Can Chronic Pain Increase Bad Cholesterol (LDL)?

Written by Jim Folk
Medically reviewed by Marilyn Folk, BScN.
Last updated June 16, 2022

chronic pain can increase bad cholesterol (LDL)

My doctor said my bad cholesterol (LDL) is up. Since I’ve been dealing with anxiety-caused chronic pain over the last year, can chronic pain increase bad cholesterol?


Medical Advisory

We recommend discussing new, changing, persistent, and returning symptoms with your doctor, as many medical conditions and medications can cause anxiety-like symptoms.

Additional Medical Advisory Information.

Yes, chronic pain can increase bad cholesterol. Here’s why:

Chronic pain stresses the body,[1][2] and stress can cause the development and persistence of chronic pain, with one fueling the other.[3]

For instance, researchers Chadi Abdallah and Paul Geha note in their research “Chronic Pain and Chronic Stress: Two Sides of the Same Coin?”[1]:

“…chronic pain leads to “wear-and-tear”—also termed allostatic overload—in the body and brain “from chronic dysregulation (i.e., over-activity or inactivity) of physiological systems that are normally involved in adaptation to environmental challenge.”

In the research “The Physiologic Effects of Pain on the Endocrine System,” Forest Tennant writes[2]:

“Initially, severe pain causes a hyperarousal of the hypothalamic–pituitary–adrenal system which results in elevated serum hormone levels such as adrenocorticotropin, cortisol, and pregnenolone.”

Moreover, the research “Pain and Stress in a System Perspective,” led by C. Richard Chapman, states[3]:

“Chronic pain can develop as a result of unusual stress. Social stressors can compound the stress resulting from a wound or act alone to dysregulate the supersystem. When the supersystem suffers dysregulation, health, function and sense of well-being suffer. Some chronic pain conditions are the product of supersystem dysregulation.”

Therefore, chronic pain stresses the body, and stress can cause and sustain issues with chronic pain.

Furthermore, research shows stress can increase bad cholesterol (low-density lipoprotein - LDL).[4][5][6][7][8]

For instance, researchers Ignatius C. Maduka, Emeka E. Neboh, and Silas A. Ufelle tested 208 undergraduate students 3 - 4 weeks before a major examination and 1 – 3 hours before a major examination.[4] They found:

“There was statistically significant increase in serum cortisol, adrenaline, Total cholesterol, HDL-cholesterol and LDL-cholesterol levels in students under examination stress compared to the non examination period.”

They conclude:

“Significant positive correlation was observed between cortisol and TC/HDL ratio before examination stress.”

Consequently, chronic stress can chronically increase bad cholesterol (LDL).

Numerous other studies have found similar results.[5][6][7][8]

Furthermore, anxiety can also increase bad cholesterol because it activates the hypothalamic–pituitary–adrenal (HPA) axis.

For instance, anxious behavior activates the stress response via the HPA axis. The stress response secretes stress hormones into the bloodstream, where they travel to specific locations in the body to bring about certain physiological, psychological, and emotional changes that prepare the body for immediate action.[9][10]

You can read more about the many changes caused by the stress response in our “Stress Response” article.

Since stress responses push the body beyond its balance point (equilibrium), stress responses stress the body. As such, anxiety stresses the body.

Consequently, in addition to causing anxiety symptoms, such as chronic pain, anxious behavior, which creates anxiety, can also increase bad cholesterol due to the stress caused by anxiety.

The combination of anxiety, chronic pain, and stress can all contribute to an increase in bad cholesterol (LDL).

So again, yes, chronic pain can increase bad cholesterol.

You can reduce bad cholesterol through a healthy diet, reducing stress, increasing rest, regular deep relaxation, regular exercise, getting good sleep, and dealing with your anxiety issues. As you overcome your anxiety issues, both anxiety-caused chronic pain and stress will diminish, reducing bad cholesterol (LDL).

In fact, research shows that regular exercise, regular deep relaxation, and getting good sleep are natural and practical ways to reduce bad cholesterol.[11][12][13]

Working with an experienced anxiety disorder therapist is the most effective way to overcome issues with anxiety.

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The combination of good self-help information and working with an experienced anxiety disorder therapist, coach, or counselor is the most effective way to address anxiety and its many symptoms. Until the core causes of anxiety are addressed – which we call the underlying factors of anxiety – a struggle with anxiety unwellness can return again and again. Dealing with the underlying factors of anxiety is the best way to address problematic anxiety.

Additional Resources

Return to our Anxiety Frequent Questions archive. Information, support, and therapy for anxiety disorder and its symptoms, including: Can Chronic Pain Increase Bad Cholesterol (LDL)?


1. Abdallah, Chadi G, and Paul Geha. “Chronic Pain and Chronic Stress: Two Sides of the Same Coin?” Advances in Pediatrics., U.S. National Library of Medicine, Feb. 2017.

2. Tennant, Forest. "The Physiologic Effects of Pain on the Endocrine System." Pain and Therapy, 20 Aug 2013.

3. Chapman, C. Richard, et al. “Pain and Stress in a Systems Perspective Reciprocal Neural, Endocrine and Immune Interactions.” Advances in Pediatrics., U.S. National Library of Medicine, Feb. 2008.

4. Maduka, Ignatius C., et al. "The relationship between serum cortisol, adrenaline, blood glucose and lipid profile of undergraduate students under examination stress." African Health Sciences, 15 Mar 2015.

5. Assadi, Seyedeh Negar. "What are the effects of psychological stress and physical work on blood lipid profiles?" Medicine, 5 May 2017.

6. Silvennoinen, Reija, et al. "Acute Psychological Stress Accelerates Reverse Cholesterol Transport via Corticosterone-Dependent Inhibition of Intestinal Cholesterol Absorption." Circulation Research, 28 Aug 2021.

7. Sara, Jaskanwal Deep Singh, et al. "Mental Stress and Its Effects on Vascular Health." Mayo Clinic Proceedings, 1 May 2022.

8. Muldoon, M. F.,"Acute cholesterol responses to mental stress and change in posture." Archives Of Internal Medicine, 15 April 1992.

9. Godoy, Livea, et al. "A Comprehensive Overview on Stress Neurobiology: Basic Concepts and Clinical Implications." Frontiers In Behavioral Neuroscience, 3, July 2018.

10. Teixeira, Renata Roland, et al. “Chronic Stress Induces a Hyporeactivity of the Autonomic Nervous System in Response to Acute Mental Stressor and Impairs Cognitive Performance in Business Executives.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 2015.

11. Alghamdi, Mansour Saleh M., et al. "Effectiveness of Low to Moderate Physical Exercise Training on the Level of Low-Density Lipoproteins: A Systematic Review." BioMed Research International, 1 Nov 2018.

12. Krittanawong, Chayakrit, et al. "Meditation and Cardiovascular Health in the US." The American Journal of Cardiology, 15 Sep 2020.

13. Kaneita, Yoshitaka, et al. "Associations of Usual Sleep Duration with Serum Lipid and Lipoprotein Levels." SLEEP, 1 May 2008.