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Chronic Pain - Is It All In Your Head?

Chronic pain. It’s invisible. Mysterious. It follows us everywhere we go during the day and haunts our sleep at night. It wakes us each morning and reminds us that it is still there, like an unwelcome visitor that hasn’t got the hint that it has overstayed its welcome.

In this blog we take a look at chronic pain and explore the evidence to support that it isn't just all in your head.

back pain often starts off as acute pain

The Role Of Acute Pain

When we first experience pain it is typically accompanied by some type of injury or trauma. We know that we have damaged something - we can see the broken bone or the torn ligament - and we can take the appropriate steps to fix it.

These types of injuries cause acute pain. Acute pain is a helpful pain. A confident pain. An easy to recognize pain. People can take one look at your cast, or sling, and offer their sympathy and wishes for a speedy recovery. It is there to guide us towards health. It is not meant to send us into a downward spiral of despair.

Chronic pain and acute pain are two very different things.

Chronic Pain - A Different Patient Experience To Acute Pain

It’s funny how people react to these two very different types of pain. Those experiencing acute pain will be told, "Don't suffer - take your medication and you will feel much better". Those experiencing chronic pain will get a very different reaction.

Sure, for a while chronic pain sufferers will be met with sympathy and understanding. Doctors will write them prescriptions for pain medication. Friends might offer to help with errands. But 3 months or so down the road things often look very different.

Friends now start to feel like they are being taken advantage of. The doctors, too. Pain medication prescriptions are withheld and sufferers start feeling like drug-seeking criminals. They are subjected to endless questions about their condition and receive very little sympathy and even less understanding.

Chronic pain often strips sufferers of their dignity and self worth.

"I have a master’s degree in clinical social work. I have a well-documented illness that explains the cause of my pain. But when my pain flares up and I go to the ER, I’ll put on the hospital gown and lose my social status and my identity. I’ll become a blank slate for the doctors to project their own biases and prejudices onto. That is the worst part of being a pain patient. It strips you of your dignity and self-worth."

Chronic pain affects around 20% of the global population.

What Is Chronic Pain?

The International Association for the Study Of Pain (IASP) defines chronic pain as “persistent or recurrent pain that lasts longer than 3 months”.

Chronic pain affects around 20% of the global population and accounts for almost 1 in 5 doctor visits. Pain is your body’s normal reaction to an injury or illness, but for chronic pain sufferers, pain continues long after its cause is gone.

Many cases of chronic pain can be traced back to a specific incident or injury but many cases lack any obvious cause.

fibromyalgia can lead to chronic pain conditions like low back pain

Conditions that can cause low back pain include:

Doctors are beginning to understand that chronic pain must have originated somewhere even if they can’t see the immediate cause of it. Over time the old thinking, that it is all in the sufferer’s head, is starting to be challenged.

Treating the underlying condition is helpful, if there is an obvious cause, but even then there is no guarantee that the pain will go away. Doctors are beginning to view chronic pain as a condition of its own that requires a revolutionary approach to treatment.

Conditions like anxiety, depression, and substance use disorder can slow down recovery from chronic pain.

Understanding How Chronic Pain Affects Our Minds

The underlying cause of chronic pain is actually rooted in biology. Our brain keeps receiving signals about injuries that don’t exist anymore. But there is more to the matter than just biology. Complex psychological factors also affect chronic pain.

When it comes to the psychology of chronic pain, different psychiatric disorders can make the pain worse and slow down the recovery process. Conditions like anxiety, depression, and substance use disorder can definitely get in the way of recovery.

psychological assessments can help with chronic pain management

Because it can be hard to find the obvious underlying cause of chronic pain it is important to do both physiological assessments and psychological assessments in order to uncover any diagnosis that might be contributing to chronic pain.

In other words, instead of just looking at biology - we need to include psychological diagnoses, too. Not because we think it is all in the individual’s head, but because co-occurring psychological diagnosis can interfere with treatment if we don’t take it into account.

Chronic pain syndrome occurs when symptoms expand beyond the pain to cause things like depression and anxiety.

Managing Chronic Pain Syndrome

Around 25% of people with chronic pain may go on to have a condition called Chronic Pain Syndrome (CPS). Chronic pain syndrome occurs when chronic pain starts to cause complications that can end up making the original pain even worse. When the symptoms expand beyond the pain to cause things like depression and anxiety.

CPS is challenging to treat - but not impossible. It just requires that we take a more integrative approach to managing pain than just one thing or another. Combining treatments using cognitive behavioral therapy along with physical therapy, exercise, and mindfulness techniques can give a boost to treatment when compared with just using one of these techniques.

Multidisciplinary treatments are sometimes not always accessible for patients.

An Integrated Approach To Managing Chronic Pain

An article published by Dr. William B. Leisure, in the psychiatric journal, Focus, in 2017 addresses the fact that while primary care doctors are trying to follow the international guidelines for treating chronic pain conditions, the multidisciplinary treatments are sometimes not always accessible for patients.

A national shortage of healthcare professionals means that accessing treatments such as CBT and physical therapy can be challenging.

"Patients who struggle with chronic pain conditions are 2.5 - 10 times more likely to also struggle with anxiety and depression, both of which are associated with worse pain outcomes".

These psychiatric conditions make it all the more challenging to manage chronic pain.

Chronic pain is a complex condition that involves both physiology, and psychology.


With the extensive research that is being conducted on managing chronic pain without the use of (often) ineffective opioids, we are learning that chronic pain seldom occurs by itself. It is not just a psychiatric condition and is therefore not "just in someone's head". It is, however, a complex condition that involves both physiology, and psychology.

It is imperative that new treatments are found so that we can combine both of these worlds. Programs that incorporate what is know as a "biopsychosocial" approach to treatment are significantly more successful in treating chronic pain and delivering lasting results to those who are suffering from these conditions.

For more information on how the biopsychosocial approach is being recommended by experts around the world, go to


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