If You Want to Manage Your Pain, Manage Your Thoughts

Woman in painFor people challenged with chronic fatigue, fibromyalgia, arthritis, and other invisible issues, managing pain is a priority. Issues such as these generally do not have outward indicators, such as the use of a wheelchair or bandages. They present with symptoms of widespread musculoskeletal pain, problems with sleep, fatigue, weakness, and memory or mood issues.

Although science hasn’t uncovered every link between chronic pain and mental health, we do know that chronic pain can worsen symptoms of depression. Studies show that people with more severe depression feel more intense pain. In fact, one article by Harvard Health Publications states: “Pain is depressing, and depression causes and intensifies pain. People with chronic pain have three times the average risk of developing psychiatric symptoms—usually mood or anxiety” issues. The article also asserts that people with depression are three times more likely than the average person to develop chronic pain.

That suggests a strong link between the mind and body, doesn’t it? So if this mind-body connection can work in a negative way (i.e., depression = pain), shouldn’t we be able to turn it around?

The answer, naturally, is yes!

But changing our emotions seems like a daunting task. Cognitive behavioral therapy (CBT) is an excellent way for people challenged by chronic or invisible issues to help reduce anxiety and depression. CBT explains the relationship between our thoughts, feelings/emotions, and behaviors/physical reactions. Think of it like a triangle. Changing one of those three factors can change them all.

For example, if a person with fibromyalgia says to herself, “I’m never to going to feel better, this is a horrible way to live,” her feelings may be rooted in depression, anxiety, or anger. Her behaviors may include withdrawal from others, and she may experience increased pain and more frequent flare-ups. See how one factor can negatively affect the other?

The good news is that we can stop this negative cycle and reduce pain and flare-ups. CBT would have this person check her thoughts (they are not positive or helpful), then challenge them (they are not necessarily true, and she may have helpful resources to access). Finally, she can change her thoughts to something more positive (“I have support,” or, “I can manage my symptoms”).

When she changes her thinking about the issue, her feelings will likely become more hopeful or peaceful. And research suggests that her behavior/physical reaction will almost certainly result in less pain and/or fewer flare-ups.

I challenge you to think about this mind-body connection and start to notice how it works in your life. If you want to manage your pain (who doesn’t?), try managing your thoughts and feelings and see if doing so helps. If you need support along the way, contact a licensed therapist in your area.


Depression and Pain (2004). Retrieved from http://www.health.harvard.edu/newsweek/Depression_and_pain.htm

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by Andrea M. Risi, LPC, Health / Illness / Medical Issues Topic Expert Contributor

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  • Diane

    November 19th, 2014 at 11:26 AM

    While I do agree that thinking positive thoughts can be a wonderful way to manage some of your symptoms, I would never want anyone to think that they are being belittled and told that what they are feeling is not valid.
    I have this fear that if we simply say to think better things and to not be so negative then those who experience this kind of pain could be made to feel like no one believes that they really hurt and that this somehow undermines what they are actually feeling.
    It is hard to understand these types of things when there is no clear cut indicator of what is going on but I also think that we have to pay attention to that and while encouraging thoughts and mantras that are more positive, we also have to understand that this is not going to make all of the pain go away all of the time.. And we must be willing to accept that and be more understanding of the situation that this patient may find herself in.

  • Andrea M. Risi, LPC

    November 19th, 2014 at 1:55 PM

    Thank you for your comments, Diane! I agree wholeheartedly that these symptoms are valid and indeed painful, as are the emotions that come with chronic illness. Thought-changing is one way to help manage symptoms, though it may not take away the pain and inflammation completely.

    When people are challenged with chronic illness, acceptance is empowering. Knowing that there may not be a cure at this time, and accepting that, can help people cope more effectively with their illness both physically and emotionally.

  • Darren P.

