When my older brother was in his last year of college, he developed a condition where he would break out in intense, painful hives whenever he was excited or stressed, when it was hot outside, when he was exercising, or even when he stepped into a hot shower. I watched as it turned his life upside down.
He had been struggling with depression before college, but college had changed things for him. He had friends, a long-term relationship, found his place, and felt like he belonged. Finally. And then, suddenly, he was just trying to make it through the day, through the week, without experiencing intense pain. He had to abandon activities he loved. Being around people caused stress, and stress caused pain, so he began to isolate. That isolation harmed his relationships and his mental health. It was all connected, and it all suffered.
I was in middle school at the time, and I was so worried about him. Our family took him to doctor after doctor in Los Angeles, searching for answers, for a path forward, and found none. I remember a trip to South Carolina to see a specialist. So much hope was riding on that visit, so much wanting there to be a cure, or at least an explanation. But that wasn’t the case either.
Ultimately, my brother was left to learn to manage the condition. He figured out how to mostly keep his body regulated, including his temperature, his stress levels, and his environment. He wore a small fan around his neck and kept cooling towels nearby. He went to therapy to grieve the life he had before, and to find a way to accept the limitations his condition placed on him. He also discovered that steam therapy, through saunas or hot baths, could actually help by inducing sweating, which desensitized his skin over time and reduced the frequency of outbreaks. There was no cure. There was only adaptation.
That experience stayed with me. It was my first real window into what it means to live with chronic pain, not as something to be diagnosed and fixed, but as an ongoing negotiation between the body, the mind, and the life you’re trying to hold onto.
What Is Chronic Pain and Why Does It Affect Mental Health?
Chronic pain is defined as pain that persists for three months or longer. That might sound simple, but the reality for the people living it is anything but. The CDC found that about 60 million Americans, roughly one in four adults, are living with chronic pain. For 8.5% of those people, it’s severe enough to regularly interfere with work and daily life.
What makes chronic pain so hard, beyond the pain itself, is what it does to everything else. It disrupts sleep. It limits movement. It strains relationships and affects the ability to work. Social life can shrink. Over time, nearly every part of a person’s life can be affected, sometimes for years. So it shouldn’t come as a surprise that people with chronic pain experience anxiety and depression at nearly five times the rate of people without it. And studies have found that up to 40% of people with chronic pain also experience anxiety or depression. That’s not a coincidence. That’s cause and effect.
Is the Connection Between Pain and the Brain Really Real?
It is so important for people to understand that chronic pain is not a mental health problem dressed up as a physical one. The brain and body are deeply, measurably connected when it comes to pain, and the research on this is striking. Research has shown that individuals living with chronic pain lose brain tissue at a rate comparable to 10–20 years of normal aging. The longer the pain persists, the more pronounced these changes become. And here’s what’s remarkable: when surgery successfully resolves the pain, follow-up scans show those brain changes can actually reverse. This demonstrates that the brain is actively responding to pain over time.
Beyond brain structure, chronic pain leads to changes in the nervous system and how it works. It becomes increasingly sensitive, sometimes generating pain signals even without a new injury. The nervous system becomes increasingly sensitive, sometimes generating pain signals even without a new injury. This heightened sensitivity helps explain why people with chronic pain report feeling that their bodies are overreacting to things that shouldn’t hurt, or why pain appears in areas seemingly unrelated to the original issue.
Why Is Therapy Recommended for Chronic Pain?
This is a fair question. Part of the reason therapy is recommended for chronic pain comes down to how the nervous system changes over time. As we covered earlier, chronic pain can rewire the brain and make the nervous system hypersensitive, sometimes sending pain signals with no identifiable source. Certain therapies, especially those developed specifically for chronic pain, are among the few treatments that directly address these changes.
Just as important is the role of mindset. Research shows that how someone thinks about their pain can have a huge impact on how much it disrupts daily life. People who feel hopeless, expect the worst, or get caught in cycles of worry about their pain tend to experience more disability and interference, regardless of how severe the pain actually is. In other words, it’s less about the severity of the pain itself and more about how a person relates to it.
Conversely, people who find success in developing some sense of control or agency over their pain have been shown to experience a better quality of life and fewer disruptions around their chronic pain. Studies tracking patients over time have found that those who learned to manage their pain with less catastrophizing and more confidence saw the biggest improvements in quality of life, even if their pain level didn’t change much.
What Types of Therapy Actually Help With Chronic Pain?
There are several therapeutic approaches backed by compelling research, and they work differently enough that the right fit will depend on the person and their individual needs.
Cognitive Behavioral Therapy (CBT) focuses on how someone thinks about and responds to pain, particularly the fear that movement or activity will make things worse. Of all the psychological treatments for chronic pain, it has the most research support.
Acceptance and Commitment Therapy (ACT) works differently. Rather than trying to change pain-related thoughts, it focuses on reducing how much those thoughts control what a person does. It produces results similar to CBT, and people tend to prefer it.
Mindfulness-Based Stress Reduction (MBSR) is an 8-week program built around mindfulness practice. It’s been shown to reduce pain, depression, and daily disruption at levels comparable to CBT.
EMDR, while better known as a trauma treatment, is increasingly being used for chronic pain, especially when the pain is tied to an injury or a traumatic experience. Research has found meaningful reductions in pain, depression, and sleep problems that held even after treatment ended.
And across the board, research shows that combining therapy with medical treatment leads to greater improvements than medical treatment alone. Therapy isn’t a replacement for medical treatment, but there is strong evidence that it works best when used alongside it.
What Gets in the Way of Therapy for Chronic Pain (And How to Overcome It)?
Even with all of this evidence, people with chronic pain are less likely to use mental health services than people without it. The biggest barrier is doubt, both from people living with chronic pain and from those around them. Many people are referred to therapy and end up feeling like their pain is being dismissed or treated as “all in their head.” That reaction is understandable, but it can keep people from seeking help/support. Research shows that one of the main reasons people hesitate to try therapy for pain is because they don’t see what a therapist could offer for something that feels so physical.
Another big challenge is not being believed by doctors, employers, or even friends and family. People with chronic pain spend years having their symptoms minimized or questioned. Research has found that being dismissed in this way is linked to higher rates of depression, more disability, and greater isolation. When people start internalizing that doubt and questioning themselves, it tends to chip away at their sense of control, making it even harder to be vulnerable and start the process.
And then there’s the issue of access. Even though people with chronic pain have much higher rates of anxiety and depression, they’re about 40% less likely to actually use mental health services compared to people without chronic pain. There are many reasons for this: limited availability, trouble finding the right therapist, insurance barriers, etc.
Studies identify that what tends to help is finding a therapist who takes both the physical and emotional dimensions of pain seriously, someone who understands the nervous system piece and isn’t going to treat this as a purely psychological problem. Learning even a little about how pain works in the body can also shift things, because it reframes the experience in a way that tends to feel empowering rather than dismissive. And for many people, flexible options like telehealth make consistent support possible in a way that in-person care simply isn’t.
My brother didn’t have a name for what he was going through for a long time. He didn’t have a therapist who specialized in chronic pain. He figured a lot of it out the hard way. But therapy was still part of what helped him find his way back to a life he actually wanted to be living. That’s what this work can do. Not erase the pain, but make room for everything else.
If anything in this article resonated with you, you don’t have to keep figuring it out on your own. At Take Root Therapy, we have therapists who have worked closely with people living with chronic pain, not to make the pain disappear, but to help shift the relationship with it. That shift is real, and it’s something we’ve seen change lives.
Chronic pain asks a lot of you. Finding support shouldn’t have to be another thing that’s hard. If you’re ready to take that step, we’d love to talk.