How stress hormones affect chronic pain in autoimmune diseases

I'm Anindita!

I am a Functional Medicine certified Health Coach and AFMC Practitioner. I help women with autoimmune conditions I help women with autoimmune conditions reverse their symptoms with their body as their guide

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Chronic is pain is a very common symptom in the case of autoimmune diseases. This symptom is usually driven by chronic inflammation that is a hallmark of autoimmune diseases. In fact, the number one complaint that I find amongst people dealing with autoimmune conditions is chronic pain.

Hidden epidemic of chronic pain and suffering

Autoimmune disorders lead to chronic inflammation in different parts of the body. This inflammation is a significant cause of chronic pain that often goes unaddressed.

The conventional approach to pain is to seek physical therapy and medications such as strong pain killers. But mostly, the focus is on shutting off the immune system with powerful medications and steroids with dangerous side effects. These drugs may be life saving for some people and prevent further damage, but they do nothing to address the causes of disease.

My personal experience with immunosuppressive medications

I should know this better than anyone else. And before I go any further, let me share a story with you.

My daughter was on such medications for a long time to manage her severe eczema. It did help to reduce the severity of her symptoms and make it more manageable. But it did nothing to address why she had eczema in the first place.

However, in spite of these strong medications, her eczema was not completely under control. We went through multiple immunosuppressive drugs and steroids over a period of five years. Finally, as a rare and unfortunate side effect, one of these medications shut down her immune system. She was hospitalised with a life threatening infection for almost a month. We were fortunate to have an amazing team of doctors who saved her life.

To cut a long story short, this whole experience opened my eyes to the fact that conventional medicine was severely limited when it came to chronic conditions.

I started doing my own research over a period of more than a year. I finally understood why a root cause approach was necessary for healing my daughter’s eczema. This eventually led me down the path to Functional Medicine. After more than 2 years of addressing the root causes, we brought her eczema under control and got her off all her medications.

The lesson that I learned?

Drugs have their place in saving lives and preventing damage. However, they do nothing to address the root causes of any chronic illness.

You can read more about this topic in an earlier post here.

Our stress response

A normal stress response to any kind of perceived threat is the release of stress hormones such as cortisol as well as adrenaline and noradrenaline to ensure our survival. Cortisol is a powerful anti-inflammatory agent which mobilises glucose reserves for energy and modulates inflammation in the body. In the short term, this stress response is life saving and necessary.

The problem begins when this kind of stress becomes chronic.

Some people may not have any emotional stressors, but overexercising, not sleeping enough, food sensitivities can act as stressors. Others may have good physical health but they may be anxious, upset, worried, or depressed and have ongoing emotional stressors. These behaviours cause the same kind of stress response and cause stress hormones to be secreted from the adrenal glands.

To be clear, our bodies are perfectly capable to handle acute stress without getting overwhelmed. However, in the case of chronic stress, our cortisol levels remain constantly elevated. This overactivation of the immune system over prolonged periods of time increases our risk of developing inflammatory conditions like eczema, hives, allergies etc.

This kind of chronic low grade inflammation leads to weight gain, brain fog, migraines, insomnia, aches and pains and depression. Elevated levels of cortisol also inhibit our immune response so that we fall sick more often. This way, seasonal cold and flu and other infections can become a way of life. High cortisol levels also directly suppress thyroid function and active thyroid production.

As you can see, chronic stress has a far reaching impact on our overall health.

Our cortisol awakening response

There is a diurnal (day/night) rhythm to optimal cortisol levels that plays an important role. Based on our body clock, cortisol goes down in the evening which allows melatonin (sleep hormone) levels to go up. This dance between cortisol and melatonin ensures that we get good quality, deep sleep.

During the first thirty to forty five minutes of waking up, our cortisol levels rise by as much as 50 percent. This spike allows us to be primed for another day, to survive, to thrive. Optimal cortisol levels are necessary for an alert, comfortable and pain-free experience.

However, it is the choices that you make- through your thoughts and your actions that determine the stress response. If there is a skewing in our cortisol levels (too high or too low) it creates health challenges in the long run.

