Psychogenic Pain: Nerve Involvement and Transmission Mechanism

Abstract

Pain, whether physical or emotional, travels through the same neural pathways, activating similar regions in the brain. The nervous system does not differentiate between the two types of pain, which is why emotional pain, such as grief, trauma, or severe stress, can often manifest physically—and sometimes with even more devastating effects than physical injuries.

Scientific research has shown that emotional distress can trigger a cascade of physiological reactions. For example, when someone experiences overwhelming sadness or shock, the hypothalamic-pituitary-adrenal (HPA) axis is activated, flooding the body with stress hormones such as cortisol and adrenaline. In extreme cases, this can lead to stress-induced conditions like stress cardiomyopathy—commonly known as “broken heart syndrome”—where intense emotional trauma causes heart dysfunction that mimics a heart attack. Prolonged emotional suffering can also compromise the immune system, increase inflammation, and contribute to chronic health issues such as cardiovascular diseases, autoimmune disorders, and even neurodegenerative conditions like Alzheimer’s.

While psychogenic pain lacks a clear physical cause, it is a real and debilitating phenomenon. Sustained emotional distress can alter pain pathways, causing a condition called central sensitisation, where the nervous system becomes hypersensitive to pain signals, leading to chronic pain syndromes. This paper examines the neurological basis of psychogenic pain, the nerve structures involved, the mechanisms of pain transmission, and natural approaches for long-term pain relief.

