Episode 26 | Grief and Pain (Part I) - When Grief Meets Pain

Grief and Chronic Pain: Why Loss Amplifies Pain and What to Do About It

Dr. Zev Nevo introduces a three-part series on grief and chronic pain, describing a patient whose longstanding low back pain sharply worsened after her husband’s sudden death despite unchanged imaging, framing it as nervous system grief rather than bodily damage. He explains how grief disrupts the HPA axis and cortisol rhythm, increases inflammatory signaling (including a 2022 study of 111 bereaved spouses showing higher stress-related IL-6 rise in those with high grief symptoms), and activates reward circuitry (UCLA fMRI work showing nucleus accumbens activation), linking grief to craving and reduced endogenous opioid regulation that normally dampens pain. He uses allostatic load to show how grief overwhelms an already taxed chronic pain system and highlights shared identity disruption and “relearning the world.” He offers three practices: stabilize the nervous system (coherence breathing, gentle movement, grief-adapted sleep support), use a “stenographer” observing practice for grief sensations, and seek witnessing/co-regulation through safe people or communities. He shares recent personal losses and previews episode two on invisible losses from chronic pain.

00:00 Grief Makes Pain Louder

01:26 Why Loss Amplifies Pain

02:03 Stress Hormones Go Offbeat

02:53 Inflammation Turns Up Pain

03:57 Grief Is Craving

06:11 Allostatic Load Explained

08:05 Identity After Pain And Loss

10:29 Three Practices To Try

10:50 Practice One Stabilize

13:20 Practice Two Observe Waves

14:31 Practice Three Be Witnessed

16:03 Personal Loss And Next Episode

This essential pre-roll message serves as a clear disclaimer, stating that the podcast provides pain and trauma-informed psychoeducation for informational and entertainment purposes only, and does not constitute medical advice. Listeners are reminded to always consult a qualified healthcare professional for specific medical conditions or symptoms.

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LINKS:

• Body and Mind Pain Center
• Mind Body Rehabilitation
• Substack

Transcript

Episode 26 | Grief and Pain (Part I) - When Grief Meets Pain

[00:00:00] Hey, it's Dr. Zev Nevo. Welcome to Mind Your Body. I wanna tell you about a patient I saw a few months ago. She'd been managing chronic low back pain for about six years. She had her routines. She knew her triggers. She'd built a life around it. Her pain was usually around a four out of ten, some days a six, rarely worse than that.

[00:00:23] Then her husband died suddenly. Heart attack. He was fifty-three. Six weeks later, she came back to my office. Same back, same diagnosis, same MRI, but her pain was a nine. She couldn't sleep. She couldn't work. She told me, "I feel like my body is falling apart." Here's what I want you to understand. Her body wasn't falling apart.

[00:00:48] Her nervous system was grieving. This is the first episode in a three-part series on grief and chronic pain. And if you're living with both right now, if you've lost someone you [00:01:00] love and your pain has gotten louder, I need you to hear this. Your body is not betraying you. It's doing exactly what bodies do when the world falls apart.

[00:01:13] Today, we're going to look at the science, what grief does inside your nervous system, 

[00:01:19] why loss amplifies pain in ways that surprise most people and what you can do about it. Here's a scenario I see regularly in integrative pain medicine. Someone has chronic pain. They've been managing it for years. They have good weeks and hard weeks. They know the difference, and then they lose someone, a parent, a spouse, a child, a close friend.

[00:01:46] Within weeks, the pain doubles. The tools that used to work stop working. And the person starts to feel like they're doing something wrong, but they're not. Their nervous system has [00:02:00] changed. Let me show you what's actually happening. There's a system in your body called the HPA axis, hypothalamus-pituitary-adrenal.

[00:02:10] It manages your stress response. When you're healthy, this system has a rhythm. Cortisol, your primary stress hormone, is high in the morning to help you wake up, and then it tapers down at night so you can sleep. Multiple studies have shown that in people with complicated or prolonged grief, this rhythm flattens.

[00:02:32] The morning peak is blunted. The nighttime dip is gone. Your stress hormone system gets stuck in a fog. And when cortisol loses its rhythm, everything downstream loses its rhythm: your immune system, your pain sensitivity, your sleep, your digestion.

[00:02:53] In twenty twenty-two, Brown and Colleagues published a study of one hundred and eleven recently bereaved [00:03:00] spouses. They measured a specific inflammatory messenger called IL-6, interleukin 6. It's one of the body's alarm signals. They compared people with high grief symptoms to people with lower grief symptoms, and here's what they found.

[00:03:15] People with high grief had a nineteen percent greater rise in IL-6 in response to stress than people with lower grief. Not depression, grief specifically. Why does that matter for you? Because pain and inflammation live in the same neighborhood. Inflammatory cytokines like IL-6 turn up the volume on your nervous system's pain signals.

