It is something I hear frequently from people living with chronic pain. “My pain is definitely worse when I’m stressed.”
Or: “If I haven’t slept properly, I know the next day is going to be difficult.”
And sometimes this is followed by a slightly worried question: “Does that mean the pain is all in my head?”
No.
Your pain is real. But understanding why stress, tiredness and worry can turn up the volume on pain can be incredibly helpful. Because rather than proving that your pain is imagined, it tells us something important about how pain works.
And, crucially, it gives us more opportunities to influence it.
Pain is more than a message from the body
We used to think about pain in quite a simple way. Something happens in the body, a pain signal travels to the brain and the brain receives the message. But we now understand that pain is much more complex than that.
The brain doesn’t simply receive information from the body. It evaluates that information alongside many other things. What has happened before? Does this situation seem threatening? Am I safe? Am I exhausted? Am I frightened? What am I expecting to happen? How much attention am I paying to the sensation? What else is happening in my life?
The brain takes all of this information into account when deciding how much protection it believes you need.
And pain is one of the ways the nervous system protects us.
This helps explain something that can initially seem very strange: The same body can experience different levels of pain at different times.
Think of pain as a volume control.
I often find it helpful to think of pain as having a volume dial.
There may be information coming from the body, but the nervous system can turn the volume up or down depending on what else is happening.
Stress can turn it up. Poor sleep can turn it up. Fear can turn it up. Worrying about the pain can turn it up. Feeling unsafe can turn it up. Previous experiences can influence it.
But other things can sometimes help turn the volume down.
Feeling safe. Being absorbed in something enjoyable. Moving confidently. Relaxation. Good-quality sleep. Connection with other people. Understanding what is happening. Feeling less frightened by the sensations.
This doesn’t mean that you can simply think your pain away. It means that pain is modifiable.
And I think that is an important message.
What happens when you’re stressed?
Imagine you are having a particularly difficult week. There is pressure at work. Someone in your family needs you. You are worried about money. You aren’t sleeping particularly well. And then your pain increases. It can feel as though your body has suddenly deteriorated.
But consider what is happening within your nervous system.
When we are stressed, the body prepares us to deal with threat. Our heart rate may increase. Our breathing changes. Muscles can become tense. Attention becomes more focused on potential problems. We become more vigilant. This is useful if we genuinely need to respond to immediate danger.
But when stress continues for days, weeks or months, the nervous system can remain in a heightened state of alert.
And a nervous system that is already on high alert may become more protective. The pain volume can increase.
“But the stress isn’t causing my pain”
This distinction is really important.
Sometimes people feel dismissed when someone says: “It’s probably stress.”
They hear: There’s nothing physically wrong. Or: You’re imagining it. Or even:
You’re causing this yourself.
That isn’t what I mean.
Stress doesn’t have to be the original cause of pain to influence how intensely pain is experienced. You can have a very real physical condition and still notice that your symptoms change depending on what is happening elsewhere in your life.
Both can be true. There can be changes in the body and changes in the nervous system.
This isn’t either/or.
Why does tiredness make such a difference?
Sleep and pain have a particularly interesting relationship. Pain can make it harder to sleep. You struggle to find a comfortable position. You wake during the night. Perhaps you begin worrying about whether you’ll sleep. Then you wake the following morning exhausted. And when we are sleep deprived, our ability to regulate pain can be affected. Pain may feel more intense. Our tolerance for discomfort may reduce. Our emotions can become more difficult to regulate. We may feel more anxious or irritable. Normal challenges feel harder. Which can increase stress. Which can increase pain. Which can make sleep more difficult again.
You can see how easily a cycle develops:
Pain → poor sleep → exhaustion → increased sensitivity → more pain → poorer sleep.
This is why improving sleep can be such an important part of chronic pain management.
Not because poor sleep means your pain isn’t real, but because sleep is one of the systems that influences how the brain and body process pain.
You might find this book helpful, if you struggle with sleep: Sleeping with Pain: Strategies for a restful night from a pain management expert
And then there is worry
When you have experienced pain for a long time, it is very difficult not to worry about it.
Why is it worse today? Have I done something wrong? Is something getting worse? Will I be able to work tomorrow? Should I cancel the weekend? What if this never gets better?
