Living with chronic pain can feel overwhelming. It affects not just your body, but your emotions, thoughts, sleep and daily life. While medications and physical therapy are often part of treatment, psychologists can play a powerful role in helping people manage pain in ways that go beyond medications.
Ravi Prasad is a pain psychologist in UC Davis Health’s Pain Medicine clinic. Below are five strategies Prasad uses to help people better understand their pain and improve their quality of life.
1. Break the pain-stress cycle
Pain doesn’t just hurt — it also stresses the body. And stress can make pain worse. When the brain senses stress, it activates the “fight or flight” response. This response causes muscle tension, increased inflammation and other changes that can amplify pain. That’s why psychologists teach patients how to calm their nervous system using simple tools like:
These techniques help reduce stress and lower the body’s pain response.
2. Incorporate skills to cope with pain throughout the day
Many people wait until pain becomes unbearable before trying to manage it. But it’s better to use coping skills throughout the day — not just when things get bad. By regularly practicing breathing techniques or mindfulness, patients can prevent pain from building up. These small, daily habits help keep the nervous system from staying in a constant state of stress (“fight or flight”). Over time, this can lead to better pain control and improved quality of life.
3. Change unhelpful thought patterns about pain
How you think about pain matters. For example, someone might believe, “This pain will never go away.” This can lead to hopelessness and depression. Psychologists use a method called cognitive behavioral therapy (CBT) to help patients identify and change these kinds of thoughts. The goal isn’t just to “think positive.” Instead, the goal is to find thoughts that are both accurate and helpful. For example, a better thought might be, “My pain may not go away, but I’m learning skills to live well despite it.” These small shifts in thinking can lead to big improvements in mood and behavior. Imaging studies have even shown that CBT produces changes in structure and activity in the brain. Here are some guidelines for how to explore CBT:
CBT skills for managing chronic pain
- Awareness. Learn to recognize the thoughts that arise in response to pain or stress. This can be difficult because many people confuse thoughts with emotions or aren’t aware of the mental “scripts” they follow.
- Evaluation. Examined your thoughts. Don’t label them as “positive” or “negative.” Instead, ask if they are:
- Accurate (based on reality)
- Helpful (leading to better emotional and behavioral outcomes)
- Modification. Gently reshape unhelpful thoughts. For example:
- Original thought: “My pain will never go away.”
- Modified thought: “My pain may not go away, but I’m learning skills to improve my quality of life.”
This subtle shift helps reduce emotional suffering and encourages proactive coping.
Repetition and practice. Changing thought patterns — modifying unhelpful thoughts — takes time. It may take dozens, or even hundreds, of repetitions before new thoughts begin to replace unhelpful old ones. CBT is a powerful tool, but it is not a quick fix; for it to work, it relies on you retraining your brain
4. Understand your pain story
Every person’s experience with pain is unique. That’s why a pain psychologist might spend time learning about each patient’s background, including early-life experiences, emotional health and coping strategies. For example, researchers have found an association between chronic pain and adverse childhood experiences (known as ACEs). This is why exploring childhood experiences may shed light on a person’s current experiences with pain.
People can also experience pain from losses, such as the loss of a loved one or the loss of a job. Loss can also come from the pain itself. For example, not being able to engage in certain meaningful activities due to the pain is a loss in and of itself. However, the grief associated with this loss can turn around and worsen the pain. That’s why psychologists consider it important to explore your own pain story so you can develop adaptive ways of coping to avoid spiraling into a negative, vicious cycle
5. Seek out support and resources to help with pain management
Managing chronic pain isn’t a quick fix. It takes time, effort and support.
Patients referred by their doctor to the Pain Management Center can take a CBT-based pain management class. After completing the class, they can also participate in free monthly follow-up groups for ongoing support.
There are also online resources and apps that can help anyone with chronic pain.
- Pain Coach, a free app from the Department of Veterans Affairs for anyone with chronic pain.
- Free Guided Meditations in multiple languages from UCLA.
- Videos and other helpful information about pain management from UC Davis Health
- Support groups from the American Chronic Pain Association.
- Resources, self-management and support groups from the S. Pain Foundation.
