The psychosomatic nature of physical pain: when the cause isn’t muscular

The typical journey for someone with chronic pain is a vicious circle: a GP, an MRI scan, a course of painkillers, massage, temporary relief, and then another flare-up. A pile of perfectly normal test results accumulates, yet the pain persists. The exhausted patient begins to doubt either the doctors’ expertise or their own sanity.

Traditionally, pain is perceived as a consequence of trauma or inflammation. But clinics are increasingly encountering cases where severe discomfort lasts for months, even though examinations reveal no abnormalities. This is no fiction. Neurophysiological data prove that one’s psycho-emotional state can directly alter the perception of physical pain, regulate muscle tone and rewire the nervous system.

Psychosomatic pain is a highly complex interdisciplinary subject at the intersection of neurology, psychotherapy and the physiology of stress. When diagnosing it, it is equally dangerous to ignore psychological factors as it is to attribute any unclear symptom solely to nervous tension. A scientific approach requires a clear understanding of the biological links between the brain and the body.

How the mind affects the body

From a biological perspective, chronic stress is not merely a bad mood, but a cascade of physical reactions. When under stress, the brain activates the hypothalamic-pituitary-adrenal (HPA) axis – the body’s primary stress control centre. Excess cortisol and adrenaline are released into the bloodstream, and the autonomic nervous system switches to a state of high alert.

In the wild, this mechanism saves lives: when danger strikes, the muscles tense instantly, preparing for flight or fight. But if stress becomes chronic and there is no physical release (a person worries for months about work or debts), muscle tone remains consistently elevated. The muscles lose their ability to relax completely. Most often, the following areas enter this state of constant readiness:

The neck and shoulders. The trapezius muscles react to stress with the most ancient defensive reflex – an attempt to pull the head into the shoulders.
Lower back. The deep back muscles are the first to tense up, preparing the body for exertion.
Jaw. Tension in the masticatory muscles leads to bruxism – night-time teeth grinding and pain in the temporomandibular joint.
Chest. Spasms in the intercostal muscles prevent deep breathing, causing a false sensation of heart problems.
Abdomen. Spasms occur in the smooth muscles of the intestines, disrupting digestion.

A standard massage here provides only a short-term effect. It works on the tense muscle at the periphery, but cannot override the ‘tension’ command that is continuously sent from the brain.

Prolonged stress leads to central sensitisation – a malfunction in the nervous system’s sensitivity settings. The brain begins to perceive normal signals from the body as pain signals. This is like a faulty car alarm that goes off not from an impact, but from a light breeze. The nerve endings are functioning normally, but the overloaded brain interprets any slight tension as a signal of serious injury.

Why the body ‘remembers’ tension

The mind and body do not exist in isolation. Any strong emotional experience is instantly reflected in the body’s physiology:

Fear causes muscle spasms and constricts small blood vessels. Less blood and oxygen reaches the tense muscle, and oxygen deprivation in the tissue always triggers pain.
Anxiety disrupts the breathing rhythm. A person begins to breathe shallowly and rapidly, which increases the overall excitability of the nerve endings.
Suppressed anger causes us to unconsciously clench our teeth and clench our fists, preparing the body for aggression that finds no outlet.

This mechanism underlies irritable bowel syndrome, tension headaches and fibromyalgia. Major medical organisations (including the Mayo Clinic and the UK’s NICE) officially include psychotherapeutic methods in their treatment protocols for chronic pain. This is not done simply to distract the patient, but to physically alter the activity of pain centres in the cerebral cortex.

Psychosomatics has nothing to do with malingering. Using functional MRI, scientists have proven that in people with chronic non-specific pain, the areas of the brain responsible for emotions (the amygdala) are active simultaneously with the areas that perceive physical pain. Their pain is absolutely real; it is simply that its source lies in the nervous system’s ‘software’, rather than in the structure of the skeleton.

When pain requires more than just pills

Attempting to treat chronic pain exclusively with analgesics and anti-inflammatory drugs is one of the main systemic errors. Taking these medicines for more than 10–14 days a month not only fails to resolve the issue of brain hypersensitivity but also leads to complications: stomach ulcers, kidney damage and even medication-overuse headaches, where the head starts to ache from the painkillers themselves.

