Thinking Your Way Out of Pain

Chronic pain is a prevalent and complex condition affecting millions worldwide. Defined as pain lasting more than three months, it often persists beyond the usual course of an acute illness or injury. The experience of chronic pain is not only physical but also deeply intertwined with our thoughts and beliefs. Understanding the cognitive aspect of chronic pain can provide valuable insights into managing and alleviating its impact on daily life.

What Is Chronic Pain?

Chronic pain is a persistent pain that can stem from various sources, including arthritis, back problems, neuropathy, and other medical conditions. Unlike acute pain, which serves as a warning signal for injury or illness, chronic pain persists over time and can exist without a clear underlying cause. It can lead to significant physical limitations, emotional distress, and reduced quality of life.

How Common Is Chronic Pain and What Are Its Consequences?

Chronic pain is a widespread issue, affecting approximately 20% of adults globally. Its consequences extend beyond the physical symptoms, often leading to psychological issues such as anxiety, depression, and sleep disturbances. People with chronic pain may also experience social isolation, relationship problems, and difficulty maintaining employment.

How Do Cognitive Beliefs Influence Chronic Pain?

The cognitive model of chronic pain emphasizes that our beliefs and thoughts about pain significantly influence our emotional and physical experience of it. Here are three common maladaptive beliefs related to chronic pain and how they can exacerbate the condition:

1. The Importance of Pain

Maladaptive Belief: “Pain is a sign of severe damage, and I must avoid all activities that cause pain.”

  • Adaptive Belief: “Pain doesn’t always mean damage. I can gradually increase my activity level and still be safe.”
  • Behavioral Change: People who believe pain is catastrophic may avoid physical activity, leading to muscle deconditioning and increased pain. In contrast, those who view pain as manageable are more likely to stay active, which can improve physical function and reduce pain.

2. Worrying About Pain

Maladaptive Belief: “I am constantly worried that my pain will get worse and never go away.”

  • Adaptive Belief: “I can learn strategies to manage my pain and reduce its impact on my life.”
  • Behavioral Change: Chronic worry about pain can lead to heightened stress and anxiety, worsening the perception of pain. Adopting a problem-solving mindset can empower individuals to seek out effective pain management techniques, reducing their overall stress and improving pain outcomes.

3. Pain and Shame

Maladaptive Belief: “I feel ashamed because of my pain; it makes me weak and less capable.”

  • Adaptive Belief: “Experiencing pain doesn’t define my worth or capabilities. I am still a strong and capable person.”
  • Behavioral Change: Feelings of shame can lead to social withdrawal and a reluctance to seek help, perpetuating isolation and suffering. Recognizing that pain does not diminish one’s value can encourage individuals to connect with others and seek appropriate support.

Case Example: Jane’s Journey with Chronic Pain

Jane, a 45-year-old accountant, developed chronic back pain following a car accident. She believed that her pain signaled severe damage and avoided physical activities, fearing further injury. Her belief that the pain would never improve led to constant worry, and she felt ashamed, perceiving herself as weak.

Through cognitive behavioral therapy (CBT), Jane began to challenge these maladaptive beliefs. She learned that pain does not necessarily mean damage and started engaging in gentle exercises. By focusing on problem-solving rather than worry, she explored different pain management strategies, such as mindfulness and physical therapy. Over time, Jane recognized that her pain did not define her worth, allowing her to reconnect with friends and family.

How Can Adaptive Thinking Help?

Adopting adaptive beliefs can transform the experience of chronic pain:

  • Maladaptive Belief: “My pain is unbearable and will never get better.”
    • Adaptive Belief: “I can find ways to manage my pain and improve my quality of life.”
  • Maladaptive Belief: “Avoiding all activities is the only way to prevent pain.”
    • Adaptive Belief: “Gradual activity can help me stay strong and manage my pain better.”
  • Maladaptive Belief: “I am alone in my suffering.”
    • Adaptive Belief: “Many people experience chronic pain, and I can find support and understanding.”


Understanding and addressing the cognitive aspects of chronic pain can significantly impact an individual’s experience and management of their condition. By challenging maladaptive beliefs and adopting adaptive ones, individuals can break the cycle of pain and distress, leading to improved physical and emotional well-being. If you or someone you know is struggling with chronic pain, consider exploring cognitive behavioral therapy as a valuable tool for managing pain and enhancing quality of life.

Chronic Pain and Cognitive Beliefs Quiz
Chronic Pain and Cognitive Beliefs: Test Your Knowledge

What percentage of adults globally are affected by chronic pain?

How can maladaptive beliefs about pain affect physical activity?

What is a key benefit of adopting adaptive beliefs about chronic pain?