Is this article saying my pain is caused by stress or emotions?

No. This article describes how emotional state amplifies or dampens pain signals that originate from a real physical source. The pain generator, whether it is a joint, a nerve, or inflamed tissue, is still there. Emotional state acts on the volume control for that signal through specific circuits like the periaqueductal gray and RVM. Addressing the emotional and inflammatory layer does not mean the physical layer is being dismissed.

Why does my pain feel worse on some days even when nothing physically changed?

Two mechanisms drive this. Increased connectivity between the default mode network and salience network can pull pain-related threat signals into your ongoing self-focused thinking, and glucocorticoid receptor resistance can leave cortisol circulating without effectively shutting down inflammation. Both of these fluctuate with your stress load, which is why identical days on paper can feel physically different.

Does this mean medication won't work for me if my pain has an emotional component?

Medication still works on the target it was designed for. Anti-inflammatories still reduce inflammation in tissue, and nerve-targeting medications still reduce nerve signal transmission. What they were not designed to do is reach brainstem circuitry, glial activation in the central nervous system, or brain network connectivity. That is why addressing the emotional and inflammatory layer alongside your current medication, rather than instead of it, tends to produce a more complete result.

What can I actually do to influence this brainstem pain circuit?

Structured mindfulness training, consistent breathwork, cognitive behavioral therapy, and consistent sleep have measurable effects on amygdala reactivity, prefrontal regulation, cortisol output, and glucocorticoid receptor sensitivity. These are not generic wellness suggestions. Each one targets a specific mechanism described above, and each requires consistency rather than a single session to produce a measurable shift.

How do positive emotions actually reduce pain, not just distract from it?

Genuine positive emotion activates the ventral tegmental area and increases dopamine signaling, which triggers release of your body's own opioid molecules, beta-endorphins and enkephalins. Those molecules bind to the same mu and delta opioid receptors that prescription opioids target, in the same PAG and RVM circuit described earlier in this article. This is a direct neurochemical effect, not a psychological distraction from the sensation of pain.

Can a Nerve Be Pinched in More Than One Place?

Jason Winkelmann

8 hours ago

3 min read

Yes. A nerve can be compressed at two or more points along its path, such as at the spine and again at the wrist, elbow, or knee. This is called double crush. Two mild compressions can cause more symptoms than either would alone, although researchers still disagree about exactly how it works.

If treatment aimed at your neck or back helped only partly, or symptoms returned after a procedure on one area, this may be why. A single explanation sometimes covers only half the problem.

The Mechanism

A nerve is a long cable, and a pinch can occur anywhere along it. A 2025 review in the Journal of Clinical Medicine describes double crush syndrome as the combination of two co-existing mild compression sites that together can produce significant nerve injury, even when neither site would be severe enough to do that alone. The authors give a lower-limb example, an L5 nerve root irritated in the spine plus the common peroneal nerve squeezed at the knee, where symptoms concentrated in the lower leg and foot, and weakness in lifting the foot, were the clue that a second site was involved.

Why would two mild squeezes add up? The proposed explanations include impaired axonal transport, the slow delivery of materials from the nerve cell body down the length of the nerve, along with changes in how the nerve's electrical channels behave and inflammation of the dorsal root ganglion near the spine. The same review is candid that the underlying mechanism remains unclear and that a firm definition is lacking. A useful picture is a garden hose with a partial kink near the tap. The flow downstream is already reduced, so a mild kink further along has more effect than it would on a hose running at full pressure.

What it does explain is a pattern many people recognize: a nerve that stays symptomatic after the obvious site is treated. The second site is often a muscle that the nerve passes through or beside, such as the scalenes in the neck, the piriformis in the buttock, or the pronator teres in the forearm, or a joint restriction or tight band at the elbow or wrist. A carpal tunnel diagnosis in someone who also has neck stiffness is one common example.

When It's Something More Serious

Weakness that is getting worse, a foot that drags or slaps when you walk, loss of bladder or bowel control, or numbness in the groin or inner thighs needs prompt medical care. Symptoms that persist or return after spine surgery deserve a fresh look for a second compression site rather than a repeat of the same approach.

How This Gets Addressed

The aim is to find and treat every site, not only the most obvious one.

Chiropractic care addresses spinal and extremity joint restrictions that narrow the nerve's path, and Massage Therapy and Dry Needling release the muscles and tissue bands where nerves commonly get caught.

Physical Therapy completes the picture by restoring the nerve's ability to glide and tolerate movement along its whole length, which is what prevents the second site from reactivating the first, and Naturopathic Medicine addresses the inflammatory and metabolic factors that make a nerve less tolerant of pressure.

You can learn more about our full approach to pinched nerves here.

Most people improve when every contributing site is addressed, though a nerve that has been compressed in two places for years may keep some sensitivity or numbness.

Written By:

Dr. Jason Winkelmann

Naturopathic doctor, Chiropractor, Chronic Pain Specialist, and Educator

Frequently Asked Questions

Can a neck problem cause symptoms in my wrist or hand?

Yes, because the nerves that serve the hand begin in the neck. Irritation at the neck can make the nerve less tolerant of pressure at the wrist or elbow, so both sites can contribute to the same symptoms.

Why did my symptoms continue after treatment on my back or neck?

If the nerve is also compressed further along its path, treating the spine may reduce only part of the problem. A careful exam along the full length of the nerve helps identify a second site.

Is double crush syndrome proven?

It is widely discussed and clinically useful, but the mechanism is not settled and much of the evidence comes from small case series. It is best viewed as a reason to examine the whole nerve path, not as a guarantee that a second site exists.