According to the U.S. Pain Foundation, chronic pain affects millions of people and can impact nearly every part of daily life – sleep, exercise, work, relationships and emotional well-being.
Felicitas Huber, PhD, a WashU Medicine pain psychologist, says that treatment often requires more than medication alone. “Chronic pain is best understood from a biopsychosocial perspective and treated with a multidisciplinary approach,” Huber explains.
This type of approach includes addressing:
- The physical body (injury, inflammation)
- Thoughts (“this is never going to get better”)
- Emotions (depression, anxiety)
- Behaviors (avoiding social events or exercise)
- Social context (supportive or dismissive behaviors towards the person in pain)
Understanding chronic pain
One of the first steps in pain psychology is helping patients better understand how chronic pain works. Acute pain comes on quickly and is caused by something specific, such as a broken bone or recent injury, and often improves with rest and healing. Chronic pain typically lasts three months or longer and may continue even after the original injury or trigger has improved. With chronic pain conditions such as migraine or neuropathy, the nervous system can become more sensitive over time.
For migraine specifically, Huber said symptom onset often occurs when multiple stressors build up together: “Little sleep, skipped meals, stress, too much caffeine or alcohol can all contribute.”
At the same time, migraines can still happen even when patients are doing everything “right,” which is why treatment focuses on overall management rather than perfection.
The body’s stress response
Living with chronic pain can put the mind and body in a constant state of stress. Many people living with pain unconsciously tense their muscles or stay physically on guard, especially when symptoms flare. Over time, this can increase fatigue, stress and discomfort.
Pain psychology management often incorporates relaxation strategies such as:
- Diaphragmatic breathing
- Progressive muscle relaxation
- Guided imagery
These approaches can help patients calm their nervous system and improve the body’s relaxation response.
Finding the right balance with activity
Living with chronic pain can sometimes lead to cycles of overdoing activity and then avoiding movement entirely. Some patients stop exercising because they fear worsening pain. Others wait for a “good day” and try to accomplish too much at once, only to feel worse afterward.
Pain psychologists often help patients develop pacing strategies that encourage consistent movement while allowing time for recovery. For patients with migraine, certain types of daily exercise may even help reduce headache frequency over time.
Once pain becomes chronic, priorities often shift to things that must get done (laundry, dishes, paying bills) over more enjoyable occupations like socializing or hobbies= because the person has less energy. Part of pain psychology treatment includes finding ways to return to activities that bring meaning, even if they look different from before. An example of this would be teaching someone how to fix a car rather than doing the repairs directly.
How thoughts affect pain
Thoughts such as “This is never going to get better” or “There’s nothing I can do” are common during chronic pain. While thoughts such as these do not cause chronic pain, they can “dial up” the pain intensity.
Pain psychology techniques help patients recognize unhelpful thought patterns and develop coping strategies. The approach is not about simply thinking positively; instead, it focuses on developing realistic, more balanced ways of thinking as well as practicing acceptance for things beyond our control.
Navigating relationships and daily life
Chronic pain can also affect communication with family, friends, employers and even healthcare providers. Because chronic pain is mostly invisible, others often misunderstand patients’ experiences. Pain psychology can support patients as they navigate the healthcare system, assert their needs and facilitate difficult conversations in productive ways.
Why medication plans matter
Medication management can be especially complex for chronic pain patients. Some medications are designed to prevent symptoms before they happen, while others are intended for acute treatment during an attack. Taking too many over-the-counter medications like aspirin can sometimes worsen headaches or other forms of pain over time. Tracking symptoms and working closely with physicians is important for developing an effective treatment plan.
A team approach to chronic pain
For many patients, chronic pain management works best when multiple strategies are combined. This may include medical treatment, physical or occupational therapy, exercise, behavioral strategies and pain psychology support.
The goal is not simply reducing pain scores, but helping patients improve function, regain confidence and return to meaningful parts of their lives.
To make an appointment with a pain psychologist like Dr. Huber, or with a pain management physician, please visit our website.