According to the Centers for Disease Control and Prevention (CDC), an estimated 20.9% of U.S. adults (51.6 million people) reported experiencing chronic pain (pain lasting >3 months), with 6.9% (17.1 million people) experienced high-impact chronic pain, which is chronic pain that results in substantial restriction to daily activities
And still, when someone has abnormal lab work, chronic pain is RARELY given the attention it deserves.
Instead, those lab changes are often blamed on body size, “lifestyle,” or vague advice to lose weight and come back later. That is a problem. Chronic pain is not just something you “feel.” It can affect sleep, stress hormones, inflammation, blood sugar regulation, and other systems throughout the body.
Chronic pain is often something that gets treated as a symptom caused by something else, rather than a standalone condition with systematic consequences that can impact various parts of the body.
These consequences can affect health markers such as:
This occurs due to the body’s prolonged response to stress and pain, which can lead to a disruption in metabolic and hormonal regulation, increased inflammation, and more.
Unfortunately, these altered health markers are often attributed as a side effect of higher body weight by clinicians, and can go without further inspection. We’re calling this out!
This ultimately leads to incomplete treatment, a delay in an accurate diagnosis, and/or prolonged pain for people in larger bodies. That is why it is crucial for clinicians to recognize chronic pain as an important piece of the puzzle in why certain health markers appear abnormal, regardless of weight or body size.
Let’s go through some health markers that are not talked about that are affected by pain!
Insulin is a hormone that helps your body use sugar (glucose) from food for energy. When insulin isn’t working properly, sugar builds up in your blood instead of getting into your cells where it’s needed.
When you’re in pain long-term, your body creates chronic inflammation. Think of inflammation as your body’s alarm system that’s stuck in the “on” position. This ongoing inflammation releases proteins (like C-reactive protein, TNF-alpha, and IL-6) that interfere with how insulin works.
Specifically, these inflammatory proteins block insulin’s ability to communicate with your cells. It’s like insulin is knocking on the door, but the cells can’t hear it. This is called insulin resistance, your body makes insulin, but your cells don’t respond to it properly.
Chronic pain also wrecks your sleep. And poor sleep makes insulin resistance even worse. When you’re not sleeping well, your body has a harder time regulating blood sugar, which creates a vicious cycle: pain disrupts sleep, poor sleep increases insulin resistance, and insulin resistance can make inflammation worse, which increases pain.
Bottom line: If your doctor sees elevated insulin or glucose levels and immediately blames your weight without asking about pain, they’re missing a huge part of the picture.
HbA1c is a blood test that shows your average blood sugar levels over the past 3 months. It’s like a snapshot of how your body has been managing glucose over time.
Just like with insulin, chronic pain keeps your body in a prolonged stress response. When you’re stressed, your body releases hormones like cortisol and adrenaline (epinephrine) to help you respond to the threat, even though the “threat” is ongoing pain, not an actual emergency.
Cortisol tells your liver to release more glucose into your bloodstream (because your body thinks you need quick energy to fight or flee). But when this happens constantly due to chronic pain, you end up with consistently elevated blood sugar levels. And over time, that shows up as a higher HbA1c.
Additionally, the same insulin resistance caused by inflammation (which we talked about above) means your body can’t clear that extra glucose from your blood effectively. So it just keeps building up.
The bottom line: Elevated HbA1c isn’t always about diet or weight. It can be a result of your body’s response to living in chronic pain.
Blood sugar (glucose) is the amount of sugar in your blood at any given moment. Your body tightly regulates this because your cells need glucose for energy, but too much or too little can cause problems.
We’ve already talked about how chronic pain triggers cortisol release, which tells your liver to pump out more glucose. But here’s the kicker: cortisol also tells your muscles not to absorb that glucose, and it blocks your pancreas from releasing insulin to help manage it.
Why does your body do this? Because from an evolutionary standpoint, this response is supposed to be protective. Your body thinks you’re facing a physical threat that requires immediate energy, like running from danger or fighting off an injury. So cortisol floods your bloodstream with glucose to give your brain and vital organs quick fuel, while temporarily blocking your muscles from using it.
This makes sense if you’re in danger or dealing with a short-term injury. The problem is that chronic pain keeps this stress response turned on 24/7. Your body keeps acting like you’re in immediate danger, even when you’re just sitting on the couch.
So you end up with more sugar in your blood, less insulin available to deal with it, and your muscles refusing to take it in. It’s like a traffic jam where glucose is stuck in your bloodstream with nowhere to go.
