Why Does My Pain Get Worse When I'm Stressed? Understanding the Connection Between Stress and Chronic Pain

If you live with chronic pain, you may have noticed that your symptoms aren't always consistent. Some days, you can go about your usual activities without much difficulty. Other days, the same activities leave you hurting, even though you haven't done anything particularly different.

For some people, those fluctuations seem to follow periods of increased stress. Maybe your pain gets worse during a demanding week at work, after a difficult conversation, or when you've been sleeping poorly. You might notice the pattern without fully understanding why it's happening.

It's a connection worth paying attention to, especially because chronic pain is so often discussed as though it's either a physical problem or an emotional one. In reality, the relationship between stress and pain is much more complicated, and understanding it can offer some useful insight into why symptoms change.

As a therapist who specializes in chronic pain and mind-body symptoms, I work with people who have often spent years trying to understand what's happening in their bodies. Many have undergone extensive medical testing, tried multiple treatments, and received conflicting explanations along the way. For some, the suggestion that stress could be influencing their symptoms has felt dismissive, particularly when they've already struggled to have their pain taken seriously.

That frustration makes sense. Fortunately, our understanding of chronic pain has evolved considerably, and we now know much more about the role of the brain and nervous system in how pain develops, persists, and changes over time.

Why Does Stress Make Chronic Pain Worse?

To understand why stress can make pain worse, it helps to understand a little about how pain works in the first place.

Most of us grow up thinking about pain as a direct reflection of what's happening in our bodies. If something hurts, we assume there must be an injury, inflammation, or another physical problem causing it. Sometimes that's exactly what's happening. If you sprain your ankle, the pain you experience helps protect the injured area while it heals.

But pain is more complex than a signal traveling directly from an injured body part to your brain. Your nervous system detects information about potential threats, and your brain uses that information, along with your past experiences, expectations, emotions, and environment, to produce the experience of pain.

This process is happening constantly, usually without our awareness.

The National Institute of Neurological Disorders and Stroke describes pain as a biopsychosocial experience, meaning that biological, psychological, and social factors all influence how we experience it. This includes things like inflammation, nervous system functioning, stress, sleep, emotional experiences, and the circumstances of our daily lives.

When you're under stress, your body responds in ways that can affect pain. Stress-related hormones such as adrenaline and cortisol influence nervous system activity, while changes in muscle tension, sleep, and attention can make physical discomfort more noticeable or intense. These responses are part of the body's normal stress response, but when stress becomes prolonged, they can contribute to an ongoing pattern of physical symptoms.

This helps explain why someone might experience more intense back pain during a stressful period, even when they haven't injured their back or changed their usual activities. Their pain may be influenced by changes in how their nervous system is processing sensations, along with other factors affecting their body at that time.

How the Nervous System Can Become More Sensitive to Pain

One of the more interesting developments in chronic pain research is our understanding of how the nervous system can become sensitized.

When pain persists, the nervous system can sometimes become increasingly responsive to sensory information. Sensations that previously felt neutral or manageable may begin to feel uncomfortable, and existing pain can become more intense. Researchers describe different aspects of this process using terms such as central sensitization and nociplastic pain.

This is particularly relevant for people whose pain continues after an injury has healed or whose symptoms don't seem to correspond with the findings of medical imaging.

For example, someone might develop back pain after an injury and initially experience pain because of tissue damage. As the injury heals, the nervous system may continue responding as though the area needs protection. Over time, certain movements or sensations can become associated with pain, even when the original injury is no longer the primary source of the problem.

Stress can influence this process because the nervous system is also involved in detecting and responding to threats. When someone is experiencing ongoing stress, the systems involved in pain processing may become more reactive.

This is one reason chronic pain can sometimes feel unpredictable. A movement that causes discomfort one day may feel completely fine another day. Someone might experience increased symptoms during a stressful week and notice improvement when their circumstances become less demanding.

It's important to recognize that chronic pain can have many contributing causes, including ongoing medical conditions, inflammation, nerve injury, and structural problems. Sensitization is one possible contributor, and it can also occur alongside other medical conditions. Appropriate medical evaluation remains important, especially when symptoms are new, changing, or unexplained.

The Relationship Between Pain, Fear, and Anxiety

One of the most difficult aspects of living with chronic pain is the uncertainty that often comes with it.

When you've experienced repeated pain flare-ups, it's natural to become more attentive to what's happening in your body. You may start noticing sensations you previously would have ignored, anticipating which activities could make your symptoms worse, or worrying about how you'll manage your responsibilities if your pain increases.

These responses usually develop through experience. If you've had a flare-up that left you unable to work, care for your children, or participate in something important, it makes sense that you'd want to prevent it from happening again.

The difficulty is that fear and anticipation can sometimes influence the pain experience itself.

