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If you live with chronic pain, you've likely had many tests: blood work, scans, and referrals. Sometimes, these lead to a diagnosis, but often they don’t. What's often missing from the picture is your story: Not what’s happening in your body, but what you and your body have lived through to get here.
There is now substantial evidence connecting chronic pain and trauma, with the Cleveland Clinic recently calling for more focus on addressing trauma in the treatment of pain-related conditions. This does not mean your pain is imagined or 'all in your head.' Rather, it means that psychology and biology shape each other in real, measurable ways. In fact, trauma can change how the body processes pain, regulates inflammation, and manages immune responses. Research links conditions like fibromyalgia,1 rheumatoid arthritis,2 migraines,3 irritable bowel syndrome,4 and chronic pelvic pain5 to stress and trauma history.
In my clinical experience, a psycho-emotional component is almost always present in chronic illness.
In this article, I’ll walk you through the biology behind these connections, share what the research shows, and describe how an integrative approach, one that addresses both the physical and psycho-emotional dimensions, can make a difference in practice.
Our bodies are designed to respond to overwhelming events. These can be sudden and shocking, such as an accident or a bereavement, or they can be prolonged, like ongoing adversity or emotional neglect in childhood. When the nervous system senses threat, it activates. Stress hormones rise. Muscles tense. Every system mobilises to help us survive.
Usually, once the danger has passed, the body’s response settles and the nervous system returns to baseline. With trauma, however, this resolution may not occur. If the activation is too intense, lasts too long, or happens early in life, the stress cycle may not complete. This may be especially true in childhood, when we often lack the emotional skills or safe relationships needed to process what has happened.
As a result, the nervous system remains on high alert. This heightened state can shape how the body processes pain, manages hormones, and regulates immune function.
Many people misunderstand the link between emotions and physical pain. Pain is not invented or imagined. By the time pain appears, biological processes are already underway and may have been for some time. In fact, the psychological part comes earlier; in the original event, in the body’s response, and in how ongoing stress continues to shape symptoms over time.
One biological mechanism linking trauma and pain is central sensitisation.6 Here, the brain and spinal cord become overly responsive to pain signals, often because of a threat that happened long ago.
With central sensitisation, the nervous system’s pain threshold drops. Sensations that were once mildly uncomfortable are now processed as severe. The nervous system is no longer accurately reading pain signals; it has become tuned to expect threat.
Trauma can be a major driver of this change, and the evidence on this is growing.7 For example, a 2025 systematic review and meta-analysis in The Journal of Pain found that an estimated 10–26% of adults with chronic pain meet diagnostic criteria for PTSD.8 Crucially, studies show that the brain pathways involved in sensing threat and those involved in feeling pain overlap to a large degree.9 For people living with PTSD, this can mean that pain sensitivity increases, along with other physical symptoms, not as a separate issue, but as part of the same underlying process.
Central sensitisation is also implicated as a key mechanism in fibromyalgia,1 a condition involving widespread pain, fatigue, and cognitive issues. Similarly, migraines and tension headaches can follow a related pattern. In chronic migraine, the sensitisation of the trigeminal pathway can lower the threshold for headaches, increasing their frequency and severity.10 Similarly, chronic migraine is associated with historic trauma with studies demonstrating a strong link between chronic migraine and maltreatment in childhood.11
Your pain is real, but the nervous system may be generating and sustaining it through processes set in motion by past events.
A second major pathway involves the endocrine system, specifically the Hypothalamic-Pituitary-Adrenal (HPA) axis. This system governs how the body produces and regulates cortisol in response to stress.
Cortisol plays a key anti-inflammatory role. In a healthy stress response, cortisol rises during stress and falls when the stress passes, helping to prevent long-term inflammation. When chronic stress or trauma disrupts the HPA axis, this control can break down.12 As a result, the body may struggle to turn off inflammation, and low-grade inflammation, which should be temporary, can persist. Over months and years, this chronic inflammation can drive pain and chronic illness, as we see in conditions like fibromyalgia and autoimmune arthritis.