There are clear signs that the pain is psychosomatic in nature:

The intensity of symptoms depends directly on levels of fatigue, stress or conflict.
The pain moves around: today it’s a backache, tomorrow a shoulder ache, and a week later the discomfort shifts to the abdominal area.
Detailed examination results (MRI, CT scans, tests) show no pathologies capable of causing the distressing symptoms.
The pain is accompanied by poor sleep, constant fatigue, anxiety or apathy.
Physiotherapy and massage provide relief for a couple of days at most.

In such cases, treatment must be comprehensive. It includes:

Cognitive behavioural therapy (CBT). This method helps break the habit of catastrophising pain and severs the link between the physical sensation and the fear of it.
Adjusting sleep patterns. It is only during the deep sleep phase that the body produces substances which naturally dull pain.
Reducing anxiety levels. The lower the background anxiety, the fewer excessive stress signals are sent to the muscles.
Breathing exercises. Diaphragmatic breathing with a prolonged exhalation stimulates the vagus nerve, which shifts the body from ‘fight’ mode to ‘rest and recovery’ mode.
Regular exercise. Moderate activity (walking, swimming) prompts the body to produce endorphins – natural internal painkillers.

Why patients find it difficult to accept the psychosomatic factor

Many people perceive the recommendation to see a psychotherapist as an insult. The phrase ‘you have a psychosomatic condition’ is often interpreted as an accusation of malingering: “You’re making it all up; go and get your nerves treated.”

This mistrust has arisen due to the abundance of pseudoscientific literature, where illnesses were attributed to absurd metaphorical causes (for example, claims that angina is caused by unspoken grievances).

Evidence-based medicine approaches psychosomatics without mysticism. It is about specific biological mechanisms. Prolonged pain depletes serotonin and noradrenaline levels in the nervous system. This lowers the pain threshold: what was previously felt as mild discomfort now causes severe suffering. A vicious circle is formed: stress triggers muscle tension and pain, whilst constant pain depletes the nervous system and intensifies stress. It is impossible to break this cycle through sheer willpower alone.

This is precisely why effective treatment for chronic pain has long gone beyond simply prescribing painkillers. Patients require a comprehensive approach aimed at retraining the sensitised nervous system and restoring its normal functioning.

FAQ: Answers to frequently asked questions

Can stress really cause actual physical pain?

Yes. During prolonged stress, muscles are constantly tense, which impairs their blood supply. Furthermore, the brain’s pain-relief system becomes depleted, causing it to perceive even weak signals from receptors as severe pain.

If the pain is psychosomatic, does that mean the person is physically healthy?

Structurally, the organs and tissues may be fine – with no injuries, tumours or hernias. However, the nervous system’s function is impaired. A disruption in the regulation of pain sensitivity is just as much a real condition requiring professional help as ordinary inflammation.

Is it necessary to have tests and an MRI if psychosomatic causes are suspected?

Yes, this is an essential step. The psychosomatic nature of the pain can only be established by a process of elimination. First, doctors must carry out standard diagnostic tests to completely rule out any underlying inflammatory, autoimmune or oncological processes in the body.

Why are antidepressants sometimes prescribed for chronic pain?

In this case, they are not prescribed to treat depression. Certain groups of these drugs, when taken in small doses, can restore the body’s natural pain-blocking mechanisms in the spinal cord and brain. This reduces the nervous system’s overall sensitivity to pain signals.

How exactly can talk therapy reduce physical pain?

Psychotherapy (in particular, cognitive-behavioural therapy) alters the brain’s response to pain signals. When a person stops panicking and expecting the worst with every twinge in their body, the brain stops releasing stress hormones, the muscles relax, and the intensity of the pain decreases on a physical level.

Why does massage only help for a couple of days with this kind of pain?

Massage temporarily relaxes the muscle itself. But if the brain, due to background stress, continues to send constant tension signals to that muscle, the spasm will inevitably return within 24–48 hours. For a lasting effect, you need to address the source of the signals in the central nervous system.

Where can you save money when treating chronic pain, and where shouldn’t you?

You shouldn’t skimp on high-quality initial diagnostics (to ensure you don’t miss any organic pathology) or on consultations with relevant evidence-based specialists. You can save on endless repeat MRIs for monitoring, expensive dietary supplements (DSs) and drips containing nootropic drugs, the effectiveness of which in treating pain has not been proven.