Physical Symptoms of Anxiety: When the Body Holds Trauma
For much of my medical career, I treated patients with chronic pain. I also spent years caring for patients struggling with addiction and substance use disorders. Those experiences taught me a great deal about pain, but they also gradually changed the way I thought about what might be driving some of the symptoms my patients were experiencing.
I began seeing patterns. Patients would come to me after years of appointments, testing, medications, procedures, and referrals to different specialists. Their symptoms were real, and often debilitating, but there wasn't always a single diagnosis that adequately explained what they were experiencing.
One patient described it to me this way:
“I feel like I’ve been given every diagnosis—an alphabet soup of conditions. Parts of each one seem to fit, but at the same time, none of them really explains what I’m experiencing.”
I've heard variations of this statement many times over the years. Patients come to me with chronic headaches, neck and back pain, gastrointestinal problems, muscle tension, fatigue, insomnia, or unusual sensations such as burning or electricity under the skin. Many have spent years searching for answers, often seeing multiple specialists along the way. Some have received several different diagnoses, while others have been told repeatedly that their testing is normal. In either case, they are often left frustrated and still searching for an explanation.
What I increasingly recognized was that, for some of these patients, we were looking at individual symptoms without looking closely enough at the nervous system connecting them.
When Trauma Doesn't Look Like Trauma
As I learned more about my patients' histories, another pattern became
increasingly difficult to ignore: trauma was often somewhere in the
background.
Sometimes it was obvious: combat, abuse, a serious accident, or a life-threatening event.
Often, it was more subtle. Perhaps years of cumulative exposure working as a first responder, healthcare professional, or caregiver; living through chronic stressors; experiencing loss; or simply spending years in a high-stress environment.
Many of these patients would never have described themselves as having PTSD. Some didn't even consider what they had experienced to be trauma. They came to me because of pain, but over time, I began to recognize a common thread in many of their stories: unresolved trauma and a nervous system that seemed to remain stuck on high alert.
Our sympathetic nervous system is designed to protect us. When we perceive danger, our heart rate increases, muscles tighten, breathing changes, and our senses become more alert. We become prepared to fight, flee, or otherwise protect ourselves. In an actual emergency, that response is incredibly useful.
But what happens when the emergency ends and the nervous system doesn’t stand down? What happens when that response is activated so often—or for so long—that it begins to feel like the body’s default setting?
For some people, the body can remain in a heightened state of alert even when the conscious mind knows there is no immediate danger. One of the most common things I hear from patients is essentially: “I know I'm safe. I just can't get my body to feel safe.”
That is a very different way of understanding anxiety.
Recognizing the Physical Symptoms of Anxiety
We often describe anxiety as excessive worrying or racing thoughts. Certainly, it can look that way. But many of the patients I see experience anxiety much more physically.
They may wake up at 3:00 in the morning with their heart pounding. They may constantly clench their jaw or tighten their shoulders. They may experience nausea, sweating, trembling, headaches, or a sensation that something is wrong even when they cannot identify what it is. Some don't describe themselves as anxious at all.
This is where my background in physical medicine became particularly relevant. Pain has never been as simple as identifying an injured body part. The brain, spinal cord, peripheral nerves, immune system, sleep, emotions, previous experiences, and autonomic nervous system all influence how we experience physical symptoms.
Saying that the nervous system is contributing to someone's symptoms does not mean those symptoms are “all in their head.” The nervous system is part of the body. Its responses are physiological and very real.
The same principle applies to trauma. You don't have to consciously think, “I'm in danger,” for your body to react as though you are. A sound, smell, environment, interaction, memory, physical sensation, or even a trigger the person cannot identify can produce a physiological response before the conscious brain has had time to make sense of it.
The mind may be saying, “Everything is fine.” The body may be saying something entirely different.
What Treating Addiction Taught Me
My experience treating addiction reinforced many of these observations. Addiction is complex, and there is never one explanation for why someone develops a substance use disorder. But I repeatedly encountered patients who had discovered that alcohol or another substance temporarily quieted something they had been unable to quiet themselves.
For some, it helped them sleep. For others, it reduced anxiety, intrusive thoughts, emotional pain, or simply that relentless feeling of being “on.”
Of course, what initially provides relief can eventually create an entirely new disease process. Treating addiction itself remains essential. But my experience taught me that we also have to ask an important question: What was the person trying to escape from or regulate in the first place?
For many patients, trauma was an important part of that answer.
