Opening the Case

What caught my attention wasn’t the shoulder. It was the timing. The ache had started the same month her mother moved into a care home.

She hadn’t connected the two. Why would she? One is a joint. The other is a feeling. But the timeline was right there in front of us, and once she saw it, she couldn’t unsee it. That’s not a diagnosis I’m qualified to make — that’s her physio and her doctor’s territory. But noticing the pattern, and asking the question nobody else had time to ask? That’s exactly the kind of clue I go looking for.

This isn’t about deciding your pain is “all in your head.” It’s the opposite of that. Your head is part of your body, and the two of them have been talking this whole time — about the fall you had at nineteen (the subject of the first file in this series), about the divorce, about the parent you’re losing slowly, about the thing you never quite said out loud. Some of that conversation shows up as pain. Today’s case looks at why, and what to do about it.

Clue #1 — Your Brain Doesn’t Have Two Separate Filing Systems

That’s not a nice metaphor — it’s what the scans actually show. People going through a breakup, and people nursing a physical injury, light up the same circuits. There’s even a study where plain old Tylenol eased people’s hurt feelings after being rejected. Not just how they said they felt, either — their brain scans showed less activity in those same pain regions, too.

Your body was never built with a hard line between “emotional” and “physical.” It has one alarm system. And it uses it for both.

Clue #2 — Pain Without a Clear Injury Is Still Real Pain

It tends to show up in people who’ve been carrying stress that never got the chance to resolve. Not because they’re fragile. Because a nervous system that’s been on high alert for years starts treating ordinary aches like threats — the kind another body would just shrug off.

Two people can have the exact same MRI and a completely different pain experience. The scan shows the tissue. It doesn’t show what the nervous system’s been carrying.

Clue #3 — The Cortisol Loop Nobody Explains Properly

Grief and chronic stress switch on the same system in your body — the HPA axis, a chain reaction between your hypothalamus, your pituitary gland, and your adrenals. It’s what pushes cortisol into your bloodstream whenever something feels like a threat. A loss counts. So does a life that’s quietly stopped feeling safe.

With normal grief, cortisol spikes, then settles, as you process what happened. But grief you never get around to feeling — because there was no time, no space, nobody who asked — doesn’t get that chance to settle. Cortisol stays high longer than it should. And it doesn’t just sit there making you feel low. It fuels inflammation. It turns up your pain pathways. It wrecks your sleep, which makes the pain feel worse again the next day.

It’s a loop, not a straight line. Stress raises cortisol. Cortisol fuels inflammation. Inflammation turns up the pain. And the pain adds more stress. Round and round it goes.

The psychiatrist and trauma researcher Bessel van der Kolk has spent decades making the case that experience that never gets processed doesn’t just fade — it gets stored physically, in muscle tension, in posture, in the body’s baseline sense of safety.
— paraphrased from the work of Bessel van der Kolk, trauma researcher

Clue #4 — Why It Tends to Surface in Midlife

None of these are small. And when there’s no time built into a busy life to actually feel them, the body often ends up holding what the schedule wouldn’t allow. A tight jaw. A locked-up lower back. A headache that shows up every time a certain conversation gets close. These aren’t random. They’re often the places where something never finished.

The Small Signal

Nutritional Support

— Vitamin C is the one to lead with here, for a reason most people don’t know: your adrenal glands hold some of the highest concentrations of vitamin C in your body, and they burn through it faster when cortisol’s been running high for weeks. Citrus, bell peppers, and berries are the easy, everyday way to keep resupplying what stress quietly drains.

— A B-complex with active forms is the close second. Your body uses B vitamins to build the very neurotransmitters that keep mood and calm steady, and prolonged stress runs them down. Look for B6 as pyridoxal-5-phosphate and B12 as methylcobalamin if you supplement; on the plate, eggs, salmon, and leafy greens cover a lot of ground.

— Magnesium — glycinate or threonate if supplementing, or pumpkin seeds and leafy greens on the plate — helps a wound-up nervous system and tense muscles actually wind down.

— And don’t let water slide on the hard weeks. A 2012 study found even mild dehydration raised cortisol and worsened mood in women — which means the exact week you’re most stretched is the worst one to forget your glass.

As always, these are nutrients that support the body doing its own regulating — not a substitute for actually feeling what needs to be felt.

One more thing worth naming: if what you actually reach for on the hard days is something closer to comfort food than kale, that’s not a failure of willpower — it’s the same cortisol loop this article’s been describing, doing exactly what it’s built to do.

More on that, and what the research actually says about it, in a future case file.

Red Flags — When to Seek Support

— Grief or stress that’s affecting your ability to function day to day, weeks or months after the event that triggered it.

— Pain that moves around your body, or that flares in a pattern tied to specific memories, anniversaries, or conversations.

— A sense that you’ve never really processed something — a loss, an ending, a version of your life that didn’t happen — and it keeps resurfacing physically.

A note for the appointment itself: asking for physical causes to be ruled out first doesn’t contradict anything in this article — it’s the correct order of operations. If you sense a symptom being filed under “stress” before it’s actually been examined, it’s completely reasonable to say, “I’d like this investigated before we assume it’s stress-related.” Both things can be true at once. The workup comes first; the timeline work comes alongside it.

A somatic therapist or grief counsellor can work with exactly this overlap in a way that nutrition and general practice medicine aren’t designed to address alone. This isn’t a substitute for that kind of support — it’s the case file that might finally point you toward asking for it.

Closing the Case

You don’t have to solve the whole file today. Just start noticing where the timeline lines up. That’s usually where the real case begins.