Why Your Body Hurts During Times of Stress

Health problems and pain are exacerbated during periods of stress.

Reviewed by Abigail Fagan

Key Points: Health problems including headaches and back pain are on the rise. Negative emotions can exacerbate pain, so it's important to develop effective strategies to cope with stress and anxiety.

As a pain expert, the question I get asked most is, “Do you treat physical pain or emotional pain?” My answer is always, “Yes!”

If you’re experiencing pain during this time of stress and sheltering—headaches, migraine, low back pain—you’re not alone. Pain is commonly triggered, and amplified, by negative emotions like stress, anxiety, anger, and depression. And that’s no coincidence: It’s biology.

Contrary to popular belief, emotions don’t just live in your head but also in your body. Nervousness before a presentation creates "butterflies" in your stomach. Depression can make your limbs feel heavy, and make you walk and talk slowly. Fear makes your heart race, eyes widen, breath quicken, palms sweat, and your body feel jittery. Anger can make your face hot, your jaw clench, and your muscles tighten.

Anxiety and stress—emotions commonly experienced during life events from pandemics to politics—also manifest physically, and in different ways for different people. While the human stress response evolved to protect you, it can also wreak havoc on your body—particularly when sustained over long periods. Anxiety and stress can trigger headaches, stomachaches, diarrhea, nausea, vomiting, muscle tension, back pain, chest pain, trouble breathing, dizziness, breakouts, hair loss, weight gain/loss, and a whole mess of other physical symptoms (Mayo, 2019).

It’s easy to attribute these issues to other causes, and we usually do! But there are multiple biological explanations for these physiological responses:

1. Stress hormones

When in a state of distress, the body releases the stress hormones adrenaline and cortisol into the bloodstream. These ready your body for an emergency, triggering the fight-or-flight response so that you can either flee the source of danger or fight it off.

This involves multiple involuntary changes: blood pressure goes up (which can trigger headaches and migraines), breathing becomes shallow (often resulting in light-headedness and dizziness), digestion halts and the enteric nervous system is disrupted (triggering stomachaches, nausea, vomiting, diarrhea, or constipation), blood rushes away from your extremities to your core (causing cold hands and feet), heart rate increases and muscles tighten, including those in your back. These physiological changes can result in body pain from head to toe.

2. Brain changes

The neuroscience of pain helps explain why emotions impact the pain we feel, and why times of stress can be particularly painful. There’s a mechanism in your central nervous system, comprised of the brain and spinal cord, that acts as a pain dial, operating much like the volume knob on your car stereo (Zoffness, 2020).

Many factors regulate pain volume, including stress, anxiety, and mood. When stress and anxiety are high, brain sites that regulate pain—including your cerebral cortex (the part of your brain responsible for thoughts) and limbic system (your brain's emotion center!)—send messages to your pain dial, turning pain volume up (Martucci & Mackey, 2018). This makes your body feel worse. The opposite is also true: when you’re calm and relaxed, experiencing positive emotions like joy and gratitude, the brain sends messages to the pain dial lowering pain volume, making pain feel less bad.

The conclusion: Pain, whether it's in your foot or your jaw, is both physical and emotional, 100 percent of the time.

How to Change Pain

This doesn't mean that pain is "all in your head." But it does mean that to regulate pain, we must find ways to regulate our emotions—particularly our stress, anxiety, and mood. If you’re one of the millions of people living with pain, it’s critical to connect the brain with the body, emotional with physical.

One way to do this is to identify coping mechanisms that help your body feel better. A list of effective strategies can be found here, which includes going outdoors, exercising, finding ways to safely be with friends, using relaxation and mindfulness techniques, and finding a therapist. Indeed, research shows that cognitive behavioral therapy is a particularly effective treatment for chronic pain, is non-addictive and has zero side effects (Murphy and colleagues 2020; Skelly and colleagues 2018). CBT is even associated with a reduced need for pain medications, including opioids (Garland and colleagues 2019). Pain workbooks like this one, rooted in science and research, also offer effective tools for pain management.

Pain is always influenced by thoughts and emotions, and never solely a physical experience. This is good news for anyone experiencing pain and for anyone treating it: To change pain, we can target the brain in addition to the body.

This article is adapted from The Pain Management Workbook, a workbook for people living with pain and the healthcare providers who treat them.