Key Terms and Definitions

• Psychogenic Pain – Pain that originates primarily from psychological factors, such as emotional distress, trauma, stress, or anxiety, rather than from direct physical injury or disease. Despite the absence of tissue damage, psychogenic pain can be debilitating and real, with neurological mechanisms that involve dysregulation of pain-processing networks in the brain and spinal cord.
• Limbic System – A group of structures in the brain that are primarily involved in emotion processing, memory, and arousal. It includes the amygdala, which processes fear and anxiety, and the hippocampus, which plays a role in memory formation. The limbic system is crucial in generating and amplifying pain perception in response to emotional stress.
• Central Sensitisation – A condition where the central nervous system (CNS) becomes hypersensitive to pain signals, even in the absence of injury. This heightened sensitivity can lead to chronic pain syndromes, where normal sensory input is interpreted as pain. Central sensitisation is often associated with conditions like fibromyalgia, chronic migraines, and irritable bowel syndrome (IBS).
• Autonomic Nervous System (ANS) – A division of the peripheral nervous system that controls involuntary bodily functions such as heart rate, digestion, respiratory rate, and stress responses. It includes the sympathetic nervous system, responsible for the “fight or flight” response, and the parasympathetic nervous system, responsible for “rest and digest.” Dysregulation of the ANS can contribute to pain perception and conditions like fibromyalgia and chronic pain.
• HPA Axis (Hypothalamic-Pituitary-Adrenal Axis) – A complex set of interactions between the hypothalamus, pituitary gland, and adrenal glands that regulate the body’s response to stress. The HPA axis controls the release of stress hormones such as cortisol and adrenaline, which can affect pain perception, inflammation, and immune responses. Chronic stress can lead to long-term activation of the HPA axis, contributing to various health problems, including chronic pain.
• Dorsal Root Ganglia (DRG) – Clusters of sensory neurons located just outside the spinal cord that play a key role in transmitting pain signals from the body to the spinal cord. These neurons can become sensitised in response to emotional distress or trauma, amplifying the sensation of pain. They act as a relay station for pain signals before they reach the brain.
• A-delta Fibres – A type of nerve fibre responsible for transmitting sharp, fast pain signals to the brain. These fibres are involved in acute pain experiences, such as the immediate sharp pain from a cut or burn.
• C-fibres – A type of nerve fibre that transmits slower, dull, aching pain signals. These fibres are involved in transmitting persistent or chronic pain and are particularly important in the experience of psychogenic pain, where emotional distress triggers prolonged discomfort.
• Amygdala – A structure in the brain involved in processing emotions, particularly fear and anxiety. The amygdala is closely linked to the perception of pain, especially when emotional distress contributes to pain amplification.
• Prefrontal Cortex – A part of the brain responsible for higher cognitive functions, including decision-making, emotional regulation, and managing pain perception. Dysfunction in this region can result in an impaired ability to regulate pain, contributing to chronic pain disorders.
• Thalamus – A relay station in the brain that processes sensory signals, including pain, before sending them to other brain regions for interpretation. Abnormal activity in the thalamus can lead to heightened pain perception, as it amplifies the signals even in the absence of physical injury.
• Cingulate Cortex – Part of the limbic system, this structure is involved in processing the emotional aspect of pain. Overactivity in the cingulate cortex can contribute to heightened emotional responses to pain, exacerbating the experience of psychogenic pain.
• Periaqueductal Grey (PAG) – A region of the brain involved in the modulation of pain, including pain inhibition. Dysfunction in the PAG can impair the body’s natural pain-relief mechanisms, contributing to chronic pain conditions, including those related to psychogenic pain.
• Glial Cells – Non-neuronal cells in the CNS that support and protect neurons. In the context of pain, glial cells can become overactive in response to injury, emotional stress, or trauma, releasing inflammatory chemicals that exacerbate pain perception.
• Neuroplasticity – The ability of the brain and nervous system to reorganise and form new neural connections. Neuroplasticity plays a critical role in the recovery from chronic pain, as the brain can be retrained to alter pain pathways through interventions such as Cognitive Behavioural Therapy (CBT), mindfulness, and neurofeedback.
• Cognitive Behavioural Therapy (CBT) – A psychological intervention that focuses on changing negative thought patterns and behaviours that contribute to pain and emotional distress. CBT is commonly used in treating chronic pain, including psychogenic pain, by helping individuals change the way they perceive and respond to pain.
• Neurofeedback – A technique that trains individuals to regulate brain activity through real-time monitoring of brainwaves. Neurofeedback has been used to help reduce chronic pain by retraining the brain to reduce hypersensitivity to pain signals.
• Mindfulness & Meditation – Practices that focus on staying present and aware, which can help reduce the emotional and physiological responses to stress. Mindfulness-based interventions have been shown to decrease pain perception and improve emotional regulation in individuals with chronic pain.
• Diaphragmatic Breathing – A form of controlled breathing that activates the parasympathetic nervous system, reducing the stress response and lowering pain perception. This technique has been used effectively in managing both physical and psychogenic pain.
• Adaptogenic Herbs – A group of herbs that help the body adapt to stress and regulate the body’s stress response. Herbs such as Ashwagandha, Rhodiola, and Holy Basil are known to support the nervous system and promote a calming effect, helping to reduce stress-related pain.
• Acupuncture – A traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body. Acupuncture is believed to restore balance in the body’s energy flow (Qi) and has been shown to help reduce pain and inflammation, including in individuals with psychogenic pain.
• Stress – A physiological and psychological response to demands, challenges, or threats. Stress activates the sympathetic nervous system and the HPA axis, leading to the release of stress hormones such as cortisol and adrenaline. These hormones can increase pain sensitivity, contribute to muscle tension, and alter the body’s response to pain signals, making individuals more vulnerable to conditions like chronic pain.
• Emotional Stress – A subset of stress related to psychological or emotional challenges, such as trauma, grief, anxiety, or interpersonal conflicts. Emotional stress activates the same physiological pathways as physical stress, triggering the release of stress hormones and increasing pain perception. Emotional stress can lead to conditions like fibromyalgia, chronic headaches, and irritable bowel syndrome (IBS), where the body’s stress response is persistently heightened, contributing to chronic pain.
• Acute Stress – A short-term, immediate response to a stressful event or threat. While acute stress can be adaptive and help the body respond to danger (via the fight-or-flight response), it can also lead to temporary physical discomfort or pain (e.g., tension headaches, muscle tightness).
• Chronic Stress – Prolonged exposure to stressors that leads to sustained activation of the stress response systems in the body. Chronic stress is closely linked to chronic pain syndromes, as it contributes to the dysregulation of the nervous system, leading to hypersensitivity to pain and conditions like central sensitisation.
• Emotional Pain – Pain that originates from emotional or psychological experiences, such as grief, loss, trauma, or anxiety. Emotional pain activates the same brain regions and neural pathways as physical pain, which is why severe emotional distress can have a physical impact on the body, leading to conditions like stress cardiomyopathy (broken heart syndrome) or psychosomatic illnesses.