The gut-brain axis is especially sensitive to changes in the HPA axis. Abnormal cortisol levels can affect gut motility, the gut lining, and the nervous system's response. This, in turn, likely explains why irritable bowel syndrome (a condition involving chronic abdominal pain, bloating, and bowel changes) is so common among people with trauma histories. Research shows much higher rates of sexual trauma, physical abuse, and childhood adversity in people with IBS than in the general population.4 Like all our bodily systems, the gut is not separate; it is part of the same stress response network.
Again, problems with the HPA axis are well documented in PTSD.12 This may help explain why people with significant trauma often experience pain, fatigue, gut symptoms, and hormone issues alongside psychological symptoms. These physical and emotional experiences may well be part of the same underlying physiological stress response.
The third pathway relates to trauma and the immune system. Chronic psychological stress can lead to increased levels of pro-inflammatory cytokines, which are chemicals that can drive inflammation throughout the body. TNF-α (tumour necrosis factor alpha) and IL-6 (interleukin-6) are two of the most studied pro-inflammatory cytokines.
In autoimmune diseases such as rheumatoid arthritis, these same cytokines are implicated in the inflammatory process that drives joint damage. It is significant that there is a biological overlap between the effects of chronic stress on immune signalling and those of autoimmune disease on the body and evidence in this area is growing. For example, stress and trauma have been linked to the development of autoimmune disease more broadly. A landmark 2018 study published in JAMA, drawing on data from more than 106,000 individuals, found that people diagnosed with stress-related disorders (including PTSD) had a significantly elevated risk of developing autoimmune conditions in the following years.13 The association was strongest in those most severely affected by PTSD, and most pronounced in the year immediately following the traumatic event.
Furthermore, studies looking at women with PTSD report much higher risks of rheumatoid arthritis.2 Some studies show increases of up to 76% compared to people without trauma.2 Reviews show that psychological trauma is strongly linked to many functional syndromes. These include conditions affecting joints, the gut, and pain sensitivity throughout the body.
Chronic pelvic pain is another area where the links between trauma and immune function are becoming clearer. This condition affects women far more often than men, and studies have shown a strong correlation between chronic pelvic pain and histories of sexual trauma and childhood abuse.5 In Somatic Therapy and body-based trauma work, this link is viewed somatically; the pelvis is a common site for the body to hold trauma, particularly when that trauma relates to sexual violence. However, evidence is also emerging that pelvic inflammation may be a factor.14 Studies have suggested that disruptions in the stress response system and cytokine-driven inflammation may play a role in how pelvic pain begins and how severe it becomes.
One more key finding: Psychological stressors do not just initiate these disease processes, but also sustain and exacerbate them. Research has documented increased joint swelling, pain, and reduced mobility in people already living with rheumatoid arthritis following acute psychological stress. But we don’t need studies to demonstrate this. Anyone living with a chronic disease will tell you that stress is often a primary trigger for a ‘flare-up’ of symptoms.
All this is to say that in my experience, our immune system is deeply attuned to our emotional and psychological lives.
The following conditions have all been linked in research to trauma history, HPA axis dysregulation, central sensitisation, or immune changes driven by chronic psychological stress. This is not an exhaustive list, but a summary of the most consistently evidenced connections, along with some of the approaches we may use at The Forbes Clinic for each.
