Hyperarousal Emerges as Key PTSD Symptom Driving Widespread Pain in Young Adults

Chronic pain rarely stays put. For many sufferers, what begins as an aching back or a sore knee gradually spreads, until pain registers in five or more regions of the body at once. A new study published in the Journal of Behavioral Medicine suggests that for young adults, one particular feature of posttraumatic stress disorder may be quietly fueling that spread: hyperarousal, the state of constant physiological vigilance that keeps the nervous system braced for threat long after danger has passed. The finding points to a potentially powerful intervention target at the intersection of mental health and pain medicine.

The research, led by Laura E. Laumann of Brown University and Dean G. Cruess of the University of Connecticut, set out to answer two questions that have largely been ignored in the existing literature. First, do young adults with chronic pain that spans multiple body regions actually feel worse than those whose pain is more localized? Second, are specific clusters of PTSD symptoms, rather than posttraumatic stress as an undifferentiated whole, associated with the odds of having multi-region pain? The distinction matters clinically, because PTSD is not a monolith. Under the DSM-5 framework, its symptoms organize into four clusters: intrusion, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity, the last of which encompasses hyperarousal symptoms such as exaggerated startle, hypervigilance, sleep disturbance, and irritability.

The study enrolled 123 young adults with chronic pain, with an average age of 19 years, roughly 71 percent of whom identified as White and about 71 percent of whom were female. Participants completed baseline measures as part of a larger study, and the researchers used the Michigan Body Map to chart where on the body each person experienced pain. The map, initially validated by a team at the University of Michigan, divides the body into distinct regions and allows clinicians and researchers to quantify pain distribution with a simple self-report instrument. The team defined multi-region pain as pain present in five or more regions, a threshold that captures the kind of widespread, dispersed pain burden long associated with conditions such as fibromyalgia and with substantially worse health outcomes.

The first answer was unambiguous. Young adults whose pain reached five or more body regions reported significantly greater pain severity than those with more localized pain, scoring 5.6 on average compared with 4.8. The gap in daily functioning was even more striking. Pain interference, a measure of how much pain disrupts activities such as work, sleep, and social life, showed a median of 57 in the multi-region group versus 32.5 in the localized group. Because the interference data were skewed, the researchers used the nonparametric Mann-Whitney U test to confirm that the difference in mean ranks was statistically significant, reporting medians simply for ease of interpretation. In practical terms, widespread pain in this age group was not merely a matter of more sore spots; it translated into measurably heavier disruption of everyday life.

The second answer was more nuanced and, ultimately, more consequential. When the researchers ran separate logistic regression models, adjusting for gender, they found that total PTSD symptoms and each of the four symptom clusters individually were significantly and positively associated with the odds of having multi-region pain. In other words, intrusion symptoms, avoidance symptoms, mood and cognition symptoms, and hyperarousal symptoms each predicted widespread pain on their own. That pattern is consistent with a growing body of work linking trauma-related distress to pain that refuses to stay confined to a single anatomical site.

But the picture changed when all four clusters were entered into the model simultaneously. In that head-to-head comparison, only one cluster retained a significant independent association with multi-region pain: hyperarousal. Each unit increase in hyperarousal symptoms raised the odds of multi-region pain by 13 percent, an odds ratio of 1.13 with a 95 percent confidence interval of 1.01 to 1.27. The confidence interval is narrow enough to signal a reliable effect, though its lower bound hovers close to the threshold of significance, a reminder that the estimate carries some uncertainty in a sample of this size. Still, the pattern is telling. When clusters are modeled separately, they overlap heavily, sharing variance with one another and with total symptom burden. Only when that shared variance is partitioned does the unique contribution of each cluster emerge, and in this sample it was hyperarousal that stood alone.

Why would a state of heightened physiological arousal be linked to pain that spreads across the body? The most compelling mechanistic account involves central sensitization, a process in which the central nervous system itself becomes amplified in its response to stimuli. In sensitized states, neurons in the spinal cord and brain become hyperexcitable, so that signals that would ordinarily register as mild pressure or ordinary movement are interpreted as pain. Researchers such as Clifford Woolf have described central sensitization as a key to understanding chronic pain that cannot be explained by tissue damage alone, and neuroimaging and psychophysical studies from networks such as the MAPP Research Network have linked sensory amplification to broader symptom spread and severity. Hyperarousal, with its sustained activation of the sympathetic nervous system and dysregulation of the hypothalamic-pituitary-adrenal axis, is precisely the kind of chronic physiological state that could promote and maintain such amplification.

Sleep provides another plausible bridge. Hyperarousal symptoms include sleep disturbance, and the relationship between disrupted sleep and pain is well documented in both directions. Polysomnography studies in people with PTSD have documented altered sympathetic activity and abnormal hypothalamic-pituitary-adrenal dynamics during sleep, and sleep loss is known to lower pain thresholds and intensify pain perception. A young adult caught in a loop of hypervigilant nights and painful days may find that each factor feeds the other, with poor sleep amplifying next-day pain, and pain further fragmenting sleep. The authors of the new study are careful to note that their cross-sectional design cannot establish which comes first, and they explicitly call for longitudinal research to identify mechanisms and clarify the directionality of the relationships they observed.

The clinical implications, however, are already taking shape. If hyperarousal is the PTSD symptom cluster most tightly bound to widespread pain in young adults, then treatments that specifically dial down physiological arousal become attractive candidates for integrated care. Trauma-focused therapies that address arousal and reactivity, alongside interventions with demonstrated effects on both PTSD and pain, such as cognitive behavioral approaches, mindfulness-based stress reduction, and emotional awareness and expression therapy, could be sequenced or combined in ways that target the shared mechanism rather than treating the mind and the body as separate problems. The study’s authors suggest that hyperarousal may serve as a potential intervention target for the treatment of multi-region pain, a framing that could reshape how pain clinics screen their patients. A simple PTSD symptom checklist administered at intake might identify the young patients whose pain is most likely to be widespread and most likely to resist purely physical treatment.

The timing of this work is significant for another reason. Chronic pain affects a substantial share of young adults, and rates of PTSD symptoms among college students have been climbing in recent years, making the intersection of these two conditions a growing public health concern at a life stage when educational, vocational, and social trajectories are still being set. Prior research has linked multi-region pain to greater disease burden than localized pain, and studies in veterans and other trauma-exposed populations have reported similar associations between PTSD symptom clusters and multisite pain. What this study adds is a developmental window: evidence that even in early adulthood, before decades of pain chronicity accumulate, the arousal component of traumatic stress is already entangled with how far pain travels through the body. The sample is modest and cross-sectional, and the authors themselves frame their results as a call for longitudinal follow-up rather than a final verdict. But the message for researchers and clinicians alike is hard to ignore. When pain spreads, the nervous system’s threat-detection machinery may be spreading it, and calming that machinery could be one of the most direct routes to relief.

Subject of Research: The association between PTSD symptom clusters, particularly hyperarousal, and multi-region chronic pain in young adults

Article Title: Associations between PTSD symptom clusters and multi-region pain in young adults with chronic pain

Article References: Associations between PTSD symptom clusters and multi-region pain in young adults with chronic pain. (n.d.). https://doi.org/10.1007/s10865-026-00714-x

Image Credits: AI Generated

DOI: 10.1007/s10865-026-00714-x

Keywords: chronic pain, PTSD, hyperarousal, multi-region pain, young adults, central sensitization, pain interference, Michigan Body Map, trauma, sleep disturbance, Journal of Behavioral Medicine, logistic regression