When the Nervous System Stays on Alert

Written By Delainne Bond

When the brain perceives threat, the nervous system activates a protective response. In the short term, that response is adaptive. But when the sense of threat persists, the body can remain in a heightened state of activation even as the original injury is being treated.

That prolonged activation can affect sleep, pain sensitivity, fatigue, attention, stress physiology, emotional regulation, confidence, and willingness to move or participate in rehabilitation.

And these effects can reinforce one another.

Poor sleep can increase vulnerability to pain, while pain can further disrupt sleep. Research supports this reciprocal relationship between sleep and musculoskeletal pain.

Fear and heightened threat perception can influence behavior and participation. Reduced activity or avoidance can then make it harder to rebuild confidence and function.

This is where the distinction between psychology and physiology begins to disappear.

The psychological response affects the physiological response.

The physiological response affects the psychological response.

Both influence function.

For workers’ compensation, that matters because the ultimate goal is not simply symptom reduction. It is functional recovery.

When clinically indicated, identifying psychological and physiological barriers to recovery can help interrupt this cycle, improve participation in rehabilitation, and support meaningful progress toward function and return to work.

When the mind and body are connected, recovery is fuller, faster, and more enduring.

Why this matters in workers’ compensation

A worker who appears to be progressing slowly may not simply need “more time.” Persistent pain, disrupted sleep, heightened threat response, fear, reduced confidence, and avoidance can interact in ways that interfere with rehabilitation.

Recognizing those factors earlier gives the treatment team an opportunity to address barriers rather than allowing them to become part of a prolonged recovery pattern.

That is the science behind whole-person recovery.

Scientific Resources

• Runge N, et al. The bidirectional relationship between sleep problems and chronic musculoskeletal pain: a systematic review with meta-analysis.PAIN. 2024;165(11):2455-2467.
• Babiloni AH, et al. The Impact of Sleep Disturbances on Endogenous Pain Modulation: A Systematic Review and Meta-Analysis.The Journal of Pain. 2024;25(4):875-901.
• Whibley D, et al. Sleep and Pain: A Systematic Review of Studies of Mediation. Review of the interconnected pathways between sleep, pain, mood, anxiety, fatigue, cognition and cortisol reactivity.
• Runge N, et al. Systematic review evidence also supports prospective associations between sleep problems and chronic musculoskeletal pain.

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Delainne Bond

Delainne Bond, BSN, RN, holds dual degrees in Nursing and Neuropsychology. She is the Founder and Chief Clinical Analyst with ProMedView and the Founder of the covidCAREgroup.

Recognized as a leader in clinical solutions for complex injuries and illnesses, Delainne has a broad spectrum of clinical experience including Workers’ Compensation, acute and critical care in the hospital setting, occupational medicine, and community health.

In the national Workers’ Compensation arena, Delainne is highly regarded for her thought leadership. Her experience includes national leadership, risk management, catastrophic case management, mass casualty incident response, critical incident management, and provider network development.

Since the event of the pandemic, Delainne has devoted her clinical expertise to researching Long COVID, offering education and resources on a global scale through the covidCAREgroup.

In addition to educating providers, clinicians, attorneys, case managers, and nurses, Delainne has published many articles about Long COVID with ~40 million views in between 2020-2025. She runs the largest clinical social media support groups in the world with followers and collaborators including physicians, clinicians, and business leaders from 110 countries.

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The Cost of Waiting