Introduction

Pain is commonly associated with physical injury, yet a significant number of chronic pain cases originate from psychological and emotional distress. This form of pain, known as psychogenic pain, occurs when the brain misinterprets stress-related signals as physical pain. Despite its lack of a clear physical cause, psychogenic pain is both real and debilitating.

Historically, psychogenic pain has often been dismissed as “imaginary” or “psychosomatic,” but advances in neuroscience have revealed a complex neurological basis. Research has shown that emotional pain and physical pain activate the same neural circuits, including the limbic system, prefrontal cortex, and autonomic nervous system (ANS). These regions are crucial in regulating both emotional responses and pain perception, explaining why psychological stress can manifest physically and cause central sensitisation, leading to chronic pain even in the absence of injury.

Understanding this deep connection between the mind and body helps explain why some individuals experience more debilitating symptoms from emotional distress than from physical trauma. The brain does not distinguish between emotional and physical pain; both involve overlapping neural pathways. Over time, chronic psychological stress can rewire these pathways, leading to persistent pain conditions. This paper explores the neural structures, pain pathways, and transmission mechanisms involved in psychogenic pain, as well as natural interventions that can help retrain the nervous system and restore balance, paving the way for long-term relief.

Clarifying Psychosomatic vs Psychogenic:

Psychosomatic and psychogenic pain are terms often used interchangeably but differ in important ways. Psychosomatic pain refers to physical symptoms that are triggered or exacerbated by psychological factors, such as stress or emotional conflict. These symptoms might include conditions like ulcers, headaches, or hypertension. Psychogenic pain, on the other hand, specifically arises when emotional distress or psychological factors are misinterpreted by the brain as physical pain. In other words, psychogenic pain is pain that originates primarily in the brain due to emotional triggers, while psychosomatic pain involves physical manifestations of psychological distress. Both forms of pain share overlapping mechanisms but require different approaches to treatment.

Nerves and Structures Involved in Psychogenic Pain

1. Central Nervous System (CNS)
   Psychogenic pain is predominantly regulated by the brain’s emotional and cognitive centres, which influence how pain is perceived and processed. The key structures involved include:

• Limbic System (Amygdala & Hippocampus) – These structures process emotions such as fear, stress, and trauma. The amygdala plays a key role in amplifying pain perception, especially in those with chronic stress.
• Prefrontal Cortex – This region is responsible for emotional regulation and cognitive control over pain perception. Dysfunction here can contribute to chronic pain disorders like fibromyalgia and tension headaches.
• Thalamus – The thalamus acts as a relay station, transmitting sensory and pain signals to the appropriate areas of the brain. Abnormal thalamic activity is often seen in those suffering from psychogenic pain.
• Cingulate Cortex – Involved in processing the emotional aspect of pain, overactivity in the cingulate cortex can intensify the emotional and physical perception of pain.
• Periaqueductal Grey (PAG) – Known for its role in pain inhibition, dysfunction in the PAG contributes to an inability to modulate pain, which is seen in chronic pain syndromes like complex regional pain syndrome (CRPS).

2. Peripheral Nervous System (PNS)
   The PNS connects the body to the CNS and plays a key role in pain transmission and modulation. Key components include:

• Autonomic Nervous System (ANS) – The sympathetic nervous system, which governs the fight-or-flight response, triggers inflammation and muscle tension, further increasing pain perception during emotional distress.
• Dorsal Root Ganglia (DRG) – These sensory neurons relay pain signals from the body to the spinal cord. Psychological distress can sensitise these neurons, making them more responsive to pain signals.
• Vagus Nerve – A major component of the brain-body connection, the vagus nerve helps regulate inflammation and pain perception. Dysfunction here has been linked to conditions like fibromyalgia, irritable bowel syndrome (IBS), and chronic fatigue syndrome.

