Drawing from the cognitive-neoassociation theory of aggression, we propose that physical pain influences a leader’s abusive supervisory behavior and a follower’s perception of abusive supervision through state hostility. We also explore the roles of pain tolerance and state paranoia in these mechanisms. Results based on a pre-registered critical incident experiment with 400 leaders showed support for our direct and indirect hypotheses (Study 1). In addition, results based on a pre-registered critical incident experiment with 400 followers showed support for our indirect hypothesis and also supported state paranoia as a second-stage mediator between state hostility and perceived abusive supervision (Study 2). Moreover, results based on a pre-registered lab experiment with 196 participants assigned to the leader role indicated that when pain tolerance is low, physical pain can lead to abusive supervision via state hostility (Study 3). These results revealed the influence of physical pain on negative leader-follower interactions from both the leader and follower perspectives. It contributes to the literature on employee pain and abusive supervision by examining the interpersonal effects of employee physical pain and exploring a prevalent yet underexamined physical sensation as an antecedent to both engaging in and perceiving abusive supervision.