Is Chronic Pain All in My Head?

People with an injury have comfort in knowing that their pain has an end date. However, for the millions of Americans who live with chronic pain, the idea that their pain will "run it course" or "go away" isn't always a reality. Chronic pain is tricky—it's isolating for those who live with it and it's misunderstood by family members, friends, and medical teams.

Chronic pain affects an estimated 10-15% of American adults. A 2012 National Health Interview Survey found that almost 30% of the adult US population lives with chronic pain or severe pain.

What Is Chronic Pain?

Chronic pain can be defined as pain that lasts more than 3-6 months at a time and is not caused by cancer. This means that chronic pain exceeds the "normal" period required for injury healing.   Chronic pain may stem from a health condition, injury, surgery, or from an unknown cause. In many cases, the root cause of chronic pain is undefined and cannot be pinpointed by a medical team.

If you can't see pain on an x-ray or MRI, does this mean that pain doesn't exist?

Chronic pain is an enduring, ongoing, and difficult-to-treat disease. Those who live with chronic pain have undoubtedly experienced their pain be underestimated, diminished, or called into question by physicians, family, friends, and sometimes even by themselves. Unlike a cancer diagnosis or a broken bone, there is sometimes a lack of "medical proof" with chronic pain. This can lead to people questioning, "is chronic pain all in my head?".

Read on as we unpack this complicated question. But first, let's unravel why the "old school' way of thinking about pain no longer measures up.

"Old School" Approach to Chronic Pain

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There are a lot of people (even physicians) who are very mechanistic in their understanding and approach to pain management. This "old school" group believes that there should be a direct correlation between a physical injury/ diagnosis and the pain someone experiences. With this method of thinking, pain that lasts longer than an injury must be inside a person's head.

The idea that chronic pain is "fake" or "in your head" is an old school approach that impedes patients seeking a solution—it's as frustrating as it is harmful.

To illustrate, think about the misconceptions and misunderstandings that used to surround mental illness, or more recently, addiction. The idea that people with mental illness or addiction should just "snap out of it" was commonly held at one time. However, with greater education and understanding, we now know that although we can't see any disease on an x-ray monitor, it doesn't make it less real. This same paradigm shift and growth in understanding is currently happening with chronic pain.

Is Chronic Pain in My Head?

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Is pain all in your head? The answer isn't a simple "yes" or a "no". No, pain is not just in your head (as in you're making it up). However, pain is in your brain. Your brain is in charge or processing pain signals. Pain is not just a physical sensation. Rather, pain signals pass through the brain in the form of emotions and thoughts. As such, your emotional state plays a direct role in how you feel pain.

A study published in the Nature Neuroscience journal ran brain scans on 40 patients who experienced injury. Looking at the brain (parts that process emotion), scientists were able to predict with 85% accuracy which patients would go on to have chronic pain.

For example, it's been proven that depression and pain are directly linked. For many patients, depression and pain are like a "chicken or the egg" scenario—it's tough to determine what came first. People with depression are far more likely to experience chronic pain, and people with chronic pain are much more likely to be depressed.

As such, it must be understood that your physical and emotional state are interconnected; pain is a physical manifestation of your emotional state. If you're anxious, fearful, angry, stressed out, are carrying shame, have endured trauma, are grieving a loss, are going through a divorce etc., you are infinitely more likely to develop pain.

To reverse this idea, have you ever broken a bone or had a temporary and debilitating injury? Physically, you may be swollen, your bone may ache and you are uncomfortable. But how is your emotional state? There's a good chance you are also feeling tired, "low", or "down in the dumps".

So, since pain is not just a physical symptom but is tied to negative, unresolved emotions and thoughts, how can you break the cycle?

How to Combat Chronic Pain

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Now that we know that pain is regulated by the brain and that the way we experience pain is actually driven by emotions, we can move on to part two. If you've dealt with chronic pain for a long time without finding a physical cause, knowing that your emotional state is a contributing factor can actually be empowering. With this understanding, you're one step closer to treating and managing your complex pain.

5 ways to address your emotional state and decrease pain:

  1. Manage Stress. Stress is the "umbrella" in which all of the other ways to address your emotional state fall under. Stress is a major catalyst for disease and pain. If you're experiencing overwhelming stress or anxiety, it will eventually manifest physically. This could be as small as bringing on a cold, or as large as chronic pain (and beyond). Back pain and chronic pain are closely linked to stress, anxiety, and mental illness. Manage stress by with exercise, getting better sleep, saying "no" to the overwhelming, asking for help, and leaning on family and friends.

  2. Exercise. You've probably heard it before and you'll hear it again: "motion is lotion".  Although exercise is painful, it is absolutely imperative for managing your physical and emotional health. Exercise not only releases endorphins that release stress and make you feel happier, but it also cuts down on pain. People who do not move or exercise (within their means) experience greater pain for a longer period. Here are some low-impact exercises for those who have back pain.

  3. Sleep. Just like stress triggering illness and pain, sleep is at the top of the list. Poor sleep for a prolonged period can have adverse health effects. Understandably, it can feel like there's a vicious cycle between sleep and pain: you can't sleep because you're in pain, but you're lack of sleep is making pain worse. Read more about getting better sleep while recovering from surgery/ dealing with pain.

  4. Mindfulness/ Meditation. Since a huge part of chronic pain is mental/ emotional, retraining your brain to better approach pain is critical. Changing thought patterns and how you process pain in a long-term solution. Mindfulness meditation is a proven way to cope with pain, let go of old pain, manage stress, face fear, overcome mental blocks.  Here is more information on mindfulness meditation to overcome fear and better deal with pain.

  5. Therapy. Studies show that people who suffer from various mental health issues, including anxiety, depression, stress sensitivity, sleep problems, and psychosis report more back pain symptoms. Counselling, cognitive therapy, psychotherapy or group therapy could positively help unload the emotional baggage that is helping to fuel your physical pain.

Round-Up: Is Chronic Pain in My Head?

  • Chronic pain is pain that's unrelated to cancer, that exceeds the normal healing time for an injury. Chronic pain lasts longer than 3-6 months.

  • The "old school" approach to pain is that there should be a direct relationship between a physical injury / disease and the pain one experiences. If pain outlasts a physical problem, some doubt that this pain is real.

  • As education and medicine progress, the approach to pain should be that pain is not just a physical sensation. Your brain is in charge or processing pain signals.

  • Stress, anxiety, trauma and depression play a major role in the pain you experience. By changing negative thought patterns and getting to the core of your emotional baggage you can reduce/ better cope with physical pain.

  • By addressing your emotional state and retraining your brain to process pain, you'll be armed with a long-term solution to chronic pain.


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Hi, I'm Grace. I write and research about hip and knee replacements, PreHab before orthopedic surgery & ReHab. Content advised or co-authored with physicians (MD) and orthopedic surgeons (OS).

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