Perhaps you've been suggested to see a psychologist for your pain, and that upset you, as if it implied your pain was 'all in your head.' Or maybe you've noticed your pain worsens when you're stressed, and you wonder if that's normal. These questions are legitimate, and you deserve clear answers.

• The brain processes physical and emotional information SIMULTANEOUSLY; they are inseparable.
• Anxiety and catastrophizing genuinely amplify pain (not just imaginarily).
• Your beliefs about pain directly influence your recovery.
• Psychological approaches (like CBT) are as effective as some medications for chronic pain¹

This guide explains how your thoughts and emotions interact with your pain. To understand the brain mechanisms involved, please read our article on the neuroscience of pain.

Why talk about psychology when you're in pain?

Let's be clear from the outset: talking about the psychological aspects of pain does not mean that your pain is "all in your head" or that it is not real. All pain is real, regardless of its cause.

Modern pain science shows us that the brain is involved in every pain experience, and that it processes both sensory AND emotional information simultaneously. This is why understanding psychological factors can help you better manage your chronic pain.

Pain vs. suffering: an important distinction

What really hurts

When someone seeks medical advice for persistent pain, it is usually not just the physical sensation that is the problem. It is often:

• The pain of not being able to do the activities you love

• The pain of feeling limited in one's role as a parent, worker, athlete

• The pain of not understanding why you are hurting

• The suffering of feeling that you have no control over your pain

• The pain of not being understood by others

Suffering is resisting what is.

A simple definition of suffering: refusing to accept what is happening right now.

It is not the pain itself that causes the most distress, but our reaction to that pain. Two people experiencing the same level of pain may experience very different levels of suffering, depending on how they respond to their experience.

This does not mean that we should "just accept" and do nothing. Acceptance means recognizing the current reality while actively working toward greater well-being. It means stopping the struggle against the experience itself and redirecting our energy toward constructive actions.

Beliefs that influence your pain

Where do our beliefs come from?

Our beliefs about pain are shaped by our past experiences, what we have been told (by doctors, family, the media), and what we have observed around us. These beliefs are often helpful at first, but they can become problematic if they no longer correspond to reality.

Categories of beliefs to watch out for

• "There's something missing to know what I really have."

• "I need an MRI to understand my pain."

• "Only surgery can fix my problem."

• "Pain = injury, so I must avoid anything that hurts."

• "If it hurts, it's because I'm hurting myself."

• "I need complete rest to heal."

• "I'm always going to be in pain."

• "At my age, you can't expect anything better."

• "Osteoarthritis cannot be cured, so I'm doomed."

• "It's up to the healthcare system to cure me."

• "It's my employer's fault that I'm in pain."

How beliefs influence your behavior

The logic is simple: if you believe movement is dangerous, you will avoid moving. If you believe that only passive treatment can help you, you won't commit to exercises. Your beliefs guide your actions, and your actions directly influence your recovery.

10 mini-tips to understand your pain

Those who have had the greatest impact on my patients' lives. 1 per day, 2 min.

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Fear of movement (kinesiophobia)

What is it?

Kinesiophobia is an excessive fear of movement and physical activity due to a fear of injury or aggravating one's condition. It is one of the most widely studied psychological responses in the context of chronic pain.

Why is this problematic?

This fear is understandable; no one wants to worsen their situation. But when it becomes excessive, it leads to:

• A gradual avoidance of activities

• Physical deconditioning

• An increase in the sensitivity of the nervous system

• A reduction in confidence in one's abilities

• Paradoxically, often an increase in long-term pain

The vicious circle of avoidance

Pain, fear, and immobility form what researchers call an "axis of evil," where each element reinforces the others:

• You feel pain when moving

• You develop the belief that this movement is dangerous.

• You avoid this movement

• Your body is losing its conditioning

• Your nervous system becomes more sensitive

• The next time you try the movement, it hurts even more.

• Your belief is "confirmed" and you avoid even more

This cycle can even be fueled by healthcare itself. Phrases like "your spine is very worn" or "your disc is crushed" can amplify fear and reinforce avoidance, even when these findings are normal for your age and are not the cause of your pain.

How to get out of it

The solution is not to "push through the pain," but to gradually reintroduce avoided movements, which is called graded exposure. A physiotherapist trained in pain management can safely guide you through this process.

