How To Break The Chronic Pain Cycle

Living with chronic pain can feel like being stuck on a relentless merry-go-round—one that you never asked to ride. The good news? You can interrupt the cycle and reclaim control of your body and your life.

In this guide, we’ll explore:

• What pain is (and how it works in your body)

• How chronic pain differs from acute pain

• The science behind the chronic pain cycle and depression

• Common causes of chronic pain

• Practical, evidence-based strategies to break the cycle

• How chronic pain is diagnosed

What Is Pain?

Pain is your body’s built-in alarm system—its way of signaling that something is wrong. Acute pain is usually linked to a clear cause, such as an injury or illness, and fades once healing occurs.

Common causes include:

• Broken bones

• Cuts or burns

• Surgery or trauma

  
  

Acute pain serves a protective purpose. Chronic pain is different.

What Is Chronic Pain?

Chronic pain is pain that lasts longer than 3–6 months, often continuing long after the initial injury has healed—or even without a clear cause. It can be constant or intermittent and often resists standard medical treatments.

Examples of chronic pain conditions:

• Arthritis

• Fibromyalgia

• Chronic back pain

• Migraines and headaches

• Multiple sclerosis

• Post-shingles nerve pain

  
  

Chronic pain can keep the nervous system in a persistent state of high alert, affecting your mood, sleep, and quality of life.

What Causes Chronic Pain?

Chronic pain can develop for several reasons:

1. Ongoing health conditions – e.g., arthritis, cancer, or shingles.

2. Post-injury nerve sensitivity – heightened pain response that lingers after recovery.

3. Psychogenic factors – stress, anxiety, or depression triggering pain signals without a clear physical cause.

   
   

One thing that we do know about pain is that it is extremely subjective and this can make it difficult for doctors to truly understand the extent, or cause, of pain that a person might be experiencing.

What Is The Chronic Pain Cycle?

Chronic pain is a major public health issue with studies reporting that around one fifth of the population in the USA and Europe are affected by it. Research shows chronic pain and depression often feed into each other with around 85% of chronic pain patients also experiencing depression. The two conditions share overlapping brain pathways, particularly in areas that help to regulate our mood and pain perception.

Why is this important? Well, in order to treat chronic pain it is important to know what factors might be influencing this condition and shows us the vicious cycle that people get stuck in.

This creates a pain cycle that:

1. Pain limits activities →

2. Loss of movement causes muscle weakness →

3. Reduced function leads to frustration, anxiety, and depression →

4. Depression heightens pain perception →

5. The cycle continues

Researchers went on to discover that patients who suffered from chronic pain-induced depression have a poorer prognosis for their condition that those who did not have depression and who only had pain.

It seems that chronic pain and depression are more closely linked than we had ever considered and that, when they are present together, it can be even more challenging for patients.

The Science Behind Pain And the Link To Depression

Chronic pain isn’t just a physical experience—it changes the way the brain works. Here's how:

1. Shared brain pathways: Pain signals and mood regulation travel through many of the same brain areas, including the hippocampus, thalamus, and amygdala. These regions help regulate both emotional processing and physical pain perception. When pain is persistent, these pathways can become overactive, reinforcing both discomfort and low mood.

2. Brain structure changes: MRI studies have found that people with depression often have a smaller hippocampus and prefrontal cortex compared to those without depression. These changes can affect decision-making, memory, and the way pain is processed.

3. Dopamine disruption: Chronic pain has been linked to reduced dopamine activity. Dopamine is a neurotransmitter that helps regulate motivation, reward, and pleasure. Lower dopamine levels can make enjoyable activities feel less rewarding—and can heighten the brain’s perception of pain.

4. Reduced BDNF levels: Depression can also decrease brain-derived neurotrophic factor (BDNF), a protein vital for nerve cell growth and communication. Low BDNF is associated with poorer pain regulation and may make chronic pain harder to treat.

Why this matters: Understanding these neurological links helps explain why treating both the physical and emotional aspects of chronic pain—through approaches like exercise, mindfulness, and therapy—can be more effective than focusing on one alone.

How Does The Chronic Pain Cycle Start?

