How stress is affecting your pain

Did you know that stress can amplify your pain or prevent it from getting better? Stress is part of our fight-or-flight response and can help us switch into survival mode whether it be during an emergency or a brutal board room meeting. During this process, a hormone called Cortisol is released which is very helpful in the short term but can be crippling in the long term. The prolonged secretion of Cortisol can lead to a cycle of stress and pain that can delay your recovery. Identifying the presence of stress in your life is essential in breaking the cycle.

Cortisol is a vital hormone that helps maintain blood glucose levels and helps redirect energy to the brain and other system where it is needed most. It is also a potent anti-inflammatory. During a stress response, as surge In Cortisol promotes alertness, goal-directed behaviour, and readies us to escape from danger. Cortisol levels can remain elevated for hours following as stress response. Afterwards, the body returns to its normal rest-and-digest state which, in turn, promotes healing, immunity and the growth of tissue and bone. If, for some reason that we may not even realise, we believe that the danger is not over, then the stress response continues which can initiate, exacerbate, or prolong the pain experience. However, after some time at an elevated state, Cortisol can become depleted which leaves the body vulnerable to inflammatory disorders such as fibromyalgia. In humans, stress-induced inflammation has been implicated in diseases such as osteoporosis, rheumatoid arthritis, myopathy, fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, temporomandibular joint dysfunction, chronic low back pain, sciatica, and more.

Pain itself may be a potential stressor. For example, if you have previously injured your back after bending down, your brain might have stored that information and adapted it to believe that you will hurt your back EVERY time that you bend down.  In preparation, your body will go into fight-or-flight mode before you even start bending which may exacerbate pain and disability causing you to become even more afraid of bending down which leads to further stress and elevated Cortisol levels and so the cycle continues. Understanding your body’s stress response and teaching your brain to think differently is part of the healing process to break the cycle.

Pain is the leading cause of disability, decrease in work productivity, poor quality of life and rising medical expenses. It is also the primary symptom driving patients to seek physical therapy. The early identification of stress is vital in the management of pain and preventing the transition into chronic pain and disability. Therefore, healthcare professionals include screening questions in their interview that might not seem relevant but can ultimately lead to the effective management of pain.

Other effects of stress on the body can present as follows:

  • Rapid Heartbeat
  • Aches and Pains
  • Frequent Colds
  • Skin Complaints
  • Indigestion
  • High Blood Pressure
  • Moodiness
  • Fatalistic Thinking
  • Panic
  • Anxiety
  • Frustration

If you think you might be stressed, you can follow this link to the Stress Management Society and complete their free stress test.

Individual Stress Test – The Stress Management Society

They also provide free resources for managing stress as well as lots of useful information.



  1. C Abdallah, P Geha, Chronic Pain and Chronic Stress: Two Sides of the Same Coin?, Chronic Stress (Thousand Oaks), 2017, vol.1 :1-10
  2. K Hannibal, M Bishop, Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation, Phys Ther. 2014
  3. E Vachon-Presseau et al, The stress model of chronic pain: evidence from basal cortisol and hippocampal structure and function in humans, Brain, 2013
  4. Ann-Marie D’arcy-Sharpe, The Stress & Chronic Pain Cycle (and how to break it!) (Pathways November 22, 2019)< > Accessed 07 April 2022