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The Mental Aspects of Chronic Pain

As a fitness or wellness professional, you understand better than anyone that the cells in our bodies adapt to the stresses that are placed on them. This is why you are able to help people experience the wonderful benefits of building muscle, reducing body fat and improving overall fitness and wellness as part of a healthy lifestyle.

However, the mind and body also adapt and acclimatize to negative stresses, such as long-term faulty movement patterns, musculoskeletal imbalances, neuromuscular damage/disorders, illnesses, injuries and unfavorable environmental conditions. We tend to fall into bad habits as the body adapts to, and becomes familiar with, the experience of these chronic conditions and the persistent pain that accompanies them (Duhigg 2012). In this article you will learn more about how the mind adapts to the experience of chronic pain; how the mental adaptations negatively affect the body; and what you can do within your role as a fitness or wellness professional to help undo bad mental habits and break the cycle of chronic pain.

The Mental Bad Habits of Pain

More than 45% of Americans experience pain on a regular basis, so it is inevitable that you will have clients who
suffer from chronic pain (Thernstrom 2010). While it is not within your scope of practice to diagnose their conditions, it is important for you to understand the mental and physical effects of chronic pain and how you can work within your scope to help clients overcome persistent pain issues that may otherwise prevent them from reaching their health and fitness goals.

Humans create habits by engaging in behaviors (both positive and negative) on a regular basis. They further develop these habits by performing a set routine in response to a prompt or cue. For example, the habit of warming up before a workout is in response to the cue that you are about to exercise. Habits become ingrained when the action you perform (i.e., warming up appropriately) provides you with some type of perceived reward (i.e., the feeling that you are more prepared for your workout) (Duhigg 2012).

Most of our habits are unconscious and very effective in helping us achieve many tasks throughout the day (Duhigg 2012). For example, most people follow similar morning routines of waking up at the same time, getting ready for work, eating breakfast, brushing their teeth and so on, without even thinking
about it. This is because they have done these activities so many times that the process is now automatic. Routines also work well to form new positive habits, like spending quality time with loved ones, eating healthily, engaging in fun/ stress-relieving activities and exercising regularly.

However, people faced with the day-in, day-out experience of chronic pain often create negative or destructive “coping” habits that can actually make their conditions worse (Thernstrom 2010). It is not unusual for chronic pain to spike at certain times of the day. This intensification of pain often cues sufferers to engage in habits or behaviors that, although dysfunctional, provide a form of short-term reward. For example, emotions such as anger and depression, thoughts of suicide and/ or comparisons to how things used to be in pain-free days distract the brain (as it processes those thoughts and emotions), temporarily overriding the sensations of pain (Thernstrom 2010). These routine habits provide fleeting relief, but unfortunately they also serve to prolong chronic pain conditions by changing brain chemistry and altering the mind and body’s response to pain (Thernstrom 2010).

How These Mental Habits Affect the Body

Mental habits (i.e., routine emotional responses) that briefly distract the mind from chronic pain can cause many physical changes to take place in the body. Because the body perceives persistent pain as a threat,
the flight or fight response is triggered, and the instinct is to adapt protective postures and positions (Hanna 1988). Imagine an animal in pain; it curls up to shield its body and internal organs from further harm.

Human beings display the same defensive mechanisms by rounding the spine and shoulders and bringing the arms across the body in protection. Humans also stick their head forward and clench their teeth to ward off potential stressful interactions with others. The lower body responds by anteriorly tilting the pelvis and bringing the knees together to protect the genitalia (Hanna 1988). All of these changes to the skeletal system, if repeated time and time again, can exacerbate chronic pain by causing joint inflammation, disease and degeneration.

Chronic pain adversely affects soft-tissue structures as well. Habitual stress responses in the brain affect the myofascial system by restricting blood supply. This causes tissues to become rigid, leading to more tension and pain (Myers 2008). Moreover, changes to the myofascial and musculoskeletal system create problematic movement compensations throughout the body that can cause other structures and soft tissues to overwork (Price & Bratcher 2010). In response to this added work, these areas become irritated and stressed, causing even more pain.

Change Your Mind to Change Your Experience of Pain

Unfortunately, the negative mental habits that chronic-pain sufferers develop are almost impossible to eliminate. This is because the brain and nervous system adapt quickly to the demands placed on them and actually grow new neural pathways to facilitate the survival of these habits (Thernstrom 2010). On the bright side, however, it is possible to create more positive habits that can override these older, unhealthy habits (Duhigg 2012). For example, if a client has a long-standing bad habit of eating a big bowl of ice cream after dinner, she can create a new habit to override her desire for ice cream by repeatedly performing a new, more desirable behavior, such as indulging in a piece of fruit or low-calorie snack instead. This new habit will eventually supersede the old habit, and she will form a healthier behavior.

Your clients’ success in creating new mental habits lies in their ability to prioritize what they want, focus on the new habits they want to acquire, and consistently apply these new skills. Most importantly, they must believe that their efforts will eventually be rewarded (Duhigg 2012).

Long-Term Strategies for Alleviating Chronic Pain

Creating new habits to relieve chronic pain requires a long-term commitment to change. The following mental and physical techniques can help clients break the cycle of pain.


Chronic pain is usually a signal that the body (along with the mind) has been taxed beyond normal limits. This can be a result of chronic stress, chronic fatigue, disease, or chronic muscle and joint pain, among other things.

Whatever the cause, the system needs rest and recovery. Daily breathing techniques and meditation can help the mind and body relax by generating physiological changes that promote cell regrowth and repair (Thernstrom 2010).

You can coach clients in chronic pain to develop habits they can perform to promote relaxation before going to sleep. Strategies like consuming destressing herbal teas, turning off the television at least an hour before bed and taking a warm bath can all foster relaxation, rest and a proper night’s sleep.

Appropriate nutrition will also contribute to rest and recovery. Encourage clients to seek out the help of a licensed
nutritionist or registered dietitian who can help them make suitable food choices for their condition.

Massage and bodywork are other great strategies to relieve muscle tension and foster relaxation in the short-term; they will also provide long-term benefits when integrated into regular workouts as part of a gentle self-myofascial-release program (Price 2013; Rolf 1989).


People have lots of goals when it comes to health and fitness. The constant bombardment of messages from the media has many people striving to look younger, live longer, get fitter/stronger and perform better. Trying to achieve these goals requires constant vigilance and hard work. If sufferers of chronic pain prioritize these aesthetic objectives over eliminating their pain, they will never realize their goal of living pain-free. It is important to coach clients in chronic pain to focus purely on the goal at hand (i.e., feeling better) and prioritize the mental habits and behaviors that will enable them to reduce their chronic pain.


The most important thing clients in chronic pain must do to get better is to believe that the strategies they are employing will prove successful. Throughout the history of medicine, there has been abundant evidence of the power of the placebo, or more specifically, the personal belief that what you are doing or taking for your illness or injury will cure you (Rankin 2013). Hundreds of studies demonstrate that when patients believe in the power of the therapy/drugs/approach they are using, they are much more likely to get better.

Therefore, one of the best things you can do for clients in chronic pain is to support those strategies they believe are working to help their condition. The mind is a powerful tool and can be harnessed to promote healing when it is encouraged to concentrate on positive outcomes.

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