If you have a pain problem, have you ever noticed how it can feel less 'painful' when you’re at home, but flares up when you have to go out, whether it's to work, a social event, or just a quick trip to the shops?
Bob Allen (osteopath) and Clare Elsby (positive psychology coach and therapist) are back to help you understand something that can feel confusing and often worrying.
In this episode, you’ll find out how your nervous system responds not just to your body, but to your environment too.
Drawing on years of clinical experience, Bob explains how pain is not just about what’s happening in your body, but how your brain interprets your environment.
When you’re in a familiar, safe space, whether that's at home or your favourite cafe, your system shifts into “relax, rest and recover” mode. If, on the other hand, you’re out in a busy shop, a hectic social situation, or unfamiliar surroundings, your system can become more alert, more protective… and this can make you more sensitive to pain.
Don’t worry, as this is a normal, human response.
Clare explores the psychological side of things, including social pressure, anxiety, and sensory overload. You’ll also hear how this can be amplified in neurodivergent individuals, where “masking” and trying to fit in can become emotionally and physically draining.
Bob brings it back to what this means for your pain, explaining why conditions like fibromyalgia, chronic fatigue, or invisible disabilities can feel worse in public, even when nothing “physical” has changed.
This episode isn’t just about pain, it’s about understanding yourself and being more aware of what might be going on with others.
Whether you are neurotypical or neurodivergent, when you understand how and why your environment can affect your pain, it becomes far more manageable and a lot less frightening. This is particularly relevant if you live with chronic pain, fibromyalgia, or an invisible illness.
If this resonates with you, share it with someone who might be experiencing the same thing, especially if their pain isn’t always visible.
🔑 5 Key Takeaways
Your pain is influenced by your environment, not just what's going on with your body.
Feeling safe can reduce your sensitivity to pain as your body shifts into a more parasympathetic (“rest and recover”) state
Social stress, noise, and unpredictability can increase pain levels
Neurodivergence and “masking” can amplify fatigue, tension, and pain
"Invisible" conditions are real and deserve understanding, not judgement
This podcast provides general information for educational purposes only. It is not medical advice and should not replace professional assessment, diagnosis, or treatment. Always seek qualified healthcare advice if you are in pain, have new or worsening symptoms, or have any concerns about your health before starting exercise or self-care routines.
Transcripts
Speaker A:
Welcome to the Pain Free Living Podcast with myself, Claire Elsby. I'm a positive psychology coach and with my colleague here, Bob Allen, who's a osteopath. Correct.
Do you want to tell us a bit more about your osteopathy?
Speaker B:
have been an osteopath since:
o I did that and qualified in:
Speaker A:
Well, what we try and do in all these episodes is to try and come up with topics that you might not hear discussed elsewhere. And our topic for this particular episode is why some pain improves in private, but flares in company.
So when Bob came up with this particular topic, it did floor me. I mean, I did think. Right. Okay. I really got to think and reflect on this.
Speaker B:
You know, I like to challenge you, Claire.
Speaker A:
You do. You do. And psychologically, I would come at it from the perspective is, what is our brain actually trying to signal to us?
Because to me, that's what I. That's what pain is about, is what are the signals coming through? Why are we experiencing pain?
And in this particular example, where pain improves in private but flares in company, it could be because in private we feel safe, we're in control of our environment, we're control of where we live, and there are no threats. But if we flip that, what is actually happening when we're in company, and with that, there is a risk.
If I look at it from a psychological perspective, there's a risk of social anxiety, emotional vigilance. And by that I mean someone's on alert thinking, what's going to happen?
A sensory overload, depending how noisy the venue is, whether it's lighting, all that, that kind of thing, how many people are about. And this is particularly important for neurodivergent individuals who develop masking skills. And that's really.
So it allows them to fit into the environment of how they feel they're expected to be. So in other words, they're not able to be. And this includes neurotypical people as well. But it's particularly important for neurodivergent.
It means that you can't be your authentic self when you're outside your private space. And that in itself is emotionally draining. So when our autonomic nervous system is on alert, our sympathetic side of it is actually on alert.
This is when our brains are perceiving a threat, and what we understand from research is that if our brains think there is a threat, it can actually generate pain in our nervous system. And that therefore the reason it does that is because that is a signal that there's something is wrong.
