Living With Chronic Pain

Living with ongoing or chronic pain is often exhausting and deeply challenging. Pain can be unpredictable and intrusive, and it commonly brings with it a wide range of emotions, including anxiety, frustration, anger, low mood, despair and, for some people, thoughts of not wanting to go on. Chronic pain can also lead to profound social losses, such as reduced friendships, strained relationships, loss of work or career opportunities, and increasing isolation. Many people living with pain have had their symptoms minimised or dismissed, sometimes over years and following multiple medical investigations or procedures. As a result, it is not uncommon to feel angry, disillusioned or mistrustful of healthcare systems or professionals. If this resonates with you, you are not alone. Importantly, there is a way forward. While it takes effort and support, it is often possible to significantly improve quality of life, and in some cases, even resolve pain.

​

Understanding Pain: A Biopsychosocial Approach

Until relatively recently, pain was understood primarily as a biomedical problem; the result of tissue damage, injury or structural dysfunction. Treatment therefore focused almost exclusively on medical and surgical interventions. While this approach can be very effective for acute or short-term pain (and remains important for some ongoing pain conditions, such as pain related to repeated injury in Ehlers–Danlos syndrome), it is often less effective for chronic pain. We now know that persistent pain is best understood and treated using a biopsychosocial model of pain, which recognises that biological, psychological and social factors are deeply interconnected and equally important. Physical health, emotional wellbeing and social context all influence how pain is generated, processed and experienced by the brain, and each can contribute to both increasing and reducing pain over time.

​

The Biological Component of Pain

The biological component of pain includes factors such as genetics, age, tissue damage, mechanical and anatomical dysfunction, immune and inflammatory processes, hormonal influences, diet, sleep, and changes within the nervous system’s pain-processing pathways. These factors are often addressed through medication, physical rehabilitation and, in some cases, surgery. Such interventions can be highly effective for acute or short-term pain. However, in chronic pain, symptoms often persist beyond tissue healing and are increasingly driven by sensitisation within the nervous system. For this reason, biological factors alone are frequently insufficient to fully explain or treat long-standing pain.

​

The Social Component of Pain

The social component of pain includes family and peer relationships, social support, socioeconomic factors, adverse childhood experiences and trauma, as well as the broader cultural and environmental context. Humans are fundamentally social beings, and our nervous systems develop and regulate through relationships. Supportive social connection promotes health-protective processes, while loneliness, isolation or ongoing relational stress increase stress hormones and can heighten pain sensitivity. Strong social support therefore acts as a powerful buffer against stress and is associated with lower pain intensity.

​

Research has also demonstrated a relationship between adverse childhood experiences, such as abuse, neglect, or growing up in a chronically unsafe or unpredictable home, and the later development of chronic pain (for more about that, click here and here). When a child is repeatedly exposed to threat without the buffering presence of a safe, supportive adult, the stress response can remain highly activated. Over time, this “toxic stress” can disrupt developing neural systems involved in stress regulation and pain processing, and may also affect immune functioning, increasing vulnerability to ill health in adulthood, including persistent pain.

​

The Psychological Component of Pain

The psychological component of pain includes cognitive, emotional and behavioural factors such as thoughts, beliefs, attentional processes, prior experiences, expectations and coping behaviours. For example, negative expectations like “I’ll never get better” can amplify pain by increasing activity in the brain’s pain-processing centres. Emotions such as anxiety, depression, distress and anger are understandable consequences of chronic pain, but they can also intensify pain by keeping the nervous system in a state of ongoing threat. Stress more generally can trigger pain flares and even illness deterioration in autoimmune and immune mediated conditions. That's why stress management in chronic pain is so important. You can read more about that here.

​

This domain also includes patterns such as perfectionism (read further here) and self-blame (read further here), where people push themselves beyond their limits, ignore bodily signals, or interpret pain as personal failure. Behaviourally, some respond to pain by avoiding activity out of fear, while others persist through pain and then pay the price later. How we cope with, react to and respond to pain including decisions about rest, pacing and activity can significantly influence pain intensity and frequency. For some people, these patterns reflect earlier relational or developmental experiences (as described in the social section above), where the nervous system learned to remain on high alert long after the original threat has passed, continuing to maintain pain even in the absence of ongoing injury.

​

How These Domains Interact

The biological, psychological and social components of pain interact continuously and influence one another in complex feedback loops. Social experiences affect brain chemistry, hormone regulation and immune function, as well as emotional wellbeing. Emotional states such as chronic stress or anxiety can in turn alter neurochemical and hormonal activity, shaping how pain signals are generated, transmitted and interpreted by the brain. Everyday factors such as sleep quality, physical activity (where possible), nutrition and pacing play an important role in nervous system regulation. Together, these influences can either amplify pain or help reduce pain sensitivity over time. Chronic pain is therefore rarely maintained by a single cause, but by interacting processes across the body, mind and environment. Understanding pain through this biopsychosocial and mind–body framework can be deeply empowering and is often a first step toward improved functioning, confidence and quality of life. If you would like to explore this further, you can read more about Mind–Body Syndrome and neuroplastic pain here and here, and about living with both structural and neuroplastic pain here.

​

My Approach to Chronic Pain Therapy

I take a holistic, evidence-based biopsychosocial approach to pain management. Therapy is never one-size-fits-all. Each person’s pain experience, history and nervous system are different, which is why I use an integrative therapeutic approach tailored to the individual rather than relying on a single therapeutic model alone. Depending on your needs, therapy may combine Pain Education, Pain Reprocessing Therapy, Acceptance and Commitment Therapy (ACT), Cognitive Behavioural Therapy (CBT), and grief processing (to process non-death losses).

​

Goals of Therapy

My aim in working with you is to help you:

• Regain a sense of control over your brain and body

• Reduce pain intensity and frequency, and where pain is neuroplastic in nature, potentially resolve it

• Feel emotionally supported and learn skills to regulate emotions and calm the nervous system

• Reduce the impact of pain or illness on your daily life

• Identify and manage triggers to minimise flare-ups

• Develop more effective ways of coping when pain flares occur

• Reduce reliance on pain medication where possible

• Improve quality of life so you can live meaningfully, even if some pain remains

​

A Final Note

Taking a holistic approach to pain management does not mean that pain is “all in the head.” All pain is real, but its cause can differ. Some pain is neuroplastic, shaped by the nervous system’s responses to adverse childhood experiences or learned patterns in adulthood, even when there is no ongoing tissue damage. Other pain is primarily structural, caused by physical injury or conditions such as arthritis, which can be worsened by chronic stress. Structural pain can also develop neuroplastic components over time through habitual nervous system patterns.

​

Many people experience a combination of structural and neuroplastic pain, which can make treatment more complex. Neuroplastic pain often responds well to pain reprocessing, cognitive strategies, and coping techniques, while structural pain may benefit from anti-inflammatory medication, physical therapy, and stress management. In some cases, combining both approaches is the most effective strategy.

​

The goal is to restore daily functioning, reduce suffering, and minimize the physical, emotional, and social impacts of chronic pain. Where neuroplastic processes are driving symptoms, treatment can help the pain resolve. With the right understanding, support, and consistent effort, there is very often a positive way forward.  (For more information about my approach to therapy and what to expect, click here.)​

​