This is why someone living with chronic pain might have elevated blood sugar levels even if their diet hasn’t changed at all.
The bottom line: High blood sugar isn’t always about what you’re eating. Chronic pain causes your body to release hormones that raise your blood sugar, even if your diet hasn’t changed at all.
Cholesterol is a waxy, fat-like substance that travels through your blood. Your body needs some cholesterol to build healthy cells, but too much can increase your risk of heart disease. LDL (“bad” cholesterol) and triglycerides are the types that can build up in your arteries.
When your body is stuck in chronic stress, cortisol doesn’t just mess with your blood sugar, it also tells your liver to produce MORE fats (aka lipids).
This leads to higher levels of LDL cholesterol and triglycerides in your blood. Essentially, your body is trying to provide extra energy resources because it thinks you’re in danger. But when that stress response never turns off, those fats just keep circulating in your bloodstream.
The bottom line: Elevated cholesterol can be a result of chronic stress and pain, not just your diet or your weight.
Your thyroid gland produces hormones (mainly T3 and T4) that regulate your metabolism, energy levels, body temperature, and more. When these hormones are off, you might feel exhausted, gain or lose weight unexpectedly, or struggle with brain fog.
Chronic pain activates what’s called the hypothalamic-pituitary-adrenal-thyroid-gonadal (HPATG) system. That’s a lot of words, but basically it’s your body’s command center for hormone production.
When you’re in severe pain, this system goes into overdrive and produces extra hormones, including cortisol, DHEA, testosterone, and thyroid hormones (T3 and T4). These hormones travel to injured nerves and your central nervous system to try to help you cope with the pain.
However, if pain continues for too long, your hormonal system gets exhausted. It can’t keep up with the constant demand. When that happens, hormone production can actually drop below normal levels, even though your body needs them.
So in the early stages of chronic pain, you might see elevated thyroid hormones. But if pain persists for months or years without relief, your thyroid hormones might actually become too low, leading to symptoms like fatigue, weight changes, and depression.
The bottom line: Abnormal thyroid levels aren’t always a standalone thyroid problem. Chronic pain can throw your entire hormonal system out of balance.
Cortisol is often called the “stress hormone.” It helps your body respond to stress by increasing blood sugar, suppressing your immune system temporarily, and helping you stay alert.
In the short term, cortisol is helpful. It gives you the energy and focus you need to respond to a threat.
But chronic pain means chronic stress. And when cortisol stays elevated for too long, it starts causing problems:
Eventually, if the pain goes on long enough, your adrenal glands (which produce cortisol) can become fatigued, and cortisol levels may drop too low. This can leave you feeling completely exhausted, unable to handle stress, and struggling with low blood pressure or dizziness.
The bottom line: When chronic pain throws your cortisol levels off balance, it doesn’t just affect one thing, it creates a ripple effect throughout your entire body.
If someone is living with chronic pain, they may also be dealing with changes in appetite, nausea, GI symptoms, poor sleep, fatigue, food avoidance, or a nervous system that feels constantly on edge.
For someone with an eating disorder history, chronic dieting history, or food trauma, that can make things even more complicated. Pain can disrupt hunger and fullness cues. Stress can intensify urges to restrict, binge, or disconnect from the body altogether. And if providers respond by focusing only on weight loss or blaming higher body weight, they may miss both the chronic pain and the eating disorder risk.
These outcomes are not just about weight. They are not proof that someone is “lazy”, “noncompliant,” or “unhealthy”- the three words that we hate. They may be signs of a body that has been under stress for a very long time.
Chronic pain can affect much more than how someone feels day to day. It can influence insulin, A1C, blood sugar, cholesterol, cortisol, and thyroid-related hormones through a mix of inflammation, stress, sleep disruption, and endocrine changes.
So if labs are off, especially in someone living with chronic pain, we need the FULL story. Not a weight-centered assumption. Not “just lose weight and come back.”
You deserve care that actually looks at the WHOLE picture instead of being prescribed lazy medicine.
Megan is a weight inclusive registered dietitian and Certified Intuitive Eating Counselor. She is the founder and director of A Soft Place to Land, a multidisciplinary group practice based in Lehigh Valley, Pennsylvania that specializes in eating disorders, chronic dieting, and body image care. She is fiercely on a mission to be a loud advocate for ethical care of every BODY. Megan’s goal is to provide a weight inclusive and trauma informed safe space with an emphasis on social justice, fat liberation, self-exploration, and compassion. When she’s not taking down the patriarchy, you can find her spending time with her dogs outside, gardening, and painting plant pots!
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