Why does my pain get worse when I’m stressed?
Your week gets busier, sleep gets patchier, and a familiar ache suddenly becomes harder to ignore. Stress can increase pain by influencing how your nervous system processes it, and by affecting muscle tension, sleep and daily habits. That does not mean the pain is imaginary—or that stress explains every single flare-up. [1,2]
Understanding the connection can give you more options than being told to “just relax”. A phrase which, in the history of stressful days, has rarely improved one.
How can stress affect something as physical as pain?
Pain is a real experience influenced by biological, psychological and social factors. Your tissues matter, but so do the systems that interpret and respond to information from them. [3]
Stress can change the way those systems regulate pain. Annoyingly, it does not always turn pain up: some stressful situations temporarily reduce it. The effect depends on the situation and the person. Research into stress and pain describes both responses, rather than one universal “stress mode”. [1]
You may also notice that you brace your shoulders, clench your jaw or sleep differently during difficult periods. These are useful things to discuss during an assessment, alongside changes in activity, an existing condition or a recent injury. [2]
Think of stress as one possible contributor to the overall picture. It may help explain why an existing problem feels worse without being the reason that problem began.
Does that mean the pain is all in my head?
No. A psychophysiological (i.e. mindbody) influence does not make a physical experience less real. The International Association for the Study of Pain explicitly recognises the many influences on pain and the importance of respecting the person’s account of it. [3]
Equally, pain that changes with stress does not prove that your tissues are healthy, that you have hidden trauma, or that you are somehow creating your symptoms. A reassuring scan alone cannot establish those conclusions either.
You do not need to choose between “physical” and “stress-related”. Several contributors can exist together. An assessment should leave room for that complexity, rather than squeeze you into a single explanation.
What can I do when a familiar pain flares up?
If the pain has already been assessed and this feels like your usual pattern, start with a manageable adjustment. Turning recovery into another full-time project is unlikely to make the week easier. Pick your battles wisely.
Notice the wider picture. Has something changed in your workload, activity, sleep or support? A brief note can help you explain a pattern to your practitioner. You do not need to monitor every sensation or find an emotional meaning behind every ache.
Use movement that suits your situation. For common back pain, NHS advice encourages staying active rather than prolonged bed rest. That is not an invitation to push through escalating symptoms. Follow advice relevant to your condition and seek guidance if movement consistently makes things worse. [4]
Make one practical change to the pressure. Asking for help, adjusting a deadline or leaving a gap between commitments may be more useful today than adding another wellbeing task. The NHS suggests small, achievable steps and seeking support when stress becomes difficult to manage. [2]
Where do meditation, Tai Chi and Qigong fit?
These practices offer different ways to explore attention, breathing and movement. They are options, not requirements for recovery.
Meditation does not have to mean sitting perfectly still with an empty mind. A brief practice might involve noticing sounds around you and gently returning your attention when it wanders. Research on mindfulness and meditation for pain is mixed, and structured research programmes are not interchangeable with every meditation course. [5]
If focusing inward makes you more anxious or uncomfortable, you can stop, keep your eyes open or choose a different activity. Meditation is not universally calming, and an uncomfortable response is not a personal failure. [5]
Tai Chi and Qigong combine movement with attention and breathing. Some people find movement a more appealing starting point than sitting meditation. Research suggests benefits for some particular conditions, but findings vary by practice and diagnosis; evidence for Tai Chi cannot simply be transferred to every Qigong programme. [6,7]
At QiBodyWisdom, movement and meditation sit alongside my clinical work. They offer opportunities to practise skills between appointments when appropriate. They do not replace assessment or necessary medical treatment, and you do not have to use all of them.
How does this connect with integrated osteopathy and pain reprocessing therapy?
My work at QiBodyWisdom brings together osteopathic assessment, physical rehabilitation and consideration of the wider factors affecting your symptoms. We start with your history and the appropriate clinical assessment, including whether further medical investigation or referral is needed.
Depending on your needs and preferences, a plan may include hands-on osteopathic care, movement advice active mobility or strength training and pain education. My SIRPA training also informs conversations about stress and the relationship between emotions, behaviour and symptoms. Discussing these factors should never mean assuming that every symptom has an emotional cause. With your approval and when appropriate we can explore this together.
Pain Reprocessing Therapy, or PRT, is a specific psychophysiological approach that aims to change the interpretation of certain persistent pain sensations as threatening, following appropriate assessment. A randomised trial (The Boulder Back Pain study) involving 151 adults with primary chronic back pain found greater pain reductions with PRT than with placebo or usual care, with benefits maintained at one year. (96% of patients improved, and 66% had full or almost full resolve of their symptoms with improvements maintained) [8]
That is encouraging evidence for the studied group and protocol. It is not proof that all persistent pain is learned, or that SIRPA, osteopathy and PRT are interchangeable, which is why the most important aspectt of all care is that thorough medical checks have been performed to rule out any hidden issues.
When should I get pain checked?
Seek advice for new, unexplained or changing pain, or pain that is disrupting daily life. Do not assume it is stress simply because you are having a difficult week.
For back pain, get urgent GP advice or contact NHS 111 if it becomes severe suddenly, worsens quickly, or comes with feeling feverish or generally unwell. Back pain with new bladder or bowel changes, loss of feeling around the genitals or anus, or symptoms such as weakness or numbness in both legs needs emergency assessment: call 999 or go to A&E. [4]
Finding a useful starting point
Stress can influence pain without being its only cause. Your symptoms deserve to be taken seriously, and a helpful plan can consider both your physical health and what life is asking of you.
If you would like to discuss whether my approach fits your situation, contact me at QiBodyWisdom. I offer appointments in Lee Green, SE12, and online support where appropriate. We can discuss whether assessment, rehabilitation or another service is the most useful next step.
Kathi Meier M.Ost — Osteopath, SIRPA practitioner and Tai Chi/Qigong instructor. About Kathi.
Sources and useful further reading
- Ferdousi M, Finn DP (2018). Stress-induced modulation of pain: Role of the endogenous opioid system. A research review explaining why stress can either increase or reduce pain; it does not diagnose an individual’s symptoms.
- NHS. Stress. Accessible information on physical symptoms, everyday steps and routes to support.
- International Association for the Study of Pain. Pain terminology and definition. Explains pain as a personal experience with biological, psychological and social influences.
- NHS. Back pain. Practical activity advice and guidance on when to seek routine, urgent or emergency care.
- NCCIH. Meditation and mindfulness: Effectiveness and safety. Reviews benefits, uncertainties and possible unwanted effects.
- NCCIH. Low-back pain and complementary health approaches. Summarises the condition-specific evidence, including Tai Chi and mindfulness-based approaches.
- NCCIH. Qigong: What you need to know. Explains the practice and the limitations of research for different conditions.
- Ashar YK et al. (2022). Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain. JAMA Psychiatry, 79(1), 13–23. A randomised trial in primary chronic back pain, not a trial of the complete QiBodyWisdom service.