We need enough cortisol to raise our blood sugar levels in the morning, but not too much. It ensures that we wake up refreshed and free of pain. Optimal levels are also necessary to have enough body fat but not too much. This body fat acts as insulation for warmth and cushioning for our vital organs and glands.

If we do not have adequate levels of cortisol, then we can feel sleepy and sluggish and have a hard time getting out of bed in the morning. This is in spite of getting adequate sleep. This is again pretty common in people with chronic illnesses.

Then, cortisol levels tend to drop off during the day so that melatonin can rise in the evening. If we are in a constant state of fight or flight and hypervigilance, we can end up with higher levels of cortisol in the evening. This disrupts the dance between cortisol and melatonin ultimately preventing us from getting deep, extended sleep.

Cortisol imbalance and chronic pain

As you can see now, the impact of cortisol goes way beyond a stress response.

Cortisol is a master hormone and affects nearly every cell in our body. It affects our metabolism, sleep/wake cycle, cardiovascular function, immune function, blood sugar, bone health and fight/flight/hide/freeze response for survival.

In the initial stages of chronic, elevated stress, our body responds with elevated levels of cortisol (hyperadrenal state). If the stress doesn’t resolve itself, our body may go to more of a progressive hypoadrenal state. It produces lower and lower levels of cortisol (as well as adrenaline) as a protective mechanism.

When the levels of these two crucial hormones reduce drastically, severe exhaustion sets in. This takes place in combination with inflammation of joints, muscles that causes swelling, pain and stiffness. This usually occurs in the morning, when our cortisol level is not at the level it is supposed to be. We miss out on the benefit of an optimal level of cortisol as an awakening response in the morning.

You can read more about adrenal dysfunction in this blog post.

 “Healing severe or chronic pain, I believe, includes transforming our relationship to the pain, and, ultimately, it is about transforming our relationship to who we are and to life.” 

—Sarah Anne Shockley

The connection between autoimmune disease and chronic stress

Chronic, ongoing stress means elevated levels of cortisol which can ultimately damage our immune system and prevent it from healing. In autoimmune diseases, chronic pain is often the first sign of an underlying imbalance. At other times it is a byproduct of the tissue damage that accompanies many autoimmune conditions. Either way, there is a lot of evidence that links chronic stress to pain that accompanies any chronic illness.

Research shows that these may be linked to immune cell activation and the release of inflammatory chemicals.  You can read about it here.

In the case of autoimmune conditions, chronic stress is a risk factor. Those with insufficient stress response (low levels of cortisol and adrenaline) have a higher risk of inflammation. Having insufficient levels of cortisol means pain syndromes, with more localized pain, where there’s a lot of inflammation, like joints. 

Ultimately, cortisol balance is key and we want to have sufficient levels which are neither too high nor too low. As an anti inflammatory agent it counters our immune systems’ strong inflammatory response to any kind of threat (real or imaginary). This ensures our survival and minimises the damage from oxidative stress. 

At the end of the day, what promotes short term vitality or protection in the body can cause disease progression. By understanding what is at play underneath your chronic health issues you can start taking steps to address the underlying imbalances and start getting better.



A carefully curated and comprehensive collection of carefully selected books, podcasts, websites, blogs, and other resources from the field of Functional Medicine with a focus on autoimmune diseases

If have been looking to get ANSWERS to questions like

-Why do I have this disease?
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 then this GUIDE would a game changer for you!

“Autoimmune Disease 101” is a carefully curated and comprehensive collection of carefully selected books, podcasts, websites, blogs, and other resources from the field of Functional Medicine with a focus on autoimmune diseases.

The Functional Medicine model of care for chronic diseases seeks to answer the question “Why do you have this disease” so that you can get personalised and effective care for your unique condition.

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Health Coach, author, blogger, podcaster, mom of two and avid reader

Before you get any further....
Hi, I'm Anindita!

I am a Functional Medicine certified Health Coach and AFMC practitioner. I help women with autoimmune conditions reverse their symptoms with their body as their guide

I work with women who want to go beyond symptom management, reconnect with their bodies and learn how to get well and stay well by tuning into their body's wisdom 

Learn more


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