So pain is actually responsive to our situation and our environment. That's my argument.
Speaker B:
Are we arguing, Cliff? I didn't know we were arguing.
Speaker A:
Where would you be on this?
Speaker B:
Where would I be on this? I would be in total agreement with you. The brain, the nervous system can. The nervous system can impact on our sensitivity to pain, as you point.
As you rightly point out. So looking around the topic, looking around this topic, we've got pain. That's that you feel better. And when you're not having.
Don't feel you're having to perform. You're in your own environment, you know, you know where you are, you know the situation, you're not under any pressure.
So in that situation, the rest digest and recover side of things. The parasympathetics tend to be more dominant because you're comfortable. As soon as you come out of that and you're in.
And you're in an environment where you're not so comfortable, that is going to make you more sensitive to pain. And an example of this potentially is if you have a disability. You have a disability badge. You drive to the supermarket.
It's not unusual for people to be challenged if they park in a disabled spot, but they don't look disabled. So that is almost an incentive. So if you have an invisible disability, if you have something like an acquired brain injury, which can cause you some.
Some issues when you're out, Nothing obvious, but, you know, the more stress you're under, the more it can become more prominent.
If you have something like chronic fatigue syndrome, fibromyalgia, all of these things, you can appear, I don't want to say normal if I do air quotes. You can appear normal.
Speaker A:
Yeah.
Speaker B:
But you can still have some of these problems, which can be debilitating.
Speaker A:
Yeah.
Speaker B:
So not obvious.
So just the act of going to the supermarket, just the act of going to, I don't know, going to the cinema, just the act of any of those things can raise your sympathetics, make you more stressed, and therefore make you more sensitive to pain. So, yeah, there's. The brain is a wonderful thing, but it can also.
It can cause problems, and particularly around pain, which is what the podcast is about, all about.
And this is one of those things that some people don't realize, you know, you may see somebody in the supermarket, you may see somebody out and about, or using a disabled toilet. And I know that's one of the things that people with a disability have. If you're in a wheelchair, it's obvious. If you're.
If you look normal, then it's less obvious, but can be very, very stressful.
And if you have something like fibromyalgia, it's more likely to increase the pain that you're feeling because synthetics are higher than they otherwise would be. So.
Yeah, I mean, I think it's a great topic, and it is something for people with a disability or something for people who have this context kind of pain issue. And it kind of explains it to them as well, because I'm sure it's not something that's commonly talked about.
But if you're in an environment where you're comfortable and comfortable and, you know, and you're happy with that environment, your pain levels are going to be less than if you're outside and your sympathetics start to. You're starting to get nervous, you start to get stressed. That can actually make your pain feel worse.
Speaker A:
Yeah.
I mean, I see it particularly with the neurodivergent community, and I would not class that as a disability, but it certainly is because you're unable to be your authentic self. You're unable to be who you feel you can be. And this is the whole masking side of things. Also social anxiety. Well, anxiety per se, that.
Extends your sympathetic nervous system, which puts you on alert, muscle tension, all the rest of it. And if you've lived with this all your life, it just puts an extra stress and tension that.
So it starts to make you very nervous about going out and doing things.
And whether it manifests as pain or not, it certainly is something that we, as a society, like the invisible disabilities, we need to be aware of, and we need to be very mindful of the people around us and the environment and how we can all help each other in. In. In. In living in the way that we do.
Speaker B:
Yeah. I mean, hopefully this.
This podcast will give people who hadn't thought about that aspect of it just give them a better idea of that could be a potential problem. And give people some ideas about how they can help others to manage that.
Speaker A:
Yeah.
Speaker B:
And not be so quick to judge.
Speaker A:
That's the thing.
Speaker B:
More tolerance.
Speaker A:
Yes. And I think knowledge and education improves, you know, will promote advocacy for the neurodivergent community.
I think a lot of us don't understand it. I certainly didn't understand it. Before I started to actually work with neurodivergent individuals and study it.
And my, my sister is autistic, so I have lived experience of living with an autistic person.
And you know, until you understand these things and understand the background and what, what is going on for people, then really things aren't going to get that much better.
Speaker B:
No, sorry, just to expand on that a little bit because I know again, this is something we will come back to, but could you just give our viewers, listeners just a quick summary of what neurodivergence actually is.
