Pain With No Visible Cause: When Your Body Hurts Because of Stress and What to Do About It

What Psychosomatic Pain Is

Psychosomatic pain is pain in which psychological factors such as stress, anxiety, low mood, or past trauma play a major role in causing or maintaining it. This does not mean the pain is not real. The person genuinely feels it, and it can be very severe. It is simply that its source is not tissue damage but the way the nervous system processes signals from the body.

Modern classifications describe these conditions in different ways. ICD-10 has a category of somatoform disorders, including persistent somatoform pain disorder. ICD-11 introduced the concepts of bodily distress disorder and chronic primary pain, and DSM-5 uses somatic symptom disorder. What they have in common is that the body suffers, and the key to relief lies in working with both the mind and the body.

Why the Body Hurts Because of Stress

With chronic stress and anxiety, the body lives in a state of constant readiness. The muscles of the neck, shoulders, back, and jaw stay tense for hours and days, which in itself causes pain. Bowel function is disrupted, the heart beats faster, and breathing changes. Stress hormones and changes in how the nervous system works make a person more sensitive to any unpleasant sensation.

Another important mechanism is central sensitization. When pain lasts a long time, the spinal cord and brain “learn” to amplify pain signals, and even mild sensations are perceived as severe pain. Depression and anxiety intensify this process, while poor sleep and inactivity reinforce it. Paying attention to the body and fearing a serious illness also increase pain: the more a person listens to their body and worries, the stronger the sensations become.

The Vicious Circle of Pain and Anxiety

Pain causes anxiety and thoughts of a serious illness. Anxiety increases muscle tension and sensitivity. The person starts moving less, sleeping worse, and avoiding exertion, and the pain gets worse. Over time, low mood joins in. The circle can be broken at any point, and it is best to break it at several points at once.

Types of Pain Most Often Linked to Stress

Pain related to psychological factors can occur in any part of the body, but some types are especially common. They typically get worse during periods of tension, are linked to fatigue and lack of sleep, ease on vacation or when the person is absorbed in an activity, and show no changes on lab tests or examinations. However, each of these symptoms can also have a physical cause, so a doctor should be seen first.

• Tension headache: a squeezing, “band-like” pain, more often toward evening
• Pain in the neck, shoulders, or back with no signs of spine or nerve damage
• Abdominal pain, bloating, and irregular bowel habits in irritable bowel syndrome
• Chest pain and tightness, a feeling of the “heart being squeezed” during anxiety
• Jaw pain and clenched teeth, especially at night
• Widespread muscle pain, fatigue, and poor sleep
• Pelvic pain not linked to any identified disease

How to Tell Psychosomatic Pain From a Physical Illness

Deciding on your own that “it’s just nerves” is dangerous: similar pain can be caused by diseases of the heart, stomach, spine, or joints. That is why the first step is an examination by a general practitioner or the relevant specialist. If serious causes are ruled out but the pain continues, this does not mean “you’re healthy, go home”; it is a reason to seek help from a psychiatrist or psychotherapist and approach the pain differently.

Some signs always require an urgent or careful medical examination, no matter how stressed the person is: sudden sharp pain; pain with fever, weight loss, bleeding, numbness, or impaired organ function; night pain that wakes you up; and severe headaches appearing for the first time after age fifty. The psychosomatic nature of pain does not rule out that another illness may be developing at the same time.

How Stress-Related Pain Is Treated

The best results come from combining approaches. Cognitive behavioral therapy helps change your relationship with pain, reduce fear and avoidance, and learn relaxation and tension-management techniques. It is particularly effective for chronic pain, tension headaches, and irritable bowel syndrome. Gradual, regular physical activity such as walking, swimming, or therapeutic exercise is also important, even if moving is unpleasant at first.

If the pain is linked to depression or an anxiety disorder, the doctor may prescribe treatment for these conditions. Some medications from the antidepressant group are also used for chronic pain, but only the doctor decides on the choice, dose, and duration. Painkillers taken constantly and without supervision can themselves keep a headache going; this is called medication-overuse headache. During an online appointment at Psychiatry Online, a psychiatrist helps you understand the link between your pain and your emotional state and draws up a plan together with your other doctors.

What You Can Do Yourself

Keep a pain diary: when, where, how severe, and what happened beforehand. This helps reveal links with stress and sleep. Move every day and set aside time for relaxation, such as breathing exercises or progressive muscle relaxation. Keep a regular sleep schedule. Limit painkillers taken without a prescription, and do not keep searching the internet for new diagnoses.

Why It Is Important Not to Put Off Getting Help

Untreated chronic pain tends to spread: new painful areas appear, sleep gets worse, energy declines, and the person gives up work and hobbies. Many people go from specialist to specialist for years, have dozens of tests, and are told “everything is fine,” which only increases their anxiety and the feeling that no one understands them. The sooner the psychological component is addressed, the faster this circle can be broken.

Seeing a psychiatrist about pain does not mean you are considered “crazy” or a fantasist. It is a recognition that the nervous system is part of the body and can suffer just like the joints or the stomach. In Kazakhstan, such a visit is protected by medical confidentiality under the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System,” and an online consultation can be completely anonymous.

When to see a doctor

• The pain has lasted more than three months, and examinations have found no serious cause
• The pain gets worse during periods of stress and comes with anxiety or low mood
• You constantly take painkillers, and the pain returns without them
• Because of the pain, you have started moving less, sleeping worse, and giving up work and activities
• You cannot shake the fear of a serious illness despite normal test results
• Along with the pain, you have insomnia, irritability, or a loss of interest in life

Questions and answers

Reviewed by

Pavel Kornilov, MDPsychiatrist

Depression, anxiety disorders, OCD, bipolar disorder; online medication selection and adjustment.