Pain Pathways and Transmission in Psychogenic Pain

Pain Scales and Measurement:

Measuring psychogenic pain presents challenges due to its subjective nature. However, several tools have been developed to quantify pain perception and assess the severity of symptoms. One commonly used tool is the Visual Analog Scale (VAS), which asks patients to rate their pain on a scale from 0 to 10, where 0 represents no pain and 10 represents the worst possible pain. For more detailed evaluations, the McGill Pain Questionnaire is often used in clinical settings to assess the sensory and affective dimensions of pain. For psychogenic pain, functional MRI (fMRI) is increasingly used in research to observe brain activity and identify abnormal patterns in pain processing. These brain imaging techniques allow scientists to explore how the thalamus and cingulate cortex (both involved in pain perception) are activated in response to emotional stress, providing valuable insights into how psychogenic pain differs from nociceptive pain.

these pains follow similar transmission mechanisms to nociceptive and neuropathic pain:

1. Emotional Stress or Trauma Triggers the Brain
   • Psychological stress activates the amygdala and prefrontal cortex, which interpret emotional distress as a physical threat.
   • The hypothalamus activates the HPA axis, releasing cortisol and adrenaline, which increase nerve sensitivity.
2. Activation of the Spinal Cord Pain Pathways
   • Stress signals heighten the sensitivity of A-delta and C-fibres, which transmit pain signals to the spinal cord.
   • Overactive glial cells (immune cells in the CNS) release pro-inflammatory cytokines, intensifying pain perception.
3. Heightened Pain Perception in the Brain
   • The thalamus amplifies these pain signals, misinterpreting them as physical pain.
   • The anterior cingulate cortex (ACC) and insular cortex reinforce pain perception, even in the absence of injury.
4. Chronic Pain Loop Formation
   • Continuous stress strengthens pain pathways, leading to central sensitisation, a condition where the nervous system remains in a heightened state of pain.

Common Manifestations of Psychogenic Pain

• Chronic headaches or migraines
• Widespread musculoskeletal pain (resembling fibromyalgia)
• Back pain, neck pain, or persistent muscle tension
• Gastrointestinal pain (e.g., irritable bowel syndrome or IBS)
• Unexplained nerve pain (e.g., burning, tingling, stabbing sensations)

Neurotransmitter Imbalance and Hormonal Influences:

Psychogenic pain is deeply intertwined with neurotransmitter imbalances, particularly in the areas of serotonin, dopamine, and GABA. These chemical messengers are essential in regulating mood, stress responses, and pain modulation. When a person experiences prolonged emotional distress, such as chronic anxiety or depression, levels of serotonin and dopamine may become depleted. This depletion not only impacts mood but also amplifies the pain response. For instance, low serotonin levels can result in heightened pain sensitivity, as serotonin plays a role in moderating pain signals in the spinal cord and brain. Similarly, imbalances in GABA, the brain’s primary inhibitory neurotransmitter, can cause overactivity in pain pathways, making the nervous system more reactive to stimuli that would normally not be perceived as painful. This chemical imbalance contributes significantly to the chronic pain experienced in psychogenic pain disorders.

Example

Consider the case of a 29-year-old woman who was juggling multiple responsibilities at home, including caring for young children, managing household tasks, and caring for an elderly parent with health issues. The constant pressure and lack of personal time led to escalating feelings of overwhelm and anxiety. Over several months, she began experiencing frequent migraines and debilitating lower back pain, despite no physical injury or strain. Her doctors couldn’t identify a specific medical cause for the pain. Research suggests that the chronic emotional stress from her overwhelming daily responsibilities triggered a series of physiological responses that altered the pain pathways in her nervous system. The resulting pain was not a result of any physical injury, but rather a manifestation of her emotional distress, similar to conditions like tension headaches and chronic fatigue syndrome, where stress is a primary contributing factor.

Management of Psychogenic Pain

Psychogenic pain is not “imaginary”—it has a distinct neurological basis and can be just as debilitating as pain resulting from physical injury. Managing psychogenic pain involves addressing both the psychological and physiological components, which requires retraining the nervous system instead of merely masking symptoms with medication.

