Mental Strategies To Reduce Chronic Pain

by Karen D. Sullivan, PhD, ABPP

Chronic pain has been defined as an unpleasant physical sensation lasting more than three months and reducing daily functioning and well-being, including mental and social health. Approximately 116 million older adults in the United States live with chronic pain.

Research studies have estimated that more than 50 percent of people with chronic pain also meet criteria for depression, but only 15-20 percent are treated. Having both depression and chronic pain often leads to decreased activity and a feeling of losing control over one’s life, which then worsens both conditions. Being in pain every day reduces our ability to deal with life’s other stressors and can lead to a feeling of being chronically overwhelmed.

The successful treatment of chronic pain requires treatment on multiple levels, including those provided by your doctor and yourself. The goal is to keep chronic pain from becoming the entire focus of your life.

Traditional treatments for pain relief have not changed much in the past 100 years, and we continue to use anti-inflammatories, sedatives, muscle relaxants and opiates. When taken properly, these medicines can be lifesavers. In recent years, doctors have begun to offer non-drug treatments for pain, including hot and cold therapy, topical rubs, physical therapy, epidural injections and transcutaneous electrical nerve stimulation (TENS) therapy that utilizes low-voltage electrical current for pain relief.

Here’s some good news. The brain can learn how to manage the sensation of pain. Many people living with chronic pain are starting to add mental strategies such as biofeedback, relaxation, guided imagery, deep breathing and cognitive behavior therapy to feel less dependent on pain medications and more able to control pain.

The first step in coping with chronic pain is to receive a thorough medical evaluation to determine the cause of the pain. Pain can serve as a warning signal from our brain of impending damage and injury.
Once it is determined why the pain is happening, these two cognitive behavioral therapy strategies—cognitive re-framing and mental distraction—can help you start to reduce pain as early as today.

Cognitive Re-framing
Cognitive strategies are based on the belief that our thoughts and behavior shape our reality. In the case of chronic pain, the way we think about our pain, the way we “make sense” of the experience of pain, determines how much the pain affects us. Changing well-worn ways of thinking and acting takes practice and effort but can pay off in a big way.

First, you need to become aware of the messages you habitually give yourself, the dialogue you have with yourself in response to any situation. This tends to be so automatic and routine that we are often not even aware of our self-talk.  Spend a day asking yourself, “What am I thinking right now that is making me feel angry, frustrated, sad, ashamed or joyful?” You will be amazed at what happens in the quick gap between a thought and an emotion.

Common themes related to chronic pain include, “This is never going to end, and I can’t do anything, so I might as well just stay here in bed.”

Next, ask yourself, “What is the evidence this is true? Is this is a balanced thought? Am I considering all the possibilities? Is it really true that I can’t do anything?”

When thinking becomes negative and all-or-nothing, try to offer yourself a positive and balanced coping thought, such as, “Today might start off not so great, but if I can get in a hot shower and stretch a bit, I always manage to have a better day.”

The Power of Distraction
Research has shown a significant relationship between focusing on the pain (how bad it hurts) and poor sleep, more anxiety and, in turn, a worsening of pain. When we focus on pain, we have a tendency to catastrophize and only focus on the hurt with thoughts like, “This is so bad that I can’t stand it,  and this will never go away.”

By switching our focus away from bodily sensations to something engaging or pleasant, we can reduce the sensation of pain. Try to focus on parts of your body that aren’t in pain and other senses like taste and smell. Listen intently to your favorite music, talk to a friend, watch a bird feeder or spend time with a pet.

Make sure to talk about other topics of conversation with friends and family, not just your physical health.


Dr. Sullivan, a clinical neuropsychologist at Pinehurst Neuropsychology, can be reached at 910-420-8041 or