Chronic pain has a way of weaving into just about every aspect of your life and it can be difficult to manage. Because chronic pain is so persistent, you often need to throw a lot of treatment approaches at it to find even a little relief. That may include therapies typically associated with the mental health world, even though chronic pain is not a mental illness and it’s not “all in your head.”
What Is Chronic Pain?
Chronic pain comes in many forms and can affect several areas of your body, including your joints, muscles and soft tissue, nerves and even your bones1. It can also be a symptom of chronic illness, like fibromyalgia, Ehlers-Danlos syndrome, migraine or rheumatoid arthritis. Unlike acute pain, chronic pain is usually not connected to a specific injury. And if you live with it, you know how much of an impact it can have on your daily life and relationships.
“Challenges abound with every domain of life when living with chronic pain,” Shenell D. Evans, Ph.D.2, a Brooklyn, New York-based clinical psychologist who also lives with chronic illness, told The Mighty. Evans added:
It’s a pervasive condition that affects one’s sense of self (many come to feel as their understanding of themselves has been shattered), the stress and frustration inherent in dealing with the health care system itself, the lack of understanding from employers and coworkers, insensitive medical providers, and family members and friends who may mischaracterize clients as lazy or liars because they cannot comprehend the day to day struggle. For these and other reasons, it can be a very isolating experience to deal with chronic pain and illness.
How Can Therapy Help Chronic Pain?
When we hear “therapy” we usually think “mental health.” As researchers learn more, however, it’s clear that chronic pain can affect your mental health and vice versa — and not just from the difficulty of living with a chronic condition. Studies suggest “catastrophizing,” ruminating on pain and difficult symptoms, can increase your chronic pain levels3 and cause more fatigue4.
Therapy can help you accept living with chronic pain, which doesn’t mean you’re OK with debilitating pain. Acceptance in this context means facing the reality chronic pain isn’t going away and learning new ways to manage your symptoms alongside other treatments like medication. Therapy is simply another tool you might want to add to your arsenal.
“It helps with managing my stress levels which helps overall. Also good for dealing with my fibro fog,” said Mighty community member Mary about therapy’s benefits, adding:
Therapy in general helps me. Having a neutral person to tell you that you are doing well with everything on your plate when you feel like you are failing because you can’t do this or that. I tend to focus too much on the negative and what I am not doing well, so I need a redirect a lot.
Pain Is Not ‘All In Your Head’
It’s also important to note that trying therapy for chronic pain doesn’t mean your pain is “all in your head” or your symptoms are your fault because you’re “thinking wrong.” That is simply not true. Dr. Evans highlighted that sometimes doctors have a hard time once they’ve tried all the traditional Western medical practices, but “a multi-faceted, multi-dimensional approach is necessary” for a complex condition like chronic pain2.
“Truth be told, perhaps a doctor’s sense of ‘this must be all in their heads’ is more of a reflection of the limitations of that practitioner’s knowledge,” Evans said, adding:
Many practitioners are fixated on the limited ‘solutions’ of their systems and don’t take the time to learn more about approaches that are foreign to them but bring relief and facilitate recovery for people. I’m talking about respecting different approaches such as bodywork, nutritional/food as medicine, herbalism, energy medicine and the like.
Even though some therapies are designed to work well for chronic pain patients, it might not work for everyone, especially depending on your individual therapist. Therapy should always be one element of a larger “care package,” as Mighty community member Lucy said.
“I was prescribed psychologist sessions for chronic pain. I quit after 2 or 3 sessions,” said Lucy. “The health professional in me can see it MIGHT be of benefit — and I put it down to you’d have to find that very very rare psychologist who is actually able to believe pain people and talk with them with a functional aim.”
What Therapies Work for Chronic Pain?
Some types of therapy are more effective than others when your primary goal is managing pain5. For example, research suggests that about 50% of fibromyalgia patients experience a positive benefit from cognitive behavior therapy (CBT). In comparison, 30 to 50% of patients find FDA-approved fibromyalgia medications are helpful6.
Three types of therapy that research shows are effective for chronic pain include cognitive behavior therapy (CBT), acceptance and commitment therapy (ACT) and condition-specific variations on CBT2,7.
1. Cognitive Behavior Therapy (CBT)
Cognitive behavior therapy (CBT) is one of the most common types of therapy for chronic pain because it’s also effective for other conditions8. When you try CBT for chronic pain, your therapist will help you learn skills such as mindfulness, reframing thoughts that might make your pain worse, coping skills to get through bad pain days, tracking your pain and fatigue levels, and even effective ways to communicate what you’re going through with others 7,9.
“CBT helps me to not feel so hopeless or useless when I’m in pain,” said Mighty community member BV. “Therapy has helped me keep my emotional self separate from my physical pain so that the two don’t feed each other and spiral out of control. It’s expensive, but well worth it.”
