Chronic Pain and Mental Health: Reconstructing Unwanted Thoughts

Person sitting at kitchen table with head in hands while working, frustrated expressionIt is often difficult to pay attention to the emotional impact of chronic pain due to the overwhelming physical symptoms. However, unwanted thoughts and pain are often linked.

Do you ever have any of the following thoughts?

  • “I can’t manage this pain!”
  • “My pain is going to kill me!”
  • “I can’t handle this pain, it is too much!”
  • “My pain has overtaken my life.”
  • “I can’t do anything right now!”
  • “My body has failed me.”
  • “This is never going to end!”
  • “I’m worthless.”

Having these unwanted thoughts often leads to emotions such as frustration, hopelessness, worthlessness, helplessness, and more. Even if these emotions don’t cause your pain, they can worsen it. Managing unwanted thoughts and emotions is an integral part of treating chronic pain.

Do you ever behave in the following ways as a result of unwanted thoughts and emotions?

  • Not getting out of bed all day
  • Sleeping all day
  • Isolating
  • Not engaging in activities that can worsen the pain
  • Taking more medication than prescribed

If any of these unwanted thoughts, distressing emotions, and/or undesirable behaviors are part of your life, keep reading. Cognitive restructuring can help.

What Is Cognitive Restructuring?

Cognitive restructuring is a process of recognizing unwanted thoughts that lead to distressing emotions and replacing them with positive, pleasant thoughts.

The following are steps of cognitive restructuring:

1. Remember a current event that has caused unwanted thoughts.

For example, have you ever gone to the doctor and had your pain either discounted or, worse, not acknowledged at all? This dismissal of symptoms can lead to unwanted thoughts.

2. Describe and write down the emotions associated with the unwanted thoughts.

When I have been to the doctor and my concerns were not addressed, it left me feeling worthless, hopeless, frustrated, and isolated. I can think of a specific time after I had a major surgery and was in excruciating pain. I called my doctor for help, but instead of receiving help, I was forced to prove that my pain was real and not a scheme to get more/stronger medication.

3. Rate the emotions from 1 to 10, with 10 being most distressing.

The distressing emotions I was having were at least an 8.

4. Record the thoughts that lead to the emotions.

A specific thought I was having through this experience was, “Am I crazy?” If a medical doctor does not believe the pain I am experiencing, maybe I made it up? Maybe I am a baby if every other woman who has this surgery can handle the pain without the medication. Why can’t I? I hate myself! Why can’t I be like everyone else?

5. Focus on the unwanted thought(s).

What unwanted thoughts are related specifically to this event? What are more general unwanted thoughts? The unwanted thoughts related to my being dismissed by my doctor are: Am I crazy? Did I make the pain up? I am just a baby. The more general unwanted thoughts are: I hate myself! Why can’t I be like everyone else?

How do you know if the unwanted thoughts are related to the specific event or a general thought? For me, if the thought I am having is recurring, it is most likely a general thought. It is important to remember that a general thought can be amplified for a specific event.

6. Evaluate the thoughts.

Now here comes the tricky part. We have to think like a detective here and just look at the facts. If not, we may continue to believe all the unwanted thoughts are true.

What about the unwanted thought(s) is true? What is false? If the unwanted thought is not 100% true, what else can you say to yourself?

What about the unwanted thought(s) is true? What is false? If the unwanted thought is not 100% true, what else can you say to yourself?

So, what are the truths in my unwanted thoughts? Well, I know I am not crazy. I just had an invasive surgery, for which MOST women DO need medication to manage the pain. Therefore, the pain is NOT made up. Hmm … I don’t think I am being a baby to want proper medical care and to have my pain managed. It is a realistic expectation!

I do think I hate myself at times and have a desire to be someone who does not have deal with constant health problems, but as a licensed counselor I can say this response to chronic pain/health issues is normal. It is important here to capitalize on times when you don’t hate yourself and you are feeling “normal.” Record your thoughts during these times to read when those unwanted thoughts surface.

7. Again, rate your emotions from 1 to 10.

Now how do I feel? Better! I would rate my emotions to this specific event to now be 3. I have been able to normalize my experience and prove to myself that not all my unwanted thoughts were factual.

8. Keep practicing!

Unwanted thoughts, distressing emotions, and/or undesirable behaviors will not significantly decrease without repetition of cognitive restructuring.

For support and guidance, contact a licensed therapist.


  1. Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. The American Psychologist, 69(2), 153-166. doi: 10.1037/a0035747
  2. Otis, J. (2007). Managing chronic pain: A cognitive-behavioral therapy approach. Oxford, UK: Oxford University Press.

© Copyright 2018 All rights reserved. Permission to publish granted by Kari Randall, LPC

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Nola Z

    January 17th, 2018 at 8:31 AM

    Maybe its just me, but I feel like #6 is kind of a tall order. I mean, if you’re in “I give up” mode, you’re not really in a place to be objective. It’s like asking a camera to take a picture of its own memory chip. …Okay, if you have a back up memory chip, that’s technically possible, but STILL.

  • Margie

    January 19th, 2018 at 8:32 AM

    I have fibromyalgia
    One thing I do is rate my pain level 1 to 10 throughout the day as a coping strategy. Hadn’t thought to do this with emotions

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