Chronic Pain

Let’s face it: Pain feels physical, but it takes an immense toll on your mental health 

People who live with chronic pain have a higher chance of mental health problems like depression, anxiety, and substance use disorders. Ongoing pain can disrupt your sleep, skyrocket your stress levels, and play a role in depression. In fact, it’s estimated that 35 to 45 percent of people with chronic pain experience depression, per the American Psychiatric Association. 

“Chronic pain and mental health struggles often are symbiotic, with each feeding off each other, making the other stronger,” says Joel Frank, PsyD, a clinical psychologist in Sherman Oaks, CA. “The more prolonged pain resides, the more substantial mental health concerns can become.” 

It’s clear that taking care of your mental health is important if you’re experiencing constant pain, but the type of chronic pain you live with requires coping mechanisms beyond “breathe deeply” or “just stay positive.”  

Here are four key tips mental health experts recommend when the pain goes on and on.   

Try Guided Imagery

Researchers found that guided imagery led to significant pain reduction for arthritis and other rheumatic diseases in a review of seven randomized-controlled trials published in the Pain Management Nursing journal. In fact, it improved mobility issues and lowered the use of pain medications.  

“This technique involves using visualization to create a mental image that promotes relaxation and pain relief,” says Harold Hong, MD, a board-certified psychiatrist at New Waters Recovery in Raleigh, NC. “For example, individuals may imagine themselves in a peaceful setting or visualize the pain being replaced by a soothing sensation.” 

This can stimulate alternate brain pathways that modify pain signals.  

“Creating vivid mental reconstructions of pleasant and relaxing experiences can activate the same brain regions involved in sensory experiences,” says John Dolores, PhD, clinical psychologist and Chief Operating Officer at Bespoke Treatment, a mental health treatment facility in California and Nevada.  

Think of it as hacking your brain to lower pain perception and its influence on daily life.  

“Continually imagining yourself in a pleasant and pain-free state provides the mind with a sensation that isn’t stressful or painful, taking advantage of the brain’s ability to reorganize itself and reinforce this painless sensation,” adds Dr. Dolores.  

Another strategy is guided meditation: Those who actively meditated reported a 32 percent reduction in pain intensity and a 33 percent reduction in pain unpleasantness in a 2022 study of 40 participants published in the journal PAIN. 

“This meditation technique involves focusing on the present moment and accepting the pain without judgment,” says Dr. Hong. “By focusing on the present, individuals can reduce worry and anxiety related to future pain.” 

To get started, seek out a mental health expert specializing in chronic pain management. You can also use online resources, such as guided imagery recordings or mindfulness meditation apps, to practice these techniques at home. The Global Healthy Living Foundation’s podcast, Wellness Evolution, provides easy-to-follow breathing exercises and meditations. 

Ask Your Doctor About Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) had a small yet positive effect on lowering pain, disability, and distress linked to chronic pain in a 2020 review published in the Cochrane Database of Systematic Reviews 

“CBT helps people manage their pain by changing their thoughts and beliefs about pain,” says Dr. Hong. “This type of therapy can teach individuals new coping skills and help them develop a more positive attitude towards pain.” 

For example, let’s say you often think, “I can’t do anything right because of this pain.” A professional using CBT therapy may ask you to identify this negative thought pattern and challenge it by asking yourself: “Is it really true that I can’t do anything right because of this pain?”  

“By putting your negative thought under a microscope, you can help reframe it into a more realistic positive thought, such as ‘Pain makes some tasks harder, but there are still many things I can do and enjoy,’” says Delia Petrescu, MA, a Toronto-based psychotherapist, psychometrist, and Founder of Get Reconnected Psychotherapy and Counselling Services.  

Reach Out to Your Support System

Remember: Asking for help doesn’t make you a burden — and everyone needs help in some capacity from time to time.  

“We are wired for connection,” says Kate O’Brien, LCAT, a licensed therapist in New York City. “Having others there to distract you, hear you out, or provide physical support can be an important piece of taking care of your mental health.” 

Speaking with close friends or family members can also give you perspective and help you have more compassion for yourself.  

“Sometimes we feel like we have to do everything all of the time, or that because we had a good day yesterday, we should be able to accomplish the same today,” says O’Brien. “Our society sometimes sends the message that productivity is the most important thing — but remember that your health is more important.” 

Be Kind to Yourself and Your Body

You may feel frustration or even anger toward your body on high-pain days, but hyper-focusing on those emotions will likely make you feel worse.  

“It can be helpful to listen to and focus on parts of your body that aren’t in pain, even if it’s as small as your pinky toe,” says O’Brien. “Sometimes that can help remind you that some part of you is OK.” 

Even when it’s difficult, try to be kind to you and your body.  

“Have compassion for yourself,” says O’Brien. “Living with pain is hard. Adding shame or judgment about your pain often just exacerbates the suffering you are experiencing.” 

Keep an open dialogue with your doctor so they can support you from a medical perspective — adjusting your medications, recommending physical therapy, and providing other guidance as needed. They can also help you get the mental health support you need to cope with your pain. 

“It’s okay to feel emotions in response to pain and to express them, so don’t be afraid to ask for what you need,” says Petrescu. “While you may never be entirely pain-free, know that you have the power to manage your pain and live a fulfilling life.” 

Be a More Proactive Patient with ArthritisPower

ArthritisPower is a patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. You can participate in voluntary research studies about your health conditions and use the app to track your symptoms, disease activity, and medications — and share with your doctor. Learn more and sign up here.

Chronic Pain and Mental Health Often Interconnected. American Psychiatric Association. November 13, 2020. 

Giacobbi PR, et al. Guided Imagery for Arthritis and other Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials. Pain Management Nursing. July 11, 2015.    

Interview with Kate O’Brien, LCAT, a licensed therapist in New York City. 

Interview with John Dolores, PhD, clinical psychologist and Chief Operating Officer at Bespoke Treatment, a mental health treatment facility in California and Nevada. 

Interview with Joel Frank, PsyD, a clinical psychologist in Sherman Oaks, CA.

Interview with Harold Hong, MD, a board-certified psychiatrist at New Waters Recovery in Raleigh, NC. 

Interview with Delia Petrescu, MA, a Toronto-based psychotherapist, psychometrist, and the founder of Get Reconnected Psychotherapy and Counselling Services. 

Riegner G, et al. Disentangling self from pain: mindfulness meditation–induced pain relief is driven by thalamic–default mode network decoupling. PAIN. February 2023. doi:   

Williams A, et al. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews. August 14, 2020. doi:   

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