Imagine someone who has experienced several episodes of severe back pain. One morning, they notice a familiar sensation while getting dressed. They immediately remember how painful the previous episodes were and begin worrying that another flare-up is starting. Throughout the day, they pay close attention to their back, avoid certain movements, and repeatedly check whether the sensation is getting worse.

That increased attention and fear can affect how the brain interprets the sensation. Muscle tension may increase, movement may become more guarded, and the nervous system may become more responsive to discomfort. As the pain intensifies, the person's concern that something is seriously wrong may grow.

Researchers often describe aspects of this pattern through the fear-avoidance model of pain. When someone begins associating pain with danger, they may become increasingly fearful of movement or physical sensations, which can contribute to greater disability and ongoing symptoms.

Of course, avoiding an activity can be appropriate when there's an injury or medical reason to do so. The challenge is identifying when a protective response is still necessary and when it may be contributing to a pattern that's making recovery more difficult.

For people with certain forms of chronic pain, learning to respond differently to physical sensations can become an important part of treatment.

Can Emotional Stress Affect Physical Pain Even When You Don't Feel Anxious?

Something I find particularly interesting in my work is how often people recognize stress in their lives without necessarily identifying themselves as anxious.

They may describe themselves as responsible, organized, productive, or simply accustomed to handling a lot. They're managing work, family responsibilities, relationships, and everyone else's needs, often without much time to consider how they're feeling.

When you've spent years functioning this way, a relatively high level of stress can begin to feel normal.

You might not consciously notice tension while you're navigating a difficult conversation or managing an overwhelming schedule. But your body is still responding to those experiences. You may hold your breath, tighten your jaw, brace your muscles, or remain physically alert long after a stressful situation has passed.

These responses can become habitual, particularly when someone has experienced prolonged stress or has learned to remain attentive to other people's emotions and needs.

For some people, chronic stress is connected to patterns that developed much earlier in life. Perhaps you grew up in an environment where you needed to anticipate conflict, manage other people's reactions, or push aside your own needs. Those experiences can shape how you respond to stress as an adult, even when your current circumstances are very different.

When we're exploring chronic pain in therapy, these patterns can be useful to understand because they give us more information about the circumstances in which someone's nervous system learned to respond to stress.

They may also help explain why someone experiences increased physical symptoms during periods of emotional strain, even when they don't consciously feel particularly anxious.

I've written more about these patterns in Why Can't I Relax? When Your Nervous System Is Stuck in Survival Mode, which explores why slowing down can feel surprisingly uncomfortable for people who are accustomed to functioning under stress.

Does Stress-Related Pain Mean My Symptoms Are Psychological?

This is an understandable concern, particularly for people who have previously felt dismissed by healthcare providers.

When someone has spent months or years living with pain, hearing that stress might be involved can sound like another way of saying their symptoms aren't real. Unfortunately, some people have had exactly that experience in medical settings, where a lack of clear findings has been interpreted as evidence that nothing is wrong.

Our current understanding of pain gives us a much more useful way to think about this.

Pain is always a real experience, and the brain and nervous system are involved in producing that experience regardless of its cause. Stress, emotions, and expectations can influence pain without making it imaginary or voluntary.

Consider someone living with an inflammatory condition. Their symptoms may be caused partly by inflammation that requires medical treatment, while stress and poor sleep may also influence the intensity of their pain. Addressing those additional factors could improve their experience without changing the underlying diagnosis.

For another person, persistent pain may be maintained primarily by nervous system processes that developed after an injury or during a prolonged period of stress. Their treatment needs may look quite different.

Understanding these distinctions matters because different types of pain respond to different interventions. Psychological and mind-body approaches can be helpful components of chronic pain treatment, but they shouldn't be used to dismiss medical concerns or assume that every symptom has the same explanation.

What Is Pain Reprocessing Therapy?

Pain Reprocessing Therapy, or PRT, is an approach developed to treat certain forms of chronic pain by changing how the brain interprets pain signals.

PRT is based on research showing that some persistent pain is maintained by learned nervous system processes rather than ongoing tissue damage. In these situations, the brain may continue interpreting sensations as dangerous even when there isn't an active injury requiring protection.

Over time, fear of pain, attention to symptoms, and expectations about what will happen can reinforce these patterns.

PRT uses a combination of pain education, cognitive techniques, emotional awareness, and somatic strategies to help people change their responses to physical sensations. An important part of this process involves learning to recognize when a sensation may be uncomfortable without necessarily indicating danger.

For example, someone who has experienced chronic back pain might have become fearful of bending, exercising, or sitting for long periods because those activities have previously triggered symptoms. When medically appropriate, treatment may involve gradually approaching these activities while developing a greater sense of safety and confidence in their body's ability to move.

This work often involves noticing how the brain responds to sensations, identifying fear-based interpretations, and practicing new ways of responding.