Fibromyalgia involves a range of symptoms like widespread musculoskeletal pain, fatigue, and cognitive difficulties and has been strongly linked to trauma. Studies also show rates of PTSD and childhood trauma are significantly elevated in Fibromyalgia populations compared to the general population.1 Crucially, central sensitisation is now considered its primary neurobiological mechanism,15 though mitochondrial dysfunction is also emerging as a relevant factor . A 2024 study in Scientific Reports found significantly impaired mitochondrial function in fibromyalgia patients, with the degree of impairment correlating with pain severity, suggesting that physiological cellular energy impairment may be another driver of symptoms.16
At The Forbes Clinic, we draw on somatic therapies like TRE® and the Felt Sense Polyvagal Model to address the deeper trauma physiology that can drive and sustain sensitisation. As central sensitisation is a key factor, we may recommend Physiokey Scenar Therapy, which works directly on sensitised nerve pathways to support recalibration. Where mitochondrial involvement is a factor, our Functional Medicine team can assess and address cellular energy dysfunction through targeted testing, nutritional and lifestyle intervention, and we may draw on Micro-Immunotherapy (MIT) to support immune and cellular regulation. Other hands-on therapies, such as acupuncture, may be beneficial for supporting nervous system regulation, relieving muscular tension, and activating the parasympathetic nervous system. Craniosacral therapy, may also be supportive and has been shown in studies to improve medium-term pain symptoms in patients with fibromyalgia.17
You can read a testimonial on our homepage from a client who came to us for support with Fibromyalgia.
Rheumatoid arthritis is an autoimmune condition where the immune system attacks joint tissue. Large cohort studies have linked PTSD and trauma history to a significantly higher risk of developing RA.2 Stress can also worsen rheumatoid arthritis after diagnosis, increasing inflammation, joint damage, and triggering flare-ups. The TNF-α and IL-6 pathways activated by trauma overlap directly with those that drive RA inflammation.
At The Forbes Clinic, our central priority for RA is supporting cytokine regulation by supporting psycho-emotional and physiological balance. For psycho-emotional support, we may draw on mind-body approaches, including TRE®, EFT Tapping and Acceptance & Commitment Therapy to address factors that may have contributed to the onset or progression. On the physiological side, we frequently employ Micro-Immunotherapy (MIT) to support immune function. MIT uses low-dose immunomodulatory substances to gently recalibrate immune function over time, including targeting pro-inflammatory cytokines implicated in both stress and RA-related joint damage. We would typically take this approach alongside functional testing, nutritional medicine, lifestyle and environmental evaluation and supplementation.
You can read a testimonial on our homepage from a client who came to us for support with Rheumatoid Arthritis.
Research has shown trauma is a significant risk factor for both migraine frequency and severity.18 Central sensitisation can lower the threshold at which pain signals in the trigeminal nerve (which serves the head and face) become activated. People with PTSD have higher rates of chronic migraine than the general population,19 and studies have shown that addressing the emotional component can lead to a reduction in the frequency of episodes.20
Dr Ayeisha Malik (Integrative Medicine Doctor & Mind-Body Therapist) leads our chronic migraine work, drawing on both the physiological and psychological dimensions as needed. She may utilise Acceptance & Commitment Therapy or personalised psycho-emotional sessions that draw on her broad skills to address underlying stressors. When central sensitisation is suspected, she may work with our pain technologist, Debra Graham using Physiokey Scenar Therapy to target sensitised trigeminal nerve pathways. Craniosacral therapy may also be beneficial for headache, jaw pain, and TMJ conditions in which cranial tension contributes to symptoms.
You can read a testimonial on our Acceptance & Commitment Therapy page from a client whose migraines resolved after focusing on the psychological component of their condition with Dr Malik.
IBS is among the most consistently trauma-associated functional conditions. The gut is sometimes called the “second brain” because it contains its own extensive nervous system. Additionally, HPA axis dysregulation can alter gut motility and mucosal integrity, contributing to gut dysfunction. Research shows that histories of sexual trauma, physical abuse, and adverse childhood experiences are significantly more common in people with IBS than in the general population. A summary of the findings is available in this Science Daily article.
Our approach to IBS addresses both the gut and the stress physiology driving it. Therapies like EFT Tapping and Acceptance & Commitment Therapy can support nervous system regulation and build emotional resilience. Hypnotherapy has a specific evidence base in IBS and is referenced in NICE clinical guidelines. For clients looking to go deeper, our Functional Medicine team provides expert support on dietary, nutritional and lifestyle factors that impact gut health, utilising functional testing such as Gastro-Intestinal Mapping to identify biological factors that may be contributing to symptoms.