That realization influenced the direction of my medical practice. I became increasingly interested not only in treating the symptom in front of me, but in understanding why so many seemingly different conditions — chronic pain, anxiety, insomnia, substance use, headaches, hypervigilance, and physical tension — could coexist in the same person.
The autonomic nervous system became an important piece of that puzzle.
From Treating Symptoms to Treating the Cause
Today, much of my practice at Reset Medical & Wellness Center in Strongsville, Ohio, focuses on trauma, PTSD treatment, and nervous system recovery. Many patients who find us are searching for options beyond traditional medication and therapy, including our dual-level stellate ganglion block (SGB), ketamine therapy, or other approaches to nervous system regulation.
Our Neuro Sympathetic Reset (NSR) is our approach to dual-level stellate ganglion block (SGB). Rather than acting directly on thoughts or memories, NSR targets the sympathetic nervous system — the part of the nervous system involved in the body's fight-or-flight response. The goal is to reduce excessive sympathetic activation and help the nervous system move toward a more regulated state.
Ketamine therapy works differently. Rather than directly targeting the sympathetic nervous system, ketamine affects pathways in the brain involved in mood and emotional processing. Through a process called "neuroplasticity", ketamine may help the brain form and strengthen these connections and support healthier emotional processing and the ability to work through difficult memories. It may be considered for patients struggling with PTSD or treatment-resistant depression.
These treatments are not interchangeable, and neither is appropriate for every patient. In some cases, we may recommend one approach; in others, a combination of treatments may make sense. Understanding what appears to be driving a person’s symptoms is an important part of deciding where to start.
At Reset, we offer free assessments to help determine whether you may qualify for our treatments, as well as free consultations with Dr. Louwers to discuss your symptoms, answer questions, and better understand which treatment options may be appropriate for your individual needs.
Trauma Is an Injury That Can Heal
One of the messages I emphasize most strongly with patients seeking PTSD treatment is that I believe trauma should be viewed as an injury that can heal, not as a personal weakness.
That distinction matters.
If someone has spent years in a heightened state of fight-or-flight, telling them to “relax” isn't particularly useful. Neither is suggesting that they simply need to think differently. Their nervous system may have spent years learning how to protect them.
The goal isn't to eliminate that protective response. We need it. The goal is to help the nervous system become more flexible — capable of responding appropriately when danger is present, but also capable of settling when it isn't.
That is also why I don't view nervous system treatments such as NSR, SGB, or ketamine therapy as replacements for psychotherapy. High-quality, ongoing therapy remains an essential part of treating trauma. Medications, exercise, mindfulness, sleep, social connection, and other approaches can also be extremely important. For some patients, however, addressing the physiological component of trauma may help create an opportunity for those other treatments to work more effectively.
My career started with treating the physical manifestations of pain. Over time, my work in pain medicine and addiction taught me to look deeper at the relationship between the brain, body, and nervous system. Today, when I meet someone who has spent years searching for an explanation for chronic pain, migraines, panic, insomnia, or other persistent physical symptoms, I don't assume trauma is the answer.
But I firmly believe it is always a question worth asking.
Sometimes the symptom that brings a patient into the office isn't the beginning of the story. It's simply where the story finally became impossible to ignore.
If you would like to learn more about our approach to trauma and nervous system recovery, explore our pages on Neuro Sympathetic Reset (NSR) and ketamine therapy, or contact our team to discuss which treatment options may be appropriate for you.
FAQ
Can anxiety cause physical symptoms?
Yes. Anxiety can cause physical symptoms such as muscle tension, headaches, rapid heartbeat, sweating, gastrointestinal symptoms, sleep disruption, and other sensations related to activation of the nervous system.
Can trauma cause physical symptoms of anxiety?
Trauma and chronic stress can affect the autonomic nervous system and contribute to persistent fight-or-flight responses. Some people experience this as physical symptoms even when they do not consciously feel anxious.
How are physical symptoms of anxiety treated?
Treatment depends on the individual and may include psychotherapy, medication, exercise, mindfulness, sleep optimization, and other approaches. For appropriately selected patients, treatments targeting nervous system recovery, including NSR and ketamine, should also be considered.
About the Author
Michael J. Louwers, MD, is a board-certified Physical Medicine & Rehabilitation physician and fellowship-trained interventional pain physician with more than 18 years of clinical experience. His work in chronic pain and addiction medicine led to a particular interest in the relationship between trauma, mental health, and the autonomic nervous system. He is the owner and Medical Director of Reset Medical & Wellness Center in Strongsville, Ohio, where he focuses on evidence-based treatments for PTSD, depression, anxiety, and nervous system dysregulation.