When Pain Isn't Physical: Emotions & the Nervous System
You've been doing so well. Then your knee starts to ache at the same point on your walk, or an old injury flares up out of nowhere, and your first thought is, "What did I do wrong?"
Most of us have been taught that if we feel pain, there must be a physical cause. So we go looking for what's damaged, and we stop doing whatever we were doing when it hurt.
But what if not every pain you feel has a physical source? What if the more helpful question isn't whether the pain is real, but what it's actually responding to?
I was lucky to see this connection early. I had been strong and healthy, and then I had a very stressful year. My mother died suddenly, I was dealing with her estate, and there was so much else going on. Then the pain arrived.
My knees swelled up like golf balls. The inflammation was physical, and I could see it... but I knew my body was responding to the year I'd just had.
Why Chronic Pain Doesn't Always Have a Physical Cause
First, something I always want to be clear about: all pain is real pain. This doesn't mean you're making it up, and it doesn't mean it's all in your head.
Your brain is always deciding what to do with the sensations it receives, whether they're physical or emotional. Neuroscientists I've interviewed have explained that the emotional and physical pain pathways sit very close together in the brain, so emotional pain can trigger physical pain. When your brain and nervous system sense danger or unpredictability, they may turn on pain to protect you, even when there's no tissue damage.
There are three places this can come from:
- Emotions. Grief, anger, overwhelm, or an old emotional experience. One of my students noticed that every time she and her husband argue, she gets a pain in her left shoulder.
- Pattern matching. A situation feels similar enough to a past one where you didn't feel safe, so your nervous system turns protection back on.
- A perceived threat. A quick thought, often one you're not even aware of, that your brain reads as danger even though you aren't actually in danger.
That last one happened to me this year. Three years after twisting my ankle on a downhill run, I started training for a 25K, the longest distance I had ever run. The same ankle began to hurt, even though I had run on it many times without pain.
Little doubts were flickering through my mind (was this going to be too much for me?), and my brain found an easy, familiar pathway to keep me safe. That's often why an "old injury" seems to come back.
A Simple Pause to Interrupt the Pain-Fear Cycle
When pain shows up, fear usually follows right behind it. Oh no, it's back. I thought I was getting better. What is this going to mean? Those thoughts are completely understandable, and they also reinforce the pain-fear cycle.
So the next time you have a pain flare, try this:
- Pause. Before assuming there must be a physical cause, give yourself a moment.
- Get curious. Ask yourself, "Could there be something else behind this pain?"
- Look in three places. What emotions were just moving through me? Is this similar to a time I didn't feel safe? Could my mind be reading this situation as a threat?
- Stay open. Simply say, "I wonder."
You don't need to find the answer. The pause itself is the practice, because in that pause you interrupt the fear and stop feeding the cycle.
A gentle reminder: this assumes you've been working with your medical team and you know there isn't something like a tumor or an infection behind your pain. And a diagnosis of arthritis, or an MRI showing a bulging disc, doesn't have to be the whole story. Plenty of people have those findings without pain.
We aren't ignoring pain. We're giving ourselves a little room before we react to it.
You Only Have to Be Open to the Possibility
You don't have to believe this 100 percent. You only have to be open to the possibility that something else may be going on.
That openness matters. If every flare means you did something wrong, your only options are to fix it or avoid it, and that can keep you stuck. Curiosity gives you another way forward.
Your brain isn't working against you. It likes to be able to predict what's coming, and it's trying to keep you safe in the best way it knows.
When you meet pain with a pause and a little curiosity, you're already opening the door to healing. Pain can be unlearned, and this is one small step you can repeat on the way to becoming pain-free on purpose.
Watch the Full Episode: When Pain Isn't About the Body
In this solo episode, I share more of these stories, including what was really going on with my ankle, and walk you through the three places to look when pain flares. I'd love for you to join me.