Chronic pelvic pain without a clear structural cause has been strongly linked to trauma history, particularly sexual trauma.5 Practitioners of Somatic Therapy understand that the pelvis is a site where somatic tension and trauma responses are frequently held. In addition, psychoneuroimmunological research has identified cytokine-driven pelvic inflammation as a key factor.21
At The Forbes Clinic, trauma-informed approaches are central to our pelvic pain work, particularly TRE®, which works with somatic tension without requiring verbal recounting of past experiences. Our women’s health expert and Traditional Chinese Medicine Doctor, Anga Gonzalez has extensive experience working with women’s health issues and may also draw on Arvigo® Abdominal Massage. Arvigo® Massage is a somatic massage technique built on Mayan healing practices that works with the abdomen and pelvis to release held tension, stimulate blood flow and support visceral and pelvic floor function.
One of the most compelling findings in this field is the supposed ‘dose-dependent’ relationship. The more adverse experiences a person accumulates, particularly in childhood, the higher their risk of developing severe and persistent pain in adulthood.22
The original Adverse Childhood Experiences (ACE) study, conducted by the CDC and Kaiser Permanente across more than 17,000 adults, found strong associations between childhood trauma exposure and multiple adult health outcomes, including chronic pain, autoimmune disease, and fatigue.23 The team found that each additional category of adverse experience increased the biological risk.
Furthermore, a review examining the contribution of psychosocial factors (including emotional history and unresolved psychological distress) to chronic pain concluded that integrated approaches addressing both the physical condition and the psycho-emotional history produce meaningfully better outcomes than biomedical management alone.24
Standard biomedical approaches to chronic pain address the physical. Anti-inflammatory medication, physiotherapy, and imaging-guided interventions all play crucial roles. However, when pain is driven in significant part by a sensitised nervous system and dysregulated stress physiology, physical-level treatment alone tends to produce incomplete results.
Without addressing the psycho-emotional component, the underlying mechanisms laid out in this article may persist. Over time, someone who is not getting better from all the right interventions can begin to feel something harder than the pain itself: that they are beyond help.
You are not beyond help. The clinical picture may just be incomplete.
Evidence is accumulating for trauma-focused approaches that specifically address these mechanisms. EMDR (Eye Movement Desensitisation and Reprocessing), originally developed for PTSD, has been evaluated in clinical trials and shows meaningful reductions in pain intensity and improvements in function in people with comorbid chronic pain and trauma history.25
Body-based approaches are particularly relevant for people in whom trauma is held somatically (in the nervous system and the body) rather than in accessible verbal memory. TRE® works through neurogenic tremoring to discharge accumulated physiological tension. The Felt Sense Polyvagal Model addresses nervous system dysregulation directly, through cultivating a felt sense of safety in the body. EFT Tapping targets the emotional and physiological components of traumatic experience simultaneously and has been shown in randomised trials to reduce cortisol levels.26 ACT Therapy works with the relationship between mind and pain, supporting people in moving forward alongside their symptoms rather than being defined by them.
For some people, the relevant factor is not a history of trauma but the accumulated weight of everyday stress, relationship difficulties, work pressures and situational challenges. This stress may sustain low-grade physiological dysregulation and contribute to symptom flares. For these individuals, Life Coaching & Relationship Support, or Hypnotherapy can be a valuable entry point. By engaging the right support, people can begin to address the patterns in daily life that continue to load the system.
None of these approaches replaces medical management of conditions like rheumatoid arthritis. But they address a dimension that standard care often overlooks. In my experience, as an Integrative Medicine Doctor, this is where, for many people, things finally begin to shift.
If you’re struggling with chronic pain, migraines, IBS, or a pain-related condition that's not responding to treatment, the right psycho-emotional support or body-based therapy may be the missing piece of the puzzle.
At The Forbes Clinic, we offer standalone complementary therapies that can be accessed without assessment or referral. You can enquire directly with a practitioner, and most offer a free introductory call to understand if they’re right for you.
For those looking to go deeper, our 360° Integrative Health Assessment maps the full clinical landscape and develops a multidisciplinary health plan covering multiple factors: physical, hormonal, immune, environmental, epigenetic, psycho-emotional and more. Integrative Health Assessments are delivered by our team of medically trained doctors working through an Integrative and Functional Medicine lens.