For some people, emotional experiences also play an important role. Exploring chronic stress, unresolved emotions, or longstanding patterns of self-pressure may help reduce the overall sense of threat their nervous system is responding to.

PRT is most appropriate for people whose pain has a significant learned or neuroplastic component, and determining whether it's a good fit requires consideration of the person's medical history and symptoms.

What Does the Research Say About Pain Reprocessing Therapy?

A randomized clinical trial published in JAMA Psychiatry examined the effectiveness of PRT for adults experiencing primary chronic back pain.

In the study, 66% of participants assigned to PRT were pain-free or nearly pain-free after four weeks of treatment, compared with 20% of participants in a placebo group and 10% receiving usual care. Many of the improvements were maintained at a one-year follow-up.

The findings are encouraging because they suggest that changing how people interpret and respond to pain can lead to meaningful improvements for some individuals.

At the same time, the study focused specifically on primary chronic back pain, and the results shouldn't be generalized to every type of chronic pain. More research is needed to understand which individuals are most likely to benefit and how these approaches compare with other treatments over time.

For people whose symptoms are influenced by nervous system sensitization and learned pain responses, however, this research offers an additional avenue for understanding and treating persistent pain.

What Can Help When Stress Makes Your Pain Worse?

If you've noticed a connection between stress and your physical symptoms, it can be helpful to begin paying attention to the circumstances surrounding your pain.

You might notice that symptoms become more intense after periods of poor sleep, during emotionally demanding situations, or when you're carrying more responsibilities than usual. Sometimes patterns become easier to recognize when you consider what's been happening over several days rather than focusing exclusively on the moment a flare-up begins.

It can also be useful to notice your response when pain appears. If you immediately anticipate that the pain will become severe, begin monitoring every sensation, or avoid activities that have previously been uncomfortable, those reactions may be worth exploring. They often develop for understandable reasons, particularly when pain has disrupted your life in significant ways.

For some people, treatment involves gradually rebuilding confidence in movement and physical activity. For others, it may involve learning to recognize when fear is amplifying symptoms or addressing the chronic stress that has become part of their everyday lives.

And sometimes the work involves examining the expectations you've developed about yourself. If you're accustomed to pushing through discomfort, ignoring your own needs, or feeling responsible for everything around you, your body may be responding to a level of pressure that you've learned to consider normal.

Approaches such as mindfulness and somatic therapy can help people become more aware of these patterns and develop different responses to physical sensations and stress. If you're curious about that work, my article on what somatic therapy is and how it works explains how body awareness can be incorporated into therapy.

The specific approach will depend on the nature of your symptoms, your medical needs, and the factors contributing to your pain.

How Therapy Can Help With Chronic Pain and Mind-Body Symptoms

When I work with clients experiencing chronic pain, I want to understand the full picture of what they've been dealing with.

That includes how their symptoms developed, what medical evaluations and treatments they've undergone, and how pain has affected their daily lives. I'm also interested in the emotional experience of living with persistent symptoms, particularly when someone has spent years feeling uncertain about their health or frustrated by treatments that haven't helped.

From there, we can begin exploring the factors that may be contributing to their experience of pain.

For some clients, that involves identifying patterns of fear and avoidance that developed after painful experiences. Others may recognize that their symptoms are closely connected to chronic stress, perfectionism, difficult relationships, or longstanding habits of pushing through their own needs.

Depending on the person's symptoms and treatment goals, I integrate Pain Reprocessing Therapy, somatic approaches, mindfulness, cognitive behavioral strategies, and insight-oriented therapy.

We might work on changing how someone responds to physical sensations, understanding the emotional patterns that contribute to stress, or gradually rebuilding confidence in activities they've come to associate with pain.

I also think it's important to acknowledge how emotionally exhausting chronic pain can be. Living with persistent symptoms often affects relationships, work, identity, and the way people think about their futures. Having space to talk about those experiences is an important part of therapy, regardless of whether someone's pain is expected to improve through mind-body treatment.

For people whose symptoms are significantly influenced by learned nervous system responses, this work may also help reduce pain intensity and improve daily functioning.

Chronic Pain Therapy in Granada Hills and Throughout California

If you've noticed that stress makes your chronic pain worse, there may be several factors contributing to that experience. Understanding how your nervous system responds to stress, physical sensations, and past experiences can help clarify patterns that previously felt confusing or unpredictable.

At Wildflower Mental Health & Wellness, I provide virtual therapy for adults throughout California, including Granada Hills and the greater Los Angeles area. My work focuses on chronic pain, mind-body symptoms, anxiety, trauma, and the ways long-term stress can affect both emotional and physical well-being.

If you're interested in exploring whether Pain Reprocessing Therapy or a mind-body approach might be appropriate for your symptoms, I'd be happy to learn more about your experience.

Contact me to schedule a free 15-minute consultation to discuss what you're looking for and whether working together might be a good fit.