Psychological Approaches to Chronic Pain

If you’re in pain, you know that you are not only physically distressed, but psychologically distressed as well. You might feel depressed, frightened, worried and out of control. Constant pain makes it hard to concentrate and think. It saps energy and you’re fatigued a lot, even if you haven’t done much. You often feel irritable and might be short with others. Often there is no outward sign of anything wrong; it’s something only you are aware of. Others in your life might have a hard time understanding why you aren’t able to do what you used to do and why it’s taking so long to get better. Or, they might feel frightened themselves about what’s happening to you and unable to support you as you’d most like. Despite your own distress, you sometimes wind up having to take care of the others. You might feel you must hide your own pain and fear to keep from overwhelming them.

Or, your loved ones might lean in the other direction and become overly involved in your condition. Their concern leads them to see you mainly as a “patient”. You become a “person in pain” and lose your role as a whole person who is more than your pain or illness. With the medical team, your family and your friends all focusing on this one aspect, you, yourself can become identified with this role of “sick person” and little more. Chronic pain can reduce the world of the sufferer. (“Chronic” pain is generally defined as pain that has persisted for more than six months.)

Your illness or your pain is a physical condition. Of course your body does need attention and treatment. But you are more than a physical body. Is the rest of you getting the attention and treatment you need? Never has it been more important to support the rest of you, even as you do all you can for your body. This article will discuss some of the types of psychological support available to you. A National Institutes of Health panel recently concluded that approaches such as these, that increase awareness and self-control, equal the effectiveness of medications for relief of pain!


Psychotherapy is adapted to your unique set of circumstances and needs. The focus is not on the “pain patient,” but on the whole person who has pain. It usually includes attention to emotions, communication, pain management, stress management, ways of coping, and encourages you to preserve and express that part of you that is not the pain or illness.

Many people are dealing with depression, anxiety, fear, anger and isolation that so often accompany pain. In fact, an international study recently published in the medical journal Pain found that people with pain were 160% times more likely to have accompanying depression than people in the general population. They were 120% more likely to have anxiety and 60% more likely to over-use alcohol or other substances. This is far greater than earlier estimates. It is easy to understand why these symptoms might accompany chronic pain. A one-to-one relationship with an understanding therapist can provide a place to deal frankly with all aspects of your experience.  A therapist who is experienced in working with people with pain is able to hear your real feelings and experiences, unlike others you might have to protect. You don’t have to hide what you’re really feeling. You need a place where you can let down the pretense and “be real”.

“Cognitive-Behavioral Therapy” (or “CBT”) is generally very helpful for people in pain. The “cognitive” part looks at your beliefs and assumptions and the “self-talk” that arise from them. Sometimes these can tend to exaggerate your sense of despair and hopelessness. These self-defeating cognitions can be challenged and more realistic ones can be strengthened. (Note that “more realistic” does not mean denying the truth of your situation.) The “behavioral” part focuses on behaviors that can be more helpful to you. An example is learning to pace yourself in your activities and building in rest periods instead of going full steam ahead as you may have done formerly. Another example is using biofeedback to develop ways of using your body and mind to decrease pain. (See below for how biofeedback is used for helping with pain.)

Part of CBT for pain is learning pain management techniques. There are many such techniques and you will find which ones are most helpful for you. Biofeedback, muscle tension release, breathing techniques, guided imagery or other visualizations, music, gentle movement and meditation are examples. Tools for managing stress are important in pain management.

Individual therapy can also be of help to partners, siblings and other family members and caregivers as they go through their own experience of a loved one’s pain or illness. It is sometimes forgotten that they are often in great need of a supportive and therapeutic place of their own. They generally have their own fears, anger and conflicts and often can’t talk about them with other family members, let alone with the loved one with pain.

Biofeedback is a powerful tool for increasing mind-body communication and providing a sense of control over what your body is doing and your relation to it. It uses electronic sensors to measure what’s happening in your body and to feed back this information to you on a computer screen as it’s happening. It can measure such things as muscle tension, breathing, heart rate, skin temperature and brain wave activity. Biofeedback can be a powerful tool in the management of pain. It can be used to identify and retrain body habits that produce or maintain pain. Examples of this are excess muscle tension and breathing patterns that heighten anxiety and trigger muscle spasms. It is also used for learning to relax, quiet and calm yourself. Many people say that they don’t feel as helpless when they have something they can do, instead of just enduring the pain. (If you’re interested in learning more about biofeedback, you can read my article, What is Biofeedback?)


If you or a loved one is living with chronic pain and/or serious illness, perhaps one or more of these psychological approaches that I use could be helpful to you. I have listened and learned from others in pain. In addition to a willingness and ability to hear your experience and feelings about your pain, I will not lose sight of the fact that you are so much more than your pain.