    November 20th, 2014 at 1:35 AM

    There are ways to twist the logic of intense chronic pain. Use the endurance as your platform to show yourself how indomitable your will can be. Even when you fall and endure gut wrenching sadness you can use that as why you enjoy being who you are. What I mean is enjoy the enduring of something by removing it’s teeth. My example was having an internal mega-prosthetic for 25 years and working 70 hour weeks at chemical plants. I also played a game by not telling any co-workers i was hurting…purely for entertaining myself..or seeing if it was possible. The leg was so messed up it was needing amputation for years but I was enjoying my little inner contest so much I never showed any pain while at work. So now I have this as a concrete platform as who I am which allows me to feel no one can play like they are better. But I have to constantly fight to make sure I still view others as more important than me. That is the only drawback, but I am at least aware that I often try to put myself above others. I can see it and change that in some instances.

  • peyton

    November 20th, 2014 at 10:55 AM

    Just thinking that meditation could be a great tool for someone in this kind of pain to utilize!

  • Andrea M. Risi, LPC

    November 21st, 2014 at 7:40 AM

    Darren – you gave a concrete example of the mind-body connection. You changed your thoughts about your physical pain, and that made it more physically and emotionally endurable. Thank you for sharing your experience!

  • Andrea M. Risi, LPC

    November 21st, 2014 at 7:47 AM

    Absolutely, Peyton – Meditation has been shown to positively rewire the neurocircuits in our brains, improving mood, memory and physical well-being. Meditation is a fantastic choice for anyone challenged with chronic pain…and everyone else ;)

  • Penelope

    November 21st, 2014 at 10:33 AM

    You have to remember that managing your pain will be something quite different than actually ending it. This does not mean that the pain will simply go away, but that you can have some success by managing your thoughts with maybe relieving some of the pain symptoms and making it all a little more manageable for you.

    I am sure that many who experience this just want to do what they can to make the pain go away entirely, and while this is not always going to be a possibility, there will always be things that you can try that could help make the pain a little less severe.

  • Mike

    November 21st, 2014 at 2:33 PM

    I have fibromyalgia, as well as bipolar and OCD and PTSD, been in therapy with good results, and I know a lot of people through support groups of various sorts (not just chronic pain support groups) and I think only 25% of the people I know have the capacity to do CBT. The other 75% find the act of “changing their thoughts” to feel like it necessarily involves self-denial and lack of empathy. I find in myself and these people that mindfulness and acceptance of emotions and thoughts “just as they are” comes before the thoughts can change. This would mean therapy and/or meditation that involves a great deal of rapport, empathy, kindness, a quiet stillness on the part of the therapist, a kind of simple acceptance of where the person is at (even with their harmful internal language), patience, etc.

  • Andrea M. Risi

    November 22nd, 2014 at 1:32 PM

    Penelope, thank you for reminding us that managing pain doesn’t mean ending pain. The tips here are to help manage pain with some CBT skills.

  • Andrea M. Risi

    November 22nd, 2014 at 1:34 PM

    Mike – I appreciate your insights! I’m sure others have similar experiences, and hearing that it is possible to accept these conditions is empowering.

  • Jeri

    November 22nd, 2014 at 2:18 PM

    Not sure how thinking positive thoughts can help to manage pain, but I sure do know that thinking negative thoughts will never make you feel better so it sure does seem like a better plan than that alternative does.

  • Andrea M. Risi, LPC

    November 23rd, 2014 at 10:12 AM

    The power of positive thinking, Jeri :)

  • Jeri

    November 24th, 2014 at 3:53 AM

    That’s so true Andrea! I wish that I had learned this little life lesson much earlier than I did but… c’est la vie! I DID eventually learn it and try to make that my mantra for everyday living now. There is nothing that can be resolved with negativity, but much that can be achieved through positive thinking!