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Can psychological trauma really cause physical pain?
Yes. Trauma alters the nervous system, hormonal system, and immune function in ways that directly produce physical pain. Central sensitisation, HPA axis dysregulation, and chronic elevation of pro-inflammatory cytokines are measurable biological mechanisms connecting trauma to pain. The pain is physiologically real — not imaginary, and not “all in your head.”
What is central sensitisation, and why does trauma cause it?
Central sensitisation is a state in which the central nervous system becomes persistently over-responsive to pain signals. The pain threshold drops, making sensations that would not normally be painful, painful, and mild pain severe. Trauma drives this by altering the neural circuits involved in threat detection and pain perception. It can be a significant mechanism in fibromyalgia, migraines, and many forms of chronic widespread pain.
How does PTSD increase the risk of autoimmune conditions like rheumatoid arthritis?
Trauma and PTSD promote the release of pro-inflammatory cytokines — including TNF-α and IL-6 — which drive the inflammatory processes central to autoimmune conditions like rheumatoid arthritis. A 2018 JAMA study of over 106,000 individuals found that stress-related disorders significantly increased the risk of subsequent autoimmune disease, with the association strongest in those most severely affected.
What are adverse childhood experiences (ACEs), and how do they affect pain?
Adverse Childhood Experiences (ACEs) are categories of adverse events in childhood, including abuse, neglect, and household dysfunction. Research shows a dose-dependent relationship: the more ACE categories a person has experienced, the higher their risk of chronic pain, autoimmune illness, IBS, and pain-related disability in adulthood. The mechanism runs through prolonged HPA axis dysregulation and its downstream effects on inflammation and immune function.
Why do people with IBS or chronic pelvic pain so often have trauma histories?
The gut and pelvis are particularly sensitive to the physiological effects of trauma. HPA axis dysregulation alters gut motility and mucosal integrity, contributing to the abdominal pain, bloating, and bowel changes of IBS. In chronic pelvic pain, somatic tension, nervous system hypervigilance, and cytokine-driven pelvic inflammation — all associated with trauma — are increasingly recognised as core drivers. The structural investigation is often normal. The underlying physiology is not.
What treatments work when chronic pain has a trauma component?
Approaches that address both the physical and psycho-emotional dimensions consistently produce better outcomes than biomedical management alone. Evidence-informed options include EMDR for comorbid trauma and chronic pain; body-based approaches such as TRE®, the Felt Sense Polyvagal Model, EFT Tapping, and Physiokey Scenar Therapy; ACT Therapy for improving quality of life alongside pain; and Integrative Hypnotherapy, particularly for IBS. The most effective approach is tailored to the individual’s specific clinical picture rather than applied generically.
Is the pain real if it has psychological or trauma roots?
Completely. Pain driven by trauma is the result of real, measurable biological processes. Central sensitisation produces actual neural signalling. Cortisol dysregulation produces actual inflammation. Cytokine elevation produces actual immune activation. Describing this as “psychosomatic” in a dismissive sense misrepresents the underlying neuroscience. The pain is in the body, driven by systems that trauma has altered.
Can addressing trauma improve conditions like fibromyalgia or rheumatoid arthritis?
Research suggests it can, particularly where trauma is contributing to immune dysregulation, central sensitisation, or HPA axis imbalance. Trauma-focused interventions that reduce psychophysiological stress and support nervous system regulation have been associated with reductions in inflammatory markers and improvements in pain-related outcomes. This works alongside — not instead of — medical management of diagnosed conditions.
The Forbes Clinic is a virtual-first integrative health clinic. Mind-body services at The Forbes Clinic are offered by qualified practitioners and are complementary to conventional medical and mental health care. All services are available to adults across the UK. If you have concerns about your health, please consult your GP or primary care provider. Services are not suitable for individuals in acute medical or mental health crisis, active psychosis, or with current suicidal ideation.
