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Pain is considered chronic after about six months (the amount of time differs in some places). By that time, the individual who is suffering has had to put up with various unhelpful treatments such as pain medicines that leave them sleeping too much and increasingly losing effectiveness. They may be told, “I can’t help you anymore,” or “If you’re not getting better, it’s all in your head.” Family and friends may also become increasingly frustrated, asking, “Why aren’t you getting better?” They may also begin to suspect that “Maybe it is all in your head.”

None of this makes the person suffering from chronic pain feel any better. While it’s not all in your head, what is going on in your head can have a huge influence on how you feel. Chronic pain patients typically have unrealistic thoughts about their pain, often catastrophizing (“If I try to work/exercise/clean/etc. again, then I’ll reinjure myself and the pain will be even worse.”) People with chronic pain also tend to have negative, unrealistic thoughts about their world and their future.

So many people with chronic pain have told me that, before their injury, they were “typical Type A’s—always going 110%, not resting, not taking breaks.” After their injury, they are unable to continue on that way, and then feel depressed about many things—losing their job, respect of others, self-respect, and even part of their self-identity. So many of us derive our sense of self and self-worth from our work, that losing the capability to work is devastating for us.

People with chronic pain have medical and psychosocial issues. Some of it is “in their heads,” because the thalamus, which processes feelings of pain in the body, is “in the head.” So are negative, unrealistic thoughts which so often accompany chronic pain. Hundreds of studies also point out that the experience of stress (which is what the individual perceives it to be) directly affect our bodies—our immune systems, our pain levels, our daily activities.

There are many behavioural methods to cope with pain. The former “Type A” individuals must learn to pace themselves. They must learn to take their pain medication as prescribed, not just when they experience more pain. They must also consider all types of alternative or complementary treatments to get better. Part of this is psychotherapy, with cognitive-behavioural therapy being the most successful, as shown in many research studies.

Unfortunately, many people with chronic pain resist psychotherapy—thinking that their physician has decided, “It’s all in my head,” when psychotherapy can help with the many negative, unrealistic thoughts that they experience. Psychotherapy includes pain activity monitoring, activity monitoring, pacing, assertiveness training, and realistic thoughts can all do much to help lower pain levels in individuals with chronic pain.