How Stress and Physical Pain Feed Each Other

Stress and pain can keep each other going by more than one route. Stress produces physical symptoms, including muscle tension and pain. Pain, in turn, can trigger fearful thinking and avoidance, which researchers describe as a loop that keeps pain and disability going. None of this means the pain is imaginary. It means there are several points in the loop where you can intervene, and hypnosis can help at some of them.

How does stress show up in the body?

The NHS page on stress lists physical symptoms including headaches, muscle tension or pain, stomach problems and a faster heartbeat. It explains that when you feel anxious or scared, your body releases stress hormones such as adrenaline and cortisol. That is useful in short bursts; being stressed all the time is what turns it into a problem.

How does pain feed fear and avoidance?

The fear-avoidance model, introduced by Lethem et al. in 1983, describes how some people develop and maintain chronic musculoskeletal pain through pain-related fear. The sequence it describes runs like this:

1. Pain is interpreted as a sign of something catastrophic.
2. The person avoids activities that might bring it on and overestimates how much they will hurt.
3. Less activity weakens the body, and the person declines physically and mentally.

Avoidance has a place: it protects an injury while it heals. The model’s point is that it becomes harmful when it continues after healing. A questionnaire developed by Waddell et al. in 1993 found that fear-avoidance beliefs about physical activity were strongly related to work loss.

The model has critics. Some researchers have questioned how well it predicts actual avoidance of activity, and the article notes that it may be too simple for every situation involving fear and chronic pain, while adding that its usefulness for understanding how people react to fear is generally acknowledged.

What is pain catastrophizing?

It is the tendency, described in the Wikipedia article on pain catastrophizing, to describe pain in more exaggerated terms than average, to ruminate on it (“I kept thinking ‘this is terrible'”), and to feel helpless about it (“I thought it was never going to get better”). Michael J. L. Sullivan, Scott R. Bishop and Jayne Pivik built the Pain Catastrophizing Scale around those three parts: rumination, magnification and helplessness.

The article describes cognitive behavioral therapy, typically delivered over 6 to 12 weeks, as the primary treatment.

Does this mean my pain is psychological?

No. Pain researchers also describe central sensitization, a hyperexcitability of the nervous system linked to conditions such as fibromyalgia. The article also reports that a 2024 review found significant limitations in the evidence for central sensitization as the underlying mechanism of such conditions, so the science of how pain persists is still developing. Either way, the pain is real, and new or changing pain needs a medical assessment before any of the steps below.

Can hypnosis break the stress-pain loop?

At the parts of the loop that involve tension and fear:

• Tension: practicing deep relaxation to bring down the physical side of stress.
• Catastrophizing: rehearsing noticing the “this is terrible” thought and answering it with a more accurate one.
• Avoidance: picturing yourself returning, in small steps, to an activity you have been avoiding, as preparation for the real attempt.

It works alongside medical care, physical therapy and cognitive behavioral therapy, not instead of them.

Find your loop

Fill in three blanks the next time your pain rises: “When the pain goes up, I think . Then I avoid . Over time, my body _.” Take the answers to your doctor or therapist; they can help show which part of the loop to work on first.

This article is general information, not medical or psychological advice; talk with a licensed clinician about your own situation.