It often begins with an injury. To protect the injured area, you change the way you move—putting extra strain on other muscles and joints.

Over time, this can cause:

• Secondary injuries

• Poor movement patterns

• Increased stiffness and pain

  
  

An example of this is like if you hurt your foot you can compensate by leaning more heavily on your opposite foot, or walking more on your heel than your toes. This can also be the start of the pain cycle. If an injury is particularly long lasting, compensating with other body parts, in a way that the body was not originally designed to do, can put pressure on these body parts.

Also, not moving certain muscles or ligaments for a period of time can sometimes train these muscles to work in a new, distorted manner, also cause unintended pain consequences. These new movements can be the cause of chronic pain.

Add in the frustration of lost abilities or work limitations, and depression can take hold.

How Can You Stop The Chronic Pain Cycle?

1. Gentle Movement

International guidelines recommend staying active for chronic pain, especially for low back pain. Light walking, stretching, or swimming can help restore mobility.

2. Physical Therapy

Seeing a physical therapist can also help to ensure that you are using the correct muscles and not putting unnecessary strain on other body parts.

3. Supportive Equipment

Braces, orthotics, or walking aids can reduce strain while you heal.

4. Mindfulness & Meditation

Mindfulness-based interventions can increase dopamine and BDNF, reduce pain sensitivity, and help you cope with flare-ups.

5. Biopsychosocial Approach

Addressing the whole person—including mental health, lifestyle, and physical factors—improves long-term outcomes.

Mindfulness Based Therapy and Meditation

Mindfulness based meditation has been shown to increase levels of BDNF, helping with pain regulation and your experience of pain. This can also increase your desire to exercise and get moving, and help to reduce concerns around increased feelings of pain.

Healthcare experts often recommend that patients who have physical injuries or disabilities practice meditation based intervention to increase their levels of BDNF.

Mindfulness based therapy has also been shown to improve dopamine levels and reduce chronic pain sensations. While some study results have shown differences, probably owing to the use of different forms of meditation, the general results show increased signals in brain regions related to the regulation and release of dopamine.

How Is Chronic Pain Diagnosed?

Because pain is so subjective it can be very difficult for providers to know exactly how intensely a person is experiencing pain. To combat this providers use a combination of:

• Pain scales (McGill Pain Questionnaire, Wong-Baker Faces, Brief Pain Inventory)

• Patient history – Where, how often, and how severely pain occurs

• Impact on daily life – Work, hobbies, relationships

  
  

Diagnostic tests (e.g., MRI, EMG, blood tests) can also be used to rule out more serious conditions.

Some general questions that can help your doctor understand your pain a bit better are:

• Where is the pain located?

• How intense is the pain (number scale of 1-10 or a visual face scale of pain)

• What movements affect your pain

• How often does your pain occur? Is it constant or intermittent?

• What is the effect of your pain on your daily life? Can you still work?

• Are you experiencing any type of stress or anxiety?

  
  

Diagnostic Tests

While diagnostic tests are often not very useful for diagnosing chronic pain conditions, depending on your medical history your doctor may order tests to rule out any red flags or concerning underlying conditions such as cancer.

Diagnostic tests for back pain might include:

• EMG (electromyography - looking at muscle activation)

• X-rays and MRIs

• Blood tests

• Nerve conduction tests

• Reflex and balance tests

  
  

Key Takeaways

• Chronic pain isn’t “just in your head”—it’s a complex mind-body condition.

• Depression and chronic pain can amplify each other, making both harder to treat.

• Non-medication strategies like movement, mindfulness, and therapy can help you break the cycle.

• Partner with your healthcare provider, and don’t be afraid to advocate for a whole-person approach.

Unfortunately there has been a history of treating chronic pain sufferers as medication-seeking or drug abusing, which can lead to more shame and more depression amongst chronic pain sufferers. If you are suffering from chronic pain it is important to discuss your concerns with your healthcare provider and to advocate for your condition, especially for individuals with chronic back or neck pain.

Written by the LivaFortis Editorial Team. All content is created and reviewed by experts in biotechnology, translational medicine, and digital health innovation. Learn more about our editorial standards.