Your attention naturally moves towards the pain. You check it. You monitor it. You compare it with yesterday. You test movements. You search online. You try to work out what caused today’s increase.
This is completely understandable as your brain is trying to solve a problem. But there is an unfortunate consequence.
The more important and threatening something appears, the more attention the brain gives it.
And increased attention can make sensations feel louder.
The pain–fear–attention loop
Imagine you notice a familiar pain. Your thought is: “Oh no. It’s starting again.”
That creates anxiety. Anxiety increases vigilance. You begin checking the pain. Because you are checking it, you notice every small change. Those sensations reinforce the belief that something is wrong. Your anxiety increases. Your body becomes tense and the pain becomes louder.
Pain leads to fear. Fear leads to increased attention. Increased attention amplifies the pain and the increased pain confirms the fear.
This can become an exhausting loop. But loops can be interrupted.
What can I actually do about it?
The answer isn’t to tell yourself to “stop stressing.” I’ve never found that particularly helpful advice.
Instead, we can begin looking at the different things that may be turning up your pain volume.
You might start by noticing patterns – What tends to happen before your pain increases?
Not just physically. What was your sleep like? What was happening at work? Were you rushing? Had you been worrying? Were you doing too much? Had you stopped doing things you enjoy? Were you feeling isolated? Were you constantly checking your symptoms?
You are not looking for something to blame. You are gathering information.
Send your nervous system signals of safety
If pain is partly about protection, one of the things we can work on is increasing the nervous system’s experience of safety.
That might include slowing your breathing. Relaxing muscles that are unnecessarily braced. Moving gently and confidently. Improving your sleep routine. Spending time with people who help you feel safe and supported. Reducing repeated checking of symptoms. Using relaxation, mindfulness or hypnosis. Returning gradually to activities you have been avoiding. Doing something enjoyable enough that your attention moves away from monitoring your body.
None of these things means ignoring pain.
They are ways of helping your nervous system recognise: “I am safe enough right now.”
Don’t underestimate enjoyment
This is something I think we sometimes forget in healthcare.
When you live with chronic pain, life can become very focused on treatment. Appointments. Medication. Exercises. Pacing. Symptom diaries. Research. Pain management strategies.
Everything becomes about trying to get better.
But as I explain in my pain psychology clinics in Milton Keynes and online, enjoyable experiences matter too.
Laughing with someone. Listening to music. Sitting somewhere beautiful. Being absorbed in a hobby. Playing with your children or grandchildren. Spending time with an animal. Doing something creative. Having a conversation where nobody asks about your pain.
These aren’t frivolous extras. These are essentials, they provide the nervous system with different information.
There is more happening here than pain.
Your flare-up or set back doesn’t necessarily mean you’ve gone backwards – This is another important point.
If your pain increases during a stressful week, after several poor nights of sleep or during a period of anxiety, it can be frightening. You may think: “I’m back to square one.”
But increased pain doesn’t necessarily mean increased damage, and it doesn’t erase the progress you have made.
Sometimes a flare-up or set back is better understood as a nervous system that has temporarily become more protective.
Instead of immediately asking: “What have I damaged?” you might gently ask: “What has my nervous system been dealing with recently?”
That question often produces a very different answer.
Your pain is real – and it can change
Perhaps the most important thing I want people with chronic pain to understand is this:
Your pain being influenced by stress, sleep, worry or emotion does not make it any less real. Every pain experience involves the brain and nervous system. That is simply how human pain works. And rather than being discouraging, I think this understanding can offer hope. Because if pain were determined only by the physical state of the body, there would be far fewer opportunities to influence it.
Instead, we can work with many different parts of the pain system.
We can improve sleep. Reduce fear. Change how we respond to sensations. Reduce unhelpful symptom monitoring. Build confidence in movement. Manage stress differently. Increase experiences of safety. Reconnect with people and activities that matter. And gradually teach the nervous system that it doesn’t always need to protect you quite so loudly.
So, the next time you notice your pain becoming louder during a stressful, exhausting or worrying period, try not to immediately assume that something has gone wrong.
Perhaps ask yourself: “What might be turning up my pain volume today?”
And then, just as importantly: “What could help me turn it down, even a little?”
Because sometimes managing chronic pain isn’t about fighting the pain harder.
It’s about helping your nervous system feel safe enough that it doesn’t need to shout quite so loudly.