Catastrophism

Think of the worst

Catastrophism is the tendency to:

• Dwelling on pain (thinking about it constantly)

• Exaggerate its importance ("This is terrible, I can't stand it.")

• Feeling powerless in front of her ("I can't do anything about it")

These thoughts are natural; when faced with a threat, our brain is programmed to pay attention to it. But when they become overwhelming, they amplify the perception of danger and, consequently, the pain itself.

The impact on the brain

Research shows that people who catastrophize have:

• Greater activation of brain regions associated with pain

• A decrease in activity in the regions that modulate pain

• Slower recovery after injury or surgery

This is not "weakness"; it's a real neurological mechanism that can be addressed.

Strategies for reducing catastrophizing

The first step is to notice when you are catastrophizing. "I'll never be able to...," "This is awful...," "I can't stand..."

Is that really true? What is the evidence? Are there other ways of looking at the situation?

Rather than dwelling on the pain, ask yourself, "What can I do now to improve my situation?"

Emotions and pain

Two-way interaction

Emotions and pain influence each other:

• Pain generates emotions (frustration, sadness, fear, anger).

• Emotions influence pain perception (stress amplifies pain).

This interaction is normal and universal. The problem arises when emotions become overwhelming or when we don't know how to manage them.

First and second level response

It's automatic and often unavoidable: a peak in pain, an emotion of frustration.

It's what you do with your initial reaction. That's where you have control.

• First level: "Ouch, my back hurts. My heart is racing."

• Second level (negative spiral): "Why again? This is terrible. I can't take it anymore. It will never end."

• Second level (adapted approach): "OK, pain. It's unpleasant, but I know it will pass. I breathe and carry on."

Initial pain is often unavoidable. The suffering that accompanies it is much less so.

Self-efficacy: Believing in one's ability

What is self-efficacy?

Self-efficacy is the confidence in your ability to manage a difficult situation, in this case, your pain. It's not blind optimism; it's the belief that you have the resources to cope.

Why it matters

People with good self-efficacy in relation to their pain:

• Are more active despite the pain

• Use more effective management strategies

• Have a better prognosis for recovery

• Often experience less pain in the long term

How to develop self-efficacy

Start with realistic challenges and succeed at them. Every small success builds confidence.

Seeing people with similar conditions who are doing well can be inspiring and normalizing.

A professional who guides you, encourages you, and celebrates your progress strengthens your sense of competence.

Learning to distinguish between "pain = danger" and "pain = normal sensitivity" helps you to fear your own sensations less.

The perception of injustice

When pain seems unfair

Some people develop a strong sense of injustice about their pain:

• "It's not fair that this is happening to me."

• "It's the fault of the accident/my employer/the doctor."

• "No one understands what I'm going through."

This feeling is human and understandable. But when it becomes dominant, it can:

• Holding on to anger and bitterness

• Prevent from taking action

• Extend recovery time

Towards acceptance

Acceptance does not mean approving of what happened or giving up your rights. It means recognizing reality so that you can move forward. The energy spent on anger and rumination can then be redirected toward healing.

The psychology of pain, not "psychological" pain

A crucial distinction

Talking about the psychology of pain does not mean that:

• Your pain is imagined

• You are weak or "too sensitive."

• You should "just calm down."

• You do not need physical treatment.

This means that:

• The brain is involved in all pain.

• Your thoughts, beliefs, and emotions influence your experience.

• You have the means to improve your situation.

• A comprehensive approach is more effective than a purely physical approach.

Key takeaways

• Suffering is not pain; it is our resistance to the experience that amplifies distress.

• Your beliefs guide your behaviors; identifying limiting beliefs is the first step to changing them.

• Fear of movement can create a vicious cycle; graded exposure helps break free from it.

• Catastrophizing amplifies pain; cognitive strategies can reduce it.

• Self-efficacy is a key factor in recovery; it develops through progressive successes.

• You are not your pain; understanding the psychological aspects empowers you, it doesn't provide excuses.

If you feel that these factors play a significant role in your back pain, neck pain, or pain elsewhere, don't hesitate to discuss them with your healthcare professional. An approach that addresses all aspects of your experience will be more effective.

Additional resources

• Understanding chronic pain

• The neuroscience of pain

• Acute pain vs. chronic pain

• Pain management strategies