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 Discuss Psychology When You're in Pain?

Let's be clear from the start: discussing the psychological aspects of pain does not mean your pain is « all in your head » or that it isn't 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 Truly Hurts

When someone seeks help for persistent pain, it's generally not just the physical sensation that causes the problem. It's often:

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

• The distress of feeling limited in your role as a parent, worker, or athlete

• The distress of not understanding why you are in pain

• The distress of feeling you have no control over your pain

• The distress of not being understood by others

Suffering is resisting what is.

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

It's not the pain itself that causes the most distress, but our reaction to that pain. Two people experiencing the same intensity of pain can have very different levels of suffering, depending on how they perceive their experience.

This doesn't mean you should “just accept” and do nothing. Acceptance means acknowledging your current reality while actively working towards improved well-being. It's about stopping the struggle against the experience itself and redirecting your energy towards 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've been told (by doctors, family, media), and what we've observed around us. These beliefs are often helpful initially, but they can become problematic if they no longer match reality.

Categories of Beliefs to Watch Out For

• “Something is missing to truly know what's wrong with me”

• “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, I'm doing myself harm”

• “I need complete rest to heal”

• “I will always be in pain”

• “At my age, you can't expect anything better”

• “Osteoarthritis can't 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 Behaviors

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 Quick Tips for Understanding Your Pain

The ones that have made the biggest difference in my patients' lives. 1 a day, 2 minutes.

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Fear of Movement (Kinesiophobia)

What Is It?

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

Why It's Problematic

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

• Progressive Avoidance of Activities

• Physical Deconditioning

• Increased sensitivity of the nervous system

• Reduced confidence in one's abilities

• Paradoxically, often an increase in long-term pain

The vicious cycle of avoidance

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

• You feel pain when you move

• You start to believe that this movement is dangerous

• You avoid this movement

• Your body becomes deconditioned

• Your nervous system becomes more sensitive

• The next time you try the movement, you feel even more pain

• Your belief is 'confirmed,' and you avoid it 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 break the cycle

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.

Catastrophizing

Thinking the worst

Catastrophizing is the tendency to:

• Ruminate on the pain (thinking about it constantly)

• Magnify its importance ("it's terrible, I can't bear it")

• Feel helpless in the face of it ("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 linked to pain

• Decreased activity in regions that modulate pain

• Slower recovery after an injury or surgery

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

Strategies to reduce catastrophizing

The first step is to notice when you are catastrophizing. "I'll never be able to...", "It's horrible...", "I can't bear it..."

Is this really true? What is the evidence? Are there other ways to look at the situation?

Instead of dwelling on the pain, ask yourself: «What can I do now to improve my situation?»

Emotions and Pain

A Two-Way Interaction

Emotions and pain influence each other:

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

• Emotions influence the perception of pain (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 Reactions

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

This is what you do with your initial reaction. This is where you have control.

• First Level: «Ouch, I have back pain. 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 (adaptive approach): «Okay, pain. It's unpleasant, but I know it will pass. I'll breathe and keep going.»

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

Self-Efficacy: Believing in Your 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's important

People with good self-efficacy regarding their pain:

• Are more active despite the pain

• Use more effective management strategies

• Have a better recovery prognosis

• Often experience less pain in the long term

How to Develop Self-Efficacy

Start with realistic challenges and succeed at them. Each 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 equals danger' and 'pain equals normal sensitivity' helps reduce the fear of your own sensations.

The Perception of Injustice

When Pain Feels Unfair

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

• “It’s not fair that this is happening to me”

• “It’s the fault of the accident/my employer/the doctor”

• “Nobody understands what I’m going through”

This feeling is human and understandable. However, when it becomes overwhelming, it can:

• Maintain anger and bitterness

• Prevent you from taking action

• Prolong recovery

Towards Acceptance

Accepting doesn't mean approving of what happened or giving up your rights. It means acknowledging the reality so you can move forward. The energy spent on anger and rumination can then be redirected towards 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 don't need physical treatment

It means that:

• The brain is involved in all pain

• Your thoughts, beliefs, and emotions influence your experience

• You have ways to improve your situation

• A holistic 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 these factors play a significant role in your back pain, neck pain, or elsewhere, don't hesitate to discuss it 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