Chronic Pain Is Not Simple And Treating It As If It Were Harms Patients

I saw a post by a therapist on Threads recently about chronic pain that gave me real cause for concern. It had over 2.2 thousand likes. In it, she argued that CBT for pain is “ridiculous,” that people with chronic pain simply need medical treatment, and that validation is what matters most. I found this framing extraordinary, troubling and profoundly ignorant. Why? Because chronic pain is complex. Yes, validation is always necessary. Anyone living with persistent pain deserves to be believed, respected, and taken seriously. Yes, for most people CBT on its own is insufficient. And yes, for others, medical treatment is essential, while for many, it offers limited or no relief at all. But presenting chronic pain as something that can be addressed by a single explanation or a single solution does a profound disservice to patients. Real (and ideal) chronic pain care doesn't work that way. What people living with chronic pain actually need is a tailored, individualized approach, shaped by the underlying drivers of their pain, their nervous system, their personal history, and their lived experience. There is no single model or modality that works for everyone. This becomes clear when we look at the very different biological and neurological pathways through which chronic pain can arise, all of them real, and all of them requiring different forms of care. Below are some examples.

Autoimmune and inflammatory pain

Autoimmune and immune-mediated inflammatory conditions, such as rheumatoid arthritis, lupus, ankylosing spondylitis, inflammatory bowel disease, and psoriatic arthritis, are characterized by immune system dysregulation. In these conditions, the immune system triggers a prolonged inflammatory response that can harm tissues, joints, or organs, leading to persistent pain, stiffness, and fatigue. Medical treatment is often central, including disease-modifying or biologic medications, alongside physiotherapy, pacing, and pain management strategies. Psychological support is equally important, as stress not only drives disease progression but also amplifies pain, and can help individuals cope with uncertainty, loss, disability, and the chronic nervous system strain associated with inflammation. I have written in more detail about that here.

Diabetic and metabolic nerve pain

Like autoimmune pain, neuropathic pain from metabolic conditions such as diabetes illustrates that even clearly measurable biological damage is not enough to fully explain or treat chronic pain. Peripheral neuropathy, most commonly seen in diabetes, results from long-term nerve and microvascular damage linked to sustained blood-glucose dysregulation, influenced not only by biology, but by behavioural factors that affect adherence to diet, physical activity, medication routines, sleep regularity, and glucose monitoring. Pain, fatigue, low mood, stress, and avoidance patterns can all disrupt self-management, destabilize glucose levels, and increase inflammation. Stress not only amplifies pain but can also worsen glycemic control and disease progression, making psychologically and behaviorally informed support alongside medical and rehabilitative care essential. Effective treatment therefore cannot rely on medication or glucose targets alone, but requires an integrated approach that addresses behaviour, stress physiology, and lived experience, underscoring again why chronic pain cannot be reduced to a simple explanation or solution.

When injury heals but pain persists

In some cases, chronic pain begins with a clear physical injury; a disc herniation, fracture, surgical trauma, or soft tissue damage, yet persists long after the tissue itself has healed. Even when the scans return to normal, the pain continues. Research shows that in these situations, pain can be maintained by neuroplastic processes, i.e. the brain’s ability to change its structure and functioning over time in response to experience, learning, injury, or repeated patterns of thought, emotion, and behaviour. Therefore, learned pain pathways, fear-based conditioning, and a sensitized nervous system continues to produce pain signals despite the absence of ongoing tissue damage. For these individuals, approaches such as Pain Reprocessing Therapy, graded exposure to movement, and education about pain neurobiology can be highly effective. Continuing to pursue purely medical interventions may unintentionally reinforce the pain cycle, whereas helping the nervous system relearn safety can lead to real improvement. You can read more about that here.

Mind–Body and neuroplastic pain rooted in early experience

For some people, chronic pain develops without a clear injury or disease process, or appears far out of proportion to identifiable pathology. In these cases, adverse childhood experiences, developmental trauma, chronic stress, emotional suppression, perfectionism, and self-blame often play a significant role. These experiences shape the developing nervous, endocrine, and immune systems, altering stress hormone regulation, increased inflammation, and increasing sensitivity to threat and pain over time. The pain is not imagined or symbolic; it is biological, but driven by learned survival responses. Effective treatment in these cases often involves trauma-informed therapy, Pain Reprocessing Therapy, and somatic approaches that help restore regulation, emotional safety, and connection with the body. You can read more about that here.

When pain is both structural and neuroplastic

Many people live with pain that cannot be neatly categorized. Conditions such as Ehlers–Danlos syndrome and hypermobility spectrum disorders involve genuine structural vulnerability alongside nervous system sensitization. Repeated injuries, autonomic dysregulation, and chronic stress interact to produce pain that is both mechanical and neuroplastic. Treatment usually requires an integrated approach that includes specialist medical care, physiotherapy tailored to stability and pacing, pain education, and nervous system regulation. Addressing only the structural aspects or only the psychological components is rarely sufficient. You can read more about that here.

Why oversimplification fails people in pain

Declaring CBT “ridiculous,” suggesting that validation alone is enough, or implying that chronic pain can be solved solely through medical treatment reflects a false and fixed, one-size-fits-all belief, rather than a careful understanding of how complex chronic pain actually is. Validation is essential, but validation without effective, individualized care can quietly become another form of abandonment. Managing chronic pain requires an approach that emphasizes curiosity instead of rigid beliefs, seeks to integrate the mind and body, and respects both biological and personal narratives. There is no universal solution, and pretending otherwise may feel reassuring or validating online, but it ultimately fails the very people it claims to support. Addressing chronic pain demands more than a simple approach; it requires complexity, humility, and personalized care for each individual. You can read more about my approach to chronic pain here.

If this is something you’ve been affected by, please leave a comment below. If there’s something important you’d like to add, please do so. I'd love to hear from you.

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Dr. Ingela Thuné-Boyle is a licensed Practitioner Health Psychologist and a Doctor in Behavioural Medicine who specializes in improving the quality of life of people struggling with long-term health problems, chronic pain and trauma. She runs a private online (telehealth) practice at www.ingelathuneboyle.com. You can find out more about her background [here], and more about her approach to therapy [here].

📩 Contact: For therapy or other enquiries, you can contact her at info@ingelathuneboyle.com.

Please note: Advice given in this blog is not meant to take the place of therapy or any other professional advice. The opinions and views offered by the author is not intended to treat or diagnose, nor is it intended to replace the treatment and care that you may be receiving from a licensed physician or mental health provider. The author is not responsible for the outcome or results following their information and advice on this blog.