From the Guidelines

Yes, pain can affect cortisol levels.

Pain can activate the hypothalamic-pituitary-adrenal axis, which is responsible for stress responses and can alter the body's homeostasis 1.
This activation can lead to changes in the levels of glucocorticoids, such as cortisol, which play a regulatory role in the immune system and can have anti-inflammatory and immunosuppressive effects at pharmacological doses 1.

Chronic pain can lead to increased stress, which can disrupt the normal functioning of the hypothalamic-pituitary-adrenal axis, resulting in altered cortisol levels 1.
Some studies have reported low blood cortisol levels in patients with chronic conditions, such as long COVID, which may be related to hypothalamus–pituitary–adrenal axis dysfunction 1.

Understanding the relationship between pain and cortisol levels is important for the management of chronic pain and related conditions, such as depression and anxiety 1.
Further research is needed to fully elucidate the mechanisms underlying the relationship between pain and cortisol levels and to develop effective treatments for related conditions.

From the Research

The relationship between pain and cortisol levels is complex, with evidence suggesting that cortisol secretion can both inhibit and intensify pain experiences 2, 3.
Studies have shown that low cortisol levels at baseline can increase the likelihood of developing chronic pain in traumatically injured individuals 2.
Conversely, high cortisol levels have been associated with chronic pain, with one study finding that patients with chronic back pain have higher levels of cortisol than healthy control subjects 4.
The stress model of chronic pain suggests that sustained endocrine stress responses, including elevated cortisol levels, can contribute to persistent pain states 5, 4.

Cortisol has been shown to modulate pain sensation, with decreased cortisol levels associated with increased pain thresholds and vice versa 3.
Testosterone, which is decreased by stress, has also been found to play a role in pain modulation, with lower testosterone levels associated with increased pain ratings 3.
The relationship between cortisol and pain is influenced by individual differences, such as psychological distress and coping mechanisms, which can affect cortisol secretion and pain perception 2, 5.

Understanding the relationship between pain and cortisol levels can inform the development of effective pain management strategies, including stress management and cortisol regulation 5, 6.
Further research is needed to elucidate the complex interactions between pain, cortisol, and other physiological and psychological factors, particularly in patients with chronic pain conditions such as fibromyalgia 6.