[00:03:42] They sensitize the very nerves that are supposed to tell your brain what's going on in your body. So when grief pushes IL-6 up, it pushes pain up with it. Now, here's where it gets really interesting.

[00:03:57] In 2008, Mary Frances O'Connor and her [00:04:00] team at UCLA did functional MRI studies of people who were grieving. They put grieving individuals in a scanner and showed them images of the person they'd lost alongside images of strangers, and they saw something no one expected. The nucleus accumbens lit up.

[00:04:20] That's your brain's reward center, the region that fires when you see something you want, food you crave, a person you love. It's tied to dopamine, oxytocin, and endogenous opioids, your body's own natural pain relievers. In grieving people, seeing the deceased activated the reward system, which means grief is not just sadness.

[00:04:48] Grief is craving. Your brain is not only mourning. Your brain is literally reaching for the person it lost. It's scanning the room. It's [00:05:00] searching the crowd. It's looking for the sound of their voice, the shape of their body, the smell of their skin. And when the person doesn't come back, that reward system stays activated, unresolved, hungry.

[00:05:16] This is why grief feels so much like addiction and withdrawal at the same time, because neurobiologically, it is.

[00:05:25] Here's the piece that ties it all back to pain. The endogenous opioid system, the system your brain uses to dampen pain naturally, is deeply connected to your bonding and reward chemistry. When you're held by someone you love, your brain releases oxytocin and opioids that literally reduce your pain sensitivity.

[00:05:45] And when you lose that person, you lose that regulatory input. Your natural pain-relieving system loses one of its most powerful anchors. That's not weakness, that's biology. So when someone comes in with their [00:06:00] scan unchanged and their pain doubled in the weeks after a loss, no new MRI is going to explain what happened.

[00:06:07] The tissue hasn't changed, but the nervous system has.

[00:06:11] Let me introduce you to a concept that explains what's happening here. It's called allostatic load. Bruce McEwen, one of the great researchers in stress physiology, described it this way: Your body has a certain amount of adaptive capacity. Every stressor you face, a hard workout, a bad night's sleep, a difficult conversation, a chronic illness, an emotional loss, takes something out of that capacity.

[00:06:39] Your body is designed to spend from that reserve and then rebuild it. Stress, recovery, stress, recovery. That's the rhythm of a healthy nervous system. But when the stressors keep coming and the recovery never fully happens, the load accumulates. That accumulated wear and tear, that's [00:07:00] allostatic load. Now think about someone living with chronic pain.

[00:07:05] Their nervous system is already carrying a load. Every day, their pain system is firing, their sleep is fragmented, their inflammation is elevated, their stress hormones are dysregulated, their brain is working overtime just to make it through the day. The reserve is already thin, and then grief walks in.

[00:07:28] Picture a computer running too many programs at once. The fan is spinning, the processor is hot, the system is slow, and then someone opens another twenty windows. That's what grief does to a nervous system that's already fighting chronic pain. Everything just slows down. Everything struggles. And the pain, which was the loudest program to begin with, gets even louder because your brain has less capacity to modulate it, less capacity to [00:08:00] inhibit it, less capacity to tell your body you're safe.

[00:08:05] There's one more layer here, and I think it's the most important one. Both chronic pain and grief do something to identity. They strip you of who you were. If you've lived with chronic pain, you know this. You used to be the person who ran marathons, or the person who picked up their kids without thinking, or the person who worked 12-hour days.

[00:08:27] And then pain arrives, and suddenly you're someone else. You don't recognize the person in the mirror. Grief does the same thing. You used to be a daughter. Now you're a daughter without a mother. You used to be a father. Now you're a father without a child. You used to be a spouse.

[00:08:48] Now you're a widow. Your role has changed. Your future has changed. Your sense of self has changed. [00:09:00] There's a paper published in 2026 in Medicine, Healthcare, and Philosophy that I want to reference here. The authors made an observation that I think is profound. They said that chronic pain and grief share a common existential core.

[00:09:16] Both involve losing life possibilities. Both involve losing your future self. Both involve what they called relearning the world. When you're grieving, you're relearning a world that no longer contains the person you loved. When you're in chronic pain, you're relearning a world that no longer contains the body you had.

[00:09:40] And when both happen at once, you're relearning everything, all at once. Picture two storms. The first storm is the pain storm. It's been rolling through your landscape for years. You've learned its patterns. You know when it's coming. You've built [00:10:00] shelters. And now, from the other direction, a second storm rolls in.

[00:10:06] The grief storm. It has its own winds, its own thunder, its own rain. And you're standing in the place where they meet. That's what it feels like to live with chronic pain and loss at the same time. That's not in your head. That's in your biology. That's in your neuroscience. And you deserve to have that named.

