show, such as eye color, height, personality, and even how the body responds to harm. It doesn’t develop on its own but is shaped by many factors, such as injury, disease, stress (like trauma or mental health struggles), and social determinants of health (SDOH). SDOH are the conditions in which people are born, grow, live, work, and age—like access to healthcare, education, safe housing, and economic stability. Random genetic changes and these environmental factors also play a role in how the body adapts over time.

One of the strongest influences on health phenotypes is adverse childhood events (ACEs). Research shows that individuals who experience a significant number of ACEs are more likely to develop chronic health conditions, including chronic pain, later in life. These early influences can lead to increased sensitivity and easier system activation of the body’s harm detector, AKA the nociceptive apparatus. This heightened sensitivity doesn’t just affect the individual—it can be passed down through generations. Just as the biological effects of trauma can be passed down through generations, a consistently activated harm detection system can make members of families more susceptible to developing chronic pain. When the body’s harm detection system becomes more sensitive, it more easily generates nociceptive signals, increasing the likelihood of experiencing pain. This increased sensitivity comes from genetic, epigenetic, behavioral, and symbolic changes, making the body’s harm detection system more likely to respond to small triggers.

For example, if a family follows high-stress behaviors tied to symbolic beliefs passed down through generations—such as valuing hard work, perseverance, and seeing rest or self-care as less important than constant productivity—these behaviors, like working long hours without rest, limited physical activity, or using high-calorie intake to suppress emotions, can alter the body’s ecosystem. Over time, such habits may increase inflammation, disrupt hormonal balance, and lead to higher stress levels, which directly affect the body’s harm detection system. The symbolic meaning of success tied to overworking or ignoring self-care can also be passed down, reinforcing these behaviors. As the body adapts to this stressed environment, the harm detector may become more sensitive or even activate without direct physical injury. This can lead to a heightened response to minor stimuli or even direct activation of the harm detector, increasing the likelihood of experiencing pain. Over time, this sensitivity can become part of our epigenetic makeup and be passed down from one generation to the next, potentially becoming part of our genetic blueprint.

Understanding these changes helps us see chronic pain as more than just an individual issue—it’s a complex multidimensional process that affects families and communities over time.

Closing Thoughts: The Path Forward in Understanding and Managing Chronic Pain

Understanding chronic pain through the lens of evolutionary and complexity science allows us to think about pain in new ways. It encourages us to consider more than just the physical aspects of pain, recognizing how genetic, epigenetic, behavioral, and symbolic change influence its development in our lifetime and across generations.

This perspective opens the door to new treatments, including future medications and other interventions that could help with changes at the genotype (genetic and epigenetic) levels. However, because the body’s systems are complex and constantly changing at the phenotype level, these treatments will likely need to be combined with strategies that address behavioral and symbolic factors through movement and behavior support, mental health care, improvements in social conditions, and environmental adjustments. Given the close interplay of human evolution across all four dimensions—genetic, epigenetic, behavioral, and symbolic—this combination of approaches is likely crucial for creating lasting change and preventing the body from slipping back into unworkable, maladaptive states such as chronic pain. A comprehensive approach is likely necessary, one that attempts to ‘tip’ maladaptive systems back into adaptive ones by selectively targeting biological, psychological, social, and environmental processes of change. This is essential for attempting to break the cycle of chronic pain, both for ourselves and for future generations.

As we explore the complexities of chronic pain, we gain better insights for understanding, predicting, and influencing it. Recognizing that pain is more than just a physical response helps us appreciate the many factors that contribute to it. With this knowledge, we can pursue long-term solutions that improve pain management and overall quality of life.

Picture of Leonard Van Gelder
Leonard Van Gelder

President, Founder

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