  • Jennifer

    May 17th, 2015 at 9:28 AM

    I am a therapist and I also have Fibromyalgia. I have noticed that filtering and examining my thoughts and how I think about my pain helps relieve the intensity of my pain. For example, I go through flares and knowing that “this is a season of pain but it will let up to a degree” helps me push through. Also, distraction has been helpful and self care. I like to watch movies that catch my focus (I have noticed on commercials my pain increases…so interesting). Also, I have noticed that performing therapy and giving to others this way (focusing on someone else’s need) helps my pain. If I am starting to flare I use self care. I give myself permission to say no more, takes hot baths, stop life and take sometime in the couch, lower expectations and assert my needs to self and others without guilt (as a mom or spouse or friend). I watch for guilty thoughts or negative thoughts about myself or the power of my pain/illness in my life. As a Christian, I also turn to scripture and find meaning for what I am going through and rely and have hope in my God and his plan for my life. I have been able to learn through my trials to have empathy for others and to help others. So meaning making has been helpful for me with my chronic pain. I have identified supports and who I can trust to be there or share about my illness. I have also used DBT in ways to perspective take others and their misunderstanding (and sometimes inability to validate my experience) therefore having grace and less judgmental thoughts of myself and others in their reaction to my illness. The list could go on in the way therapy (CBT, DBT) can be used to help someone with chronic illness.

  • Andrea M. Risi, LPC

    May 17th, 2015 at 2:20 PM

    Thank you for sharing your experience, Jennifer! It sounds like you use several Cognitive Behavioral and Dialectical Behavioral Therapy techniques to manage your pain successfully. It goes to show how powerful positive thinking can be in managing pain.

  • Barb

    July 22nd, 2015 at 12:06 AM

    What if the chronic pain started then you get frustrated and depressed because you are unable to do basic daily living things such as….dishes,laundry,shopping…much less work activities….if the pain comes first how is the pain associated with a person depression & thinking?

    I managed my mental health issues for 25-30 years the chronic pain that disabled my physical abilities didn’t start till I. Was injured in 2009…then my depression,anxiety & chronic. PTSD became harder if not impossible to manage….
    I do have good days but as soon as I. Start doing household chores or get on computer it increases. My arms and joints swell but the dr’s say my pain is not caused by that…really now….they labeled me with fibromyalgia but yet the research I have done nothing on fibromyalgia symptoms does it say swelling of bicep muscles or other muscular area…or joint swelling…
    I think chronic pain causes the depression & other mental health issues also causes the negative thoughts as dr’s can’t find the problem or fix it….it’s very very frustrating especially when your told it’s in your head and referred to a theropist

  • Barb

    July 22nd, 2015 at 12:21 AM

    Another thought on the thinking patterns and negative self talk….I raised a son with severe behavior issues associated with…adhd,depression,separation &social anxiety,odd and some minor ocd…..I read and learned parenting techniques and all about these disorders so I could help my son learn to cope,and cognitive behavioral theropy…along with bringing him to a phycologist and a child psychiatrist in doing so I learned to manage and cope with my own mental health issues…until I hurt my left shoulder and developed tendinitis and rotor cuff, frozen shoulder issues…as well as discovered a ruptered cervical disk and still have 2 bolging disk…now many days I’m afraid to leave my house because I never know what,when,how it will start hurting again and I’m deeply depressed because my very active life..is totally non igsistant now..physically but mentally I am and/or want to work 2 jobs..take care of my house and partner,animals and still find time to socialize but physically I’m 20years older than my age yet no dr’s have answers or a plan of action to solve these issues…except go to counseling or see a psychiatrist

    So in some cases I don’t agree the pain is caused by depression,anxiety and negative thought process or self talk

  • Jackie Johnson

    July 22nd, 2015 at 6:59 AM

    I had lots negative thoughts about the arthritis pain in my knees, back and hip! And reached a place that it seemed that living in this kind of pain robbed me of the quality of life that I had known. But when I called a friend and discussed how hopeless that I was feeling answers about how I could get through the pain came to me and that chronic pain that had caused me to feel ran down and wanting die never came back since that day nearly a year ago. When I feel any pain today I stretch and tell myself something positive about my pain. Such as:this ain’t means that I need to stretch walk a little more or less. I also say “Relex you are in charge of this pain, take a deep breathe and relex!” Self -talk has proven to be most effective way to deal with the issue of pain.
    Does anyone have any other information about dealing with chronic pain?

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