[00:10:29] So what do we do with all this? I wanna give you three practices, not theory, practices you can actually do this week. Because grief that stays in the head doesn't move. Grief needs to be witnessed. It needs to be named. It needs to live in the body, and then it needs to move through the body.

[00:10:50] The first practice begins with first stabilizing the nervous system. You cannot process grief in a body that's on fire. [00:11:00] You cannot do pain reprocessing when the nervous system is in overwhelm. The first job always is stabilization. Think of it this way. If a house is burning, you don't start rearranging the furniture.

[00:11:13] You put the fire down first, just enough. For the grieving patient in chronic pain, stabilization looks like a few specific things. Coherence breathing. I use the Heart Math approach with many of my patients. Slow, rhythmic breathing, focused on the area of the heart, about five seconds in, five seconds out.

[00:11:35] What this does is bring your heart rate variability up. It signals to the brain gently that the body is not in danger right now, in this moment.

[00:11:46] We're not asking the nervous system to feel safe about the loss. That's too big. We're asking it to feel safe in this one breath, and then the next one. Somatic movement, [00:12:00] not exercise in the traditional sense. Gentle, slow, ten minutes of walking, stretching in bed before you get up. The point is not to burn calories.

[00:12:13] The point is to remind the body that it's safe to move, that movement doesn't always mean pain. Sleep. Grief-adapted sleep hygiene, which means understanding that if you're waking up at three in the morning, that's not insomnia. That's your nervous system searching for the person who's gone. And fighting it makes it worse.

[00:12:36] Getting angry at yourself makes it worse. What helps is a gentle re-entry, warm water, a cool room, a weighted blanket, sometimes a body pillow, because the body remembers who used to sleep next to it. That's not weakness, that's neurobiology. And how do you know when you're stable enough to move to the [00:13:00] next practice?

[00:13:01] Here's the marker I use with patients. You can observe your feelings without being completely consumed by them. The wave still comes, but you can watch it come and watch it go without disappearing into it. That's not the absence of grief. That's the beginning of being able to hold it. The second practice is the stenographer practice applied to grief.

[00:13:25] I've talked about the stenographer practice in previous episodes for pain. Today, I wanna show you how it works for grief. When a grief wave comes, and it will, your job is not to fight it, not to run from it, not to fix it. Your job is to observe it, like a stenographer taking notes in a courtroom. Where is it in your body?

[00:13:48] The chest? The throat? The gut? The shoulders? What is its texture? Sharp? Heavy? Hot? A [00:14:00] pressure? A hollowness? Does it move? Does it stay? You're the witness, not the flood. Here's what this does in the nervous system. The prefrontal cortex, the observing part of the brain, comes online.

[00:14:18] The amygdala, the alarm center, quiets. You're still feeling the grief. You're not being consumed by it. Practice this in small waves first. Then over time, you can hold bigger ones. The third practice is to be witnessed. Grief shrinks in the presence of someone who says, "I see what you lost."

[00:14:40] That single sentence said by a person who means it can do more for your nervous system than most interventions I can offer you in my clinic. We're wired for co-regulation. When we're held physically or emotionally by another safe human being, our vagus nerve responds. Our heart rate variability [00:15:00] improves.

[00:15:01] Our cortisol drops. Our inflammatory markers settle. Community and witnessing are not soft skills. They are nervous system medicine. Find one person, one safe person, and let them see what you've lost. Don't perform for them. Do not tidy it up. Let them witness. If you don't have that person right now, I want you to hear this.

[00:15:27] There are communities out there of people walking through exactly what you're walking through. Grief groups, chronic pain communities, faith communities, and online spaces that are held with care. You don't have to do this alone, and you were never meant to.

[00:15:44] Three practices: stabilize the nervous system, use the stenographer practice for grief, and be witnessed. You don't need to do all three this week, but pick one, the one that landed while I was describing [00:16:00] it. That's the one your body is asking for. Before we end, I want you to know something. Over the past two months, I lost my father.

[00:16:13] Nine days later, I lost my four-year-old daughter. I'm not sharing that to make this episode about me. I'm sharing it because I can't sit here and talk about grief and pain without telling you I know what this feels like. Not from a textbook, from my body. I'm doing the work I'm asking you to do. I'm stabilizing my nervous system.

[00:16:42] I am observing the waves, and I'm letting people witness me. Some days it works, some days it doesn't, and that's the process. I'm not speaking to you from the other side of this. I'm in it with you. Next time, in episode two, [00:17:00] we're going to talk about the invisible losses, the ones that don't come with a funeral.

[00:17:05] The layers of self that chronic pain strips away slowly over years, and how to name them. If today's episode landed for you, share it with one person, please. Just one. Someone who might be carrying grief and pain at the same time. Thank you so much for being here, for being brave enough to look at what's hard.

[00:17:26] Be gentle with your body this week. Be gentle with your losses. Be gentle with yourself. I'll see you next time.