Because CBT has been around for decades, it’s backed by a significant amount of research suggesting it can benefit people who experience chronic pain as well as other chronic illnesses7. It’s largely considered the “gold standard” therapy for chronic pain10. In addition, CBT is one of the more accessible types of therapy — lots of therapists having CBT training and you can often complete a course of CBT therapy in less than a year.
2. Acceptance and Commitment Therapy (ACT)
The hallmark of acceptance and commitment therapy (ACT) is an emphasis on mindfulness and acceptance of your present situation, which can be helpful to chronic pain patients11,12. ACT is a newer therapy that helps you shift your focus from making the pain go away completely to living your best life while still experiencing chronic pain11,12.
As painful as this acceptance can be — and grief may be part of the process for you — it can free up some of your mental space to focus on your life goals. Skills you might do with your ACT therapist include mindfulness practices, seeing your identity as separate from chronic pain, defining your values and learning ways to cope with difficult thoughts and emotions13.
3. Chronic Illness-Specific CBT
Now that research has established CBT is effective for dealing with a variety of chronic illnesses, some experts have designed CBT specifically for certain conditions. For example, CBT therapies have been designed for rheumatologic pain or fibromyalgia14.
While these therapies are similar to most CBT programs, they incorporate additional support just for chronic pain patients. CBT for rheumatologic pain, for example, emphasizes relaxation techniques, building fun activities into your life, support for lifestyle changes like exercise or diet, stress management, goal setting, problem solving and communication skills14.
Just remember seeking therapy doesn’t mean your pain is imaginary or “all in your head.” Therapy can help you learn new ways to cope with chronic pain and make sure your mental health is supported too, since living with chronic pain can be so difficult. Along with other treatment options like medications, physical therapy or lifestyle changes, therapy will likely only be one of several ways you manage your pain in the face of a complex symptom2.
“Chronic pain clients benefit from keeping in mind that even [a] little support, progress or relief contributes to their healing and recovery,” Evans said, adding:
There are no magic bullets or pills or practices. I believe with a knowledgeable and supportive care team comprised of family, friends, medical providers, and assistance with navigating our increasingly complicated health care system that eventually things begin to work together to create a new momentum on the path of healing and recovery.
Wyant, P. (2018, November 18). 27 Things Chronic Pain Is Not. Retrieved from https://themighty.com/2018/11/what-chronic-pain-is-and-is-not/.
Evans, Shenell. (2019). Therapies for Chronic Pain [Email interview].
Edwards, R. R., Cahalan, C., Mensing, G., Smith, M., & Haythornthwaite, J. A. (2011). Pain, catastrophizing, and depression in the rheumatic diseases. Nature Reviews Rheumatology, 7(4), 216–224. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21283147
Lukkahatai, N., & Saligan, L. N. (2013). Association of catastrophizing and fatigue: A systematic review. Journal of Psychosomatic Research, 74(2), 100–109. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0022399912003157
Niknejad, B., Bolier, R., Henderson, C. R., Delgado, D., Kozlov, E., Löckenhoff, C. E., & Reid, M. C. (2018). Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults. JAMA Internal Medicine, 178(6), 830–839. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2680318
The Mighty. (2019, April 2). Living With Fibromyalgia: Standard Treatment Options. Retrieved from https://themighty.com/2019/04/fibromyalgia-treatment/#standard-treatment.
Sturgeon, J. (2014). Psychological therapies for the management of chronic pain. Psychology Research and Behavior Management, 7, 115–124. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986332/
Beck Institute. (n.d.). What is Cognitive Behavior Therapy: Beck Institute. Retrieved from https://beckinstitute.org/get-informed/what-is-cognitive-therapy/.
Songer, D. (2005). Psychotherapeutic approaches in the treatment of pain. Psychiatry (Edgmont), 2(5), 19–24. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000182/
Day, M. A., Thorn, B. E., & Burns, J. W. (2012). The continuing evolution of biopsychosocial interventions for chronic pain. Journal of Cognitive Psychotherapy, 26(2), 114–129. Retrieved from https://connect.springerpub.com/content/sgrjcp/26/2/114
Hayes, S. (n.d.). Acceptance & Commitment Therapy (ACT). Retrieved from https://contextualscience.org/act
Society of Clinical Psychology. (2016). Treatment: Acceptance and Commitment Therapy for Chronic Pain. Retrieved from https://www.div12.org/treatment/acceptance-and-commitment-therapy-for-chronic-pain/.
Dewane, C. (2008). The ABCs of ACT — Acceptance and commitment therapy. Social Work Today, 8(5), 34. Retrieved from https://www.socialworktoday.com/archive/090208p36.shtml
Society of Clinical Psychology. (2016). Multi-Component Cognitive Behavioral Therapy for Rheumatologic Pain. Retrieved from https://www.div12.org/treatment/multi-component-cognitive-behavioral-therapy-for-rheumatologic-pain/