Speaker A:
Okay. All right. This is a big topic question.
Okay, so the first myth that I didn't realize when I first started studying this was that I would have said, oh, we're all on the spectrum. And technically that's spectrum, right? Our mental well being spectrum, I guess.
Speaker B:
Yeah.
Speaker A:
So I would have said we're all on the spectrum, but that's not technically correct. There is a spectrum for neurodivergence.
Speaker B:
Okay.
Speaker A:
So anyone who is not neurodivergent is neurotypical and neurotypical. So let's go. Neurodivergent would mean that you are at some point on this line, on this spectrum.
So things included within neurodivergence are autism, adhd, a combination of the two, dyspraxia, dyslexia, Dyscalculus, Tourette's.
There is a whole list of things that would be conditions, I would say not disabilities, but conditions that are included on the neurodiverse spectrum. So every individual on that spectrum is going to be different. So no two people with ADHD are going to be the same.
No two people with autism are going to be the same.
Speaker B:
But to be fair, no two people are the same anymore.
Speaker A:
Exactly, exactly. So we can't generalize. Also what you find is that you have CO conditions. So someone with autism could also have adhd.
They could also have dyspraxia, dyslexia, they could also have Tourette's. So it's a big, if you like, mix of conditions.
And what it does is it just means that the brains are mapped differently and therefore the way a neurodivergent individual would see and experience the world is different to a neurotypical person. So how they present might be different because of the way that they see the world and understand it.
And a lot of the education is about being able to explain or educate in terms of how the world works. Because for a neurotypical person, the world has been designed for neurotypical people to live and exist and work in.
For a neurodivergent person, there is no handbook, there is no manual, and therefore everything can be confusing.
And so I'm a huge advocate for, for education, psychoeducation as to what autism is, what it means, how it would manifest in someone, what ADHD is, what that means, and then all the different CO conditions. But what it ultimately means is that for people, for individuals with neurodiversity, they see the world differently.
And there are massive strengths for people with neurodiversity, huge creative strengths. They can literally see outside the box because thinking differently is part of who they are.
But one of the challenges is because they do think differently, they feel different and don't necessarily know why they feel different. There is an internal pressure to try and fit in, and because there's no manual, it's not necessarily known how to fit in.
So they will mask and try and do whatever it is they feel they need to do to fit into the society that is designed for neurotypical people.
Speaker B:
Thank you, Claire. That's a good summary. That's a good summary.
I think what's worth pointing out is that both you in your therapy coaching and myself as an osteopath are very, very aware of neurodivergence. A few of my clients have been neurodivergent, and all we do is we just make small adjustments. It's not.
Being neurodivergent is not a difference species. It just means that depending on who they are, they may need to be.
They may need a little bit more time, they may need a little bit more, you know, maybe turn the lights down a little bit, get rid of some background noise. But it, but it only takes very small adjustments to adapt.
For somebody who is neurodivergence and in what we do, whoever walks through the door is who we treat. You know, we don't judge, we don't say, okay, don't know what. We don't treat everyone the same way because everyone is different.
Everyone has different needs, and we adapt to that. I think we're not unique, but in terms of the therapies that we do, we will make allowances regardless of what your needs are.
And I think that's really important to let people who consider themselves to be neurodivergent, to let them know that there are therapists out there who understand and are happy to support them. And now I'll get off my soapbox.
Speaker A:
No, we need to be on soapboxes on this one.
Speaker B:
Both of us on the soapbox.
Speaker A:
Yeah, we do.
Speaker B:
We do yeah, but we digress because I wasn't going to ask Claire about neurodivergence at all, but it seemed to fit in with what we were talking about today. Are we, are we done?
Speaker A:
I think yes. Yeah, I think we're done on that one.
Speaker B:
Okay, we are done on that one. And as always, hope you enjoyed the show.
Even though we did digress a little bit from what we were originally talking about, hope it all still made sense. And if you enjoyed it, we'll be back again in a week with another topic which you may not have heard of, but hopefully you will find interesting.
So if you liked it, tell all your friends, tell your family, tell your mum, tell your dad, tell everyone how great this podcast is. And like, subscribe, share, do all of those good things that you always do, and we will see you at the next one.
