• Chronic pain can both lead to mental health challenges, and be the result of psychological and emotional distress

  • Living with chronic pain can be debilitating and isolating, says psychotherapist Karen Morton, but therapy can help

  • We have therapists who specialise in chronic pain – find them here

Persistent pain affects every aspect of your life. A holistic approach is essential to living well with chronic pain, and therapy is an important component in that approach. Therapy can be beneficial whatever the cause of your pain, whether a structural, soft tissue or nerve injury, a diagnosed condition, or an unknown issue. If your pain persists longer than six months, then it is defined as chronic or persistent pain.


Why does pain persist once injury has healed? 

Most structural and soft tissue injuries heal in approximately six weeks, but with chronic pain, pain increases and becomes more widespread. Pain acts as a warning system, alerting us that something is not right. When you touch a flame or twist your ankle, your brain evaluates the risk level, and sends out pain signals, much like alarm bells, alerting you to danger.

When your brain’s pain alarm system is activated, your body responds by becoming tense and rigid, as you brace in response, and emotional tensions rise. These are useful alerts in acute pain and can prevent further injury. However, in some instances, the nervous system becomes sensitised (called ‘central sensitisation’ [1]) and increasingly reactive (a process called ‘wind up’). This means your brain sends out progressively intense and frequent pain signals and often to more parts of your body. The result is that your pain sensitivity becomes amplified and self-perpetuates. The good news is, in time, you can learn how to turn down that pain volume.


What if there’s no injury, no cause, and yet your pain remains?

Where the cause of your pain is unclear, or the pain level is considered ‘disproportionate’ for the condition, you may experience not being taken seriously, and then begin to doubt yourself. Rest assured - all pain experienced is ‘real’, regardless of cause.

Pain is now known to have a biopsychosocial component, and the International Association for the Study of Pain recently revised their definition of pain to reflect that. It states that pain is ‘[a]n unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’ [2]. Pain therefore may have a cause which may not be evident from an MRI, scan or x-ray. This type of chronic pain has no structural basis, but the pain experience is no different.

There are many causes of chronic pain, including emotional distress, repressed anger, adverse childhood experiences, and trauma. Experiences in childhood, for example, can show up in the body as chronic pain much later in life [3]. Working through these experiences and identifying emotions which have been ‘pushed down’ and held within the body can result in greatly reduced pain and in some cases, complete recovery. 

What if you have been diagnosed with an illness?

Whether you have been diagnosed with chronic migraines, IBS, ME, fibromyalgia or an autoimmune or terminal illness, you may become depressed and anxious about your prognosis and may grieve for the loss of the life you imagined. The stress, tiredness and psychological pressure can cause an increase in pain, compounding the pain you already experience, due to central sensitisation and wind up. A therapist who works with chronic illness can support you with these issues, and if appropriate, with facing your own mortality [4].


What if friends, family and doctors do not understand what you are going through?

Pain flares may prevent you from engaging in activities some days and not others. You may find that people do not understand, which increases pain further. Many people I speak to experience dismissive medical professionals, and face learning to live with side effects of medication, limitations to their existence, fear of symptom flares, and grief for the life they had planned. Where there is no known diagnosis, they may be referred to mental health. Although this may be well-intended, and healing on many levels, you may feel dismissed and misunderstood. This has adverse effects on physical and mental health, as well as recovery. 

Limited activity, inability to work and related financial implications, uncertainty around socialising or going on holiday is incredibly stressful and isolating. It is not surprising if you are depressed and anxious.


So, what can I do about it?

Therapy can help you live well within the limitations of your condition. If you have a medical treatment plan, it likely focuses on managing physical symptoms and not on the psychological and emotional impact of these conditions, which clients often say is worse than the pain itself.

Effective therapy for chronic pain is a multifaceted, holistic and individual approach, based on your needs. We look at what life is like for you, how chronic pain impacts your daily life, explore stressors which increase pain as well as those factors which provide some relief. Therapy may include grief work, positive lifestyle changes, facing fears, learning how to self-advocate, regaining self-confidence and reducing anxiety.

Talking through your experiences, being believed, and understanding the mind body connection, are all fundamental to healing. With the right support, you may find that you are no longer just ‘coping’ and ‘managing’ between flares, but that your pain decreases, you are no longer in a ‘boom or bust’ [5] cycle, and you are able to return to some former pastimes or discover new ones and live your best life!

Karen Morton is a verified Welldoing psychotherapist in Rickmansworth and online

Further reading

Chronic lower back pain and trauma: is it time to think differently?

Using Emotional Freedom Technique for physical health issues

How yoga can help with chronic pain

Why do some people get more stressed than others?

Body psychotherapy: working non-verbally


[1] Institute for Chronic Pain (2017) ‘What is Central Sensitization?’ [Available at: https://www.instituteforchronicpain.org/understanding-chronic-pain/what-is-chronic-pain/central-sensitization]

[2] International Association for the Study of Pain (2020) ’ IASP Announces Revised Definition of Pain’ [Available at:   https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/ ]

[3] See Van der Kolk, B (2014) The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. London: Penguin Random House and Maté, G (2019) When the Body Says No: The Cost of Hidden Stress. London: Vermilion

[4] Yalom, I (2011) Staring at the Sun: Overcoming the Dread of Death. London: Piatkus  

[5] NHS Royal Orthopaedic Hospital, ‘Boom or Bust’   https://www.roh.nhs.uk/patient-information/musculoskeletal-medicine-msk/1100-boom-or-bust/file