1. Nervous System Regulation
   • Mindfulness & Meditation – Reduces amygdala hyperactivity, retraining the brain’s pain response.
   • Diaphragmatic Breathing – Activates the parasympatheticnervoussystem, reducing stress and pain perception.
2. Neuroplasticity & Cognitive Approaches
   • Cognitive Behavioural Therapy (CBT) – Helps reframe negative thought patterns that amplify pain.
   • Neurofeedback – Regulates abnormal pain signals and reduces hypersensitivity.
   • Journaling & Emotional Processing – Expressing unresolved trauma can reduce limbicsystem overactivity.
3. Physical Therapies to Release Tension
   • Massage Therapy – Alleviates chronic muscle tension caused by stress.
   • Yoga & Tai Chi – Helps restore nervous system balance and reduces chronic pain.
4. Nutritional & Lifestyle Approaches
   • Anti-Inflammatory Diet – Minimises processed foods and sugar, reducing inflammation and enhancing nervous system function.
   • Magnesium & Omega-3 Fatty Acids – Support nerve function and reduce hyperactive pain signalling.
   • Adequate Sleep – Crucial for reducing central sensitisation and improving pain tolerance.
5. Natural Remedies for Pain Modulation
   • Adaptogenic Herbs (e.g., Ashwagandha, Rhodiola, Holy Basil) – Support the body’s response to stress and calm the nervous system.
   • Essential Oils (e.g., Lavender, Peppermint, Frankincense) – Reduce nerve pain and promote relaxation.
   • Acupuncture – A well-documented method to restore nervous system balance and reduce pain perception.
6. The Role of Social Support and Mental Health Interventions:

In addition to individual therapeutic approaches, the role of social support and peer networks in managing psychogenic pain cannot be overstated. Emotional pain is often compounded by isolation, and supportive social relationships have been shown to have a profound effect on reducing stress and enhancing well-being. Studies indicate that individuals who engage in group therapy or have strong family or community support systems report lower levels of pain intensity and better overall health outcomes. Social interventions, such as peer support groups or therapy focusing on emotional healing, play a critical role in the rehabilitation of those suffering from psychogenic pain. Supportive environments can reduce the physiological stress response, alleviate emotional distress, and create positive neuroplastic changes in the brain, ultimately mitigating pain perception.

7. Research Gaps and Future Directions:

Although significant progress has been made in understanding the neurological underpinnings of psychogenic pain, several areas remain underexplored. One key area for future research is the interdisciplinary approach to psychogenic pain, combining neuroscience, psychology, and social sciences. For example, research that investigates how childhood trauma or socioeconomic stress influences the development of chronic pain would provide valuable insights into the environmental factors contributing to pain. Furthermore, more work is needed on biomarkers for psychogenic pain to move toward objective diagnostic criteria. Research into neuroplasticity and its potential to reverse or alleviate pain-related changes in the brain is another promising direction. Longitudinal studies are needed to understand how early interventions, such as trauma-informed care and stress management, can prevent the onset of chronic psychogenic pain. These areas of research will not only improve diagnostic tools but also lead to more effective treatment options tailored to individual needs.

8. Treatment Accessibility:

The Barriers to Treatment Access and Practical Recommendations:

While the natural and neuroplasticity-based approaches to treating psychogenic pain outlined in this paper are promising, access to these treatments can be a significant barrier for many people. Cognitive Behavioural Therapy (CBT), neurofeedback, and biofeedback may not always be readily available, particularly in low-income or rural areas. To overcome these barriers, it is important to explore accessible options such as online therapy platforms or mindfulness and meditation apps, which have been shown to provide effective pain relief and emotional regulation. Programs like Headspace or Calm offer guided meditation sessions specifically tailored for pain management, and online CBT services such as BetterHelp can provide psychological support remotely. In addition, integrating community-based initiatives such as support groups for pain sufferers or self-care workshops can empower individuals to take control of their pain management in a more cost-effective and accessible manner.

Conclusion

Psychogenic pain exemplifies how emotional distress can manifest physically, engaging the same neural pathways as physical pain. The nervous system does not distinguish between emotional and physical pain, which explains why prolonged emotional suffering can lead to real, debilitating pain. The limbic system, thalamus, and spinal pain pathways play pivotal roles in this process, often creating a pain loop where psychological distress heightens pain perception, even in the absence of injury.
Chronic stress and trauma can rewire pain pathways, leading to central sensitisation and exaggerated pain responses.

While pharmaceutical interventions may offer temporary relief, they often fail to address the underlying causes and may contribute to dependency. In contrast, a holistic approach—which includes nervous system regulation, neuroplasticity techniques, physical therapy, nutrition, and natural pain modulation—can help retrain the brain and restore balance.

By acknowledging the deep mind-body connection and actively working to rewire the nervous system, individuals can break free from the cycle of psychogenic pain, enabling true healing and long-term well-being.