Managing Chronic Pain: More Than Just a Physical Experience
Living with chronic pain is more than just a physical struggle—it touches every part of life. It affects how you move through the world, your relationships, your work, and even how you see yourself. If you're reading this and feeling exhausted, frustrated, or even hopeless, I want to take a moment to say:
you’re not alone.
Pain is real. And so is the toll it takes—on your whole experience. The good news? Science tells us pain isn’t just a body problem. . . that means there’s more than just the body’s pathways to experience relief and regain control, even if the pain doesn’t fully go away.
The Mind-Body Connection in Pain
Pain isn’t just a signal from the body—it’s influenced by our thoughts, emotions, stress levels, and even past experiences. Maybe you’ve noticed that pain feels worse on high-stress days or that feeling supported makes it more manageable? That’s because our nervous system plays a huge role in how pain is processed.
Pain is processed in the brain, not just the site of injury. Pain is not a direct reflection of tissue damage but rather an interpretation by the brain that is based on multiple factors, including (1) sensory input, (2) emotions, and (3) past experiences. Research shows that regions such as the somatosensory cortex, anterior cingulate cortex, and prefrontal cortex all contribute to the experience of pain.
Source: Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150(3699), 971-979.
The nervous system can amplify or dampen pain signals. The concept of "central sensitization" explains how the nervous system can become hypersensitive, leading to increased pain perception even without new injury. This occurs when neurons in the spinal cord and brain become more reactive over time.
Source: Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3), S2-S15.
The autonomic nervous system influences pain perception. Stress and emotional states can impact how pain is processed due to the involvement of the autonomic nervous system. Increased sympathetic nervous system activity (or, the body's fight-or-flight response) can heighten pain perception, while parasympathetic activation (or, the relaxation response) can help dampen it.
Source: Tracey, I., & Mantyh, P. W. (2007). The cerebral signature for pain perception and its modulation. Neuron, 55(3), 377-391.
Psychological approaches to pain management help retrain the brain’s response to pain signals. These strategies don’t mean your pain isn’t “real”—instead, they acknowledge that pain lives in both the body and mind, and both deserve care.
Strategies That Can Help
Here are some evidence-based ways to manage chronic pain, beyond medications and medical procedures:
1. Cognitive Behavioral Therapy (CBT) for Pain
CBT helps you recognize unhelpful thought patterns that may be amplifying pain (remember: pain is processed in the brain) and replace them with healthier, more balanced thoughts. Here’s an example of an unhelpful thought: “I’ll never feel better, and it’s only going to get worse.” Compare that with an example of a helpful, more balanced thought: “Even though it sucks right now, I know I have tools to help me get through this.” CBT helps you recognize the connection between your mindset and your emotions and actions. By recognizing how thoughts, behaviors, and emotions can influence each other, you can create meaningful shifts towards more active coping—and more living.
2. Mindfulness and Relaxation Techniques
Chronic pain can pull you into a cycle of tension, stress, and fear. Practices like deep breathing, meditation, and progressive muscle relaxation can help calm the nervous system. When the relaxation response (or parasympathetic nervous system) is activated, this can help unwind signals of stress and danger and reduce pain’s intensity. Practiced regularly, mindfulness and relaxation techniques can help you become more aware of subtle shifts and changes in your stress and tension, which helps you powerfully apply skills to unwind those sensations before they become too intense (or escalate your pain). Over time, your regular practice can also lead to reductions in muscle tension and a more relaxed nervous system, overall.
3. Acceptance and Commitment Therapy (ACT)
ACT encourages a shift from constantly fighting against pain to a willingness to accept its presence. It’s not about liking or wanting the pain—or about resigning yourself to the current circumstances, as if nothing is going to change. It’s about choosing to In fact, it’s quite the opposite—it’s about committing to changing your behaviors now, rather than waiting for pain to disappear first. ACT provides you with tools and strategies to take action on the things you love, that bring you meaning, purpose, and fulfillment—so you can still living a fulfilling life, in this moment.
4. Pain Reprocessing Therapy (PRT)
PRT is a newer, research-supported approach designed to retrain the brain’s response to chronic pain by changing the way pain signals are interpreted. It focuses on how fear signals in the brain can influence pain intensity and works to help clients take back control by increasing mindful awareness of these connections and building in safety. By shifting the brain’s response from perceiving danger and threat to recognizing safety and calm, PRT helps reduce pain sensitivity and fosters a greater sense of ease in daily life.
5. Behavioral Activation
(Or, a fancy way of saying “do more stuff.”)
Pain often leads people to avoid activities for fear of making it worse (or disappointing themselves or others when they have to cut out early). Over time, this can shrink life’s joy. Principles of behavioral activation help us see that avoidance actually leads to more sadness and suffering—and doesn’t give us a chance to see when things might actually be okay. Gentle movement, engaging in social activities, and accomplishing small goals can help break that cycle and get you back in an upward trend.
6. Social Support and Connection
Pain can be isolating. You might find it hard to focus or enjoy in social situations when your pain is worse. Or perhaps you’re worried others are tired of hearing about it (maybe they’ve even said so). No matter what your experience of social changes because of pain, one thing is for certain—you don’t have to go through this alone. Whether it’s a support group, therapy, or simply a friend who understands, having people to talk to can ease the burden.
You Deserve Relief—And Support
Chronic pain is complex, and there’s not a one-size-fits-all solution.
But healing is possible—
not by eliminating pain entirely, but by finding ways to live well with it.
A pain psychologist specializes in helping people (1) understand the mind-body connection in pain, (2) develop coping strategies, and (3) retrain the brain’s response to pain signals. Through therapy, you can learn how to reduce pain-related distress, improve daily functioning, and regain a sense of control over your life.
Dr. Anahita Kalianivala, clinical psychologist, specializes in chronic pain management and helping adults cope with chronic illness or complex medical conditions. Her goal is to help people build a toolkit of skills that can reduce suffering, improve daily function, and move toward a life with more ease and confidence. Through evidence-based approaches like CBT, ACT, and Pain Reprocessing Therapy, we can work together to change your relationship with pain in meaningful ways.
If you’re ready for a more active approach to managing pain, we’re ready for you.
And we’d love to help.
Check out our single-session Empowered Relief class for quick access to effective coping skills like the ones mentioned in this article!
Or if you’re looking for a more personalized approach, schedule a free 15 minute consultation to learn more about how Dr. Kalianivala can create a personalized care plan for your best support.
Alcove Mental Health provides psychological evaluations and online therapy for chronic pain, health-related stress and individuals coping with complex medical conditions in over 40 states, including Alabama, Arizona, Arkansas, Colorado, Commonwealth of the Northern Mariana Islands, Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.