Reclaiming life from chronic pain

Dr Dennis Roberts Clinical Psychologist

Chronic pain changes people. Not only in their bodies, but in the structure of their days. It shapes how someone plans a morning, whether they commit to dinner with friends, how they approach sleep. Over time it can quietly erode trust. Trust in one’s back, one’s neck, one’s stamina – even trust in the future. It also brings a real sense of loss. Many of the people I see who are experiencing chronic pain describe something that sounds a lot like grief. Grief for the body they once inhabited without having to think about it, and grief for a sense of physical reliability that now feels uncertain.

It is important to emphasise that chronic pain is real. Psychological treatment does not question that reality. What it does suggest is that pain is processed by the nervous system, and the nervous system responds to stress. Modern neuroscience has shown that pain is not a direct readout of tissue damage. It is an output of the brain and spinal cord, shaped by context and interpretation. Researchers studying neural circuits have demonstrated how deeply intertwined emotion regulation and bodily experience are. When pain persists for months or years, the nervous system can become sensitized. The alarm keeps firing even when the original injury has largely healed.

In acute injury, that alarm is protective. In chronic pain, it can become overprotective. The tissues may be stable, yet the signal continues. This does not make the pain imaginary. It means the signaling system has become reactive. And reactive systems can, with time and repetition, become less reactive. We can learn and change.

Cognitive Behavioral Therapy (CBT) remains one of the most researched approaches for chronic pain. I sometimes describe CBT not as correcting faulty thinking, but as examining the conclusions the mind has reached while under strain. After living with discomfort for a long time it is entirely understandable to think, “This is never going to improve,” or “If I move the wrong way, I will make it worse.” These thoughts are attempts at self-protection.

The difficulty is that they also tend to increase vigilance. Attention narrows and the nervous system scans for threats. When the brain anticipates danger, it amplifies sensation and pain feels louder.

"When our attention widens beyond our symptoms, suffering can sometimes decrease"

In therapy we approach this carefully. Not with forced positivity, and not with dismissal. Instead we try experiments. We test assumptions gradually and we look at the fear and avoidance that often develop around pain. Pain leads to withdrawal. Withdrawal leads to deconditioning and isolation. Both of those can increase sensitivity. Small, steady behavioral changes can begin to interrupt that pattern.

Acceptance and Commitment Therapy (ACT) offers a related but slightly different emphasis. ACT distinguishes between pain and the struggle against pain. Many patients describe constant monitoring of pain and the comparison to how things used to be. That struggle adds another layer of suffering.

Acceptance in this context does not mean resignation. It means acknowledging what is present without making elimination of pain the only condition for living. From there we ask a different question. What still matters? Is it relationships or work or creativity? Even with discomfort, meaningful action is possible. When our attention widens beyond symptoms, our suffering can sometimes decrease.

There is also an emotional dimension that is easy to overlook. Chronic pain frequently coexists with long-standing stress and memories of loss. The nervous system does not separate physical and emotional activation as neatly as we might wish. Patients sometimes notice that flare-ups correspond with times of conflict, overwork, and feeling unsupported. Because of this connection, learning to recognize and express emotions can sometimes reduce overall physiological arousal.

Alfred Adler wrote about the human drive to move from felt limitation toward significance and contribution. Chronic pain can easily derail this and shrink our world. Part of the work in therapy is helping people resist that shrinking. Not by denying limitation, but by refusing to let it define the whole of one's identity.

Practical regulation strategies matter as well. Many people fall into what sometimes is called a good day/bad day cycle. On a better day, there is a push to catch up on everything. The following day is spent paying for it. But these swings are destabilizing. A steadier approach, which we might call pacing, aims for moderate and consistent activity regardless of fluctuation. Predictability helps the nervous system settle.

One of the most healing aspects of therapy is simply being believed. People with chronic pain are often used to subtle or direct dismissal. When their experience is taken seriously, the defensive edge softens. From there, collaborative work becomes possible. Psychological care can complement medical treatment rather than compete with it.

If I were to distill this down to one or two main ideas it would be this: Chronic pain is real, and so is our ability to change. Therapy for chronic pain does not promise a cure. It aims to reduce amplification, increase flexibility, and expand life so that pain is not the organizing force of someone's story.