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3 Ways to Overcome Negative Thoughts Associated With Pain

Slowing the downward spiral of pain catastrophizing.

For those who suffer from chronic pain, dealing with daily discomfort can be frustrating and exhausting. Beyond the physical discomfort, people also must cope with the complicated and equally exhausting psychological and emotional side of living with chronic pain. It's not easy.

Source: DepositPhotos
Source: DepositPhotos

Many who live with chronic pain also struggle with the overwhelm caused by negative thoughts, also known as pain catastrophizing, a concept that comes packaged with a heated debate by many pain experts and people living with pain.

Why? Just the sound of the words “pain catastrophizing” is scary and may be perceived as judgmental by those living with pain, for good reason. I prefer the term negative thoughts or just negative thinking because we all have negative thoughts. It is part of being human, whether you have pain or not.

Catastrophizing is a concept developed in 1962 by physician Albert Ellis; pain catastrophizing was later refined by psychologist Michael Sullivan. It is a type of thinking in which people have persistent negative thoughts and emotional responses to persistent pain that interfere with daily function.

The 3 "I"s of Negative Thinking Related to Pain

Negative thoughts related to pain develop from what I call the 3 "I"s of pain. These include thoughts that the pain may be:

  1. Infinite
  2. Insurmountable
  3. Incurable

This helps us notice that the experience of pain is much more complicated and layered than just the physical perception of pain. Negative thinking (pain catastrophizing), in addition to being associated with a physical disability, also impacts self-efficacy and the ability to function in social situations.

How to Recognize Pain Catastrophizing

While negative thoughts related to pain are unique to the person living with pain here are a few common signs that negative thinking may be impacting the quality of life:

  • Magnification: magnifying the power of your pain and its possibility to get worse.
  • Rumination: constant thinking about your pain, potentially to the point of distraction.
  • Helplessness: a loss of hope of curing or overcoming your pain.

Here are some negative thoughts associated with persistent pain:

  • I worry all the time about whether the pain will end.
  • I keep thinking of other painful events.
  • I can’t seem to keep it out of my mind.
  • I keep thinking about how much it hurts.
  • I wonder whether something serious may happen.

When people with pain struggle and are unable to find a qualified and compassionate practitioner who understands pain, it is normal for these thoughts to develop.

However, negative self-talk can have a profound impact on our physical and psychological health. It can affect you in some pretty damaging ways. Negative self-talk is linked to higher levels of stress and lower levels of self-esteem. This can lead to decreased motivation as well as greater feelings of helplessness. This is one of the reasons why the rates of depression, anxiety, and suicide are so high in those with persistent pain.

However, there is hope—as people begin to notice and acknowledge the way that pain manifests emotionally and psychologically they can begin to break free from the chains of negative thoughts.

3 Ways to Ease Negative Thoughts Related to Pain

#1 Cognitive Defusion

Acceptance and Commitment Therapy (ACT) is a type of therapy that focuses on willingly accepting some pain without judgment. However, the end goal of ACT is not simply to accept your situation —part of ACT is identifying values that align with your desires and goals for your life and committing to pursuing them. With regard to pain, ACT operates from the belief that in dealing with pain, the pain itself is not the source of suffering; instead, it is the psychosocial struggle of dealing with the pain that is the challenge.

A central process in ACT is called cognitive defusion.

Cognitive defusion allows you to see thoughts as what they are, not as what they say they are. This means thoughts about pain does not have to take the wheel and control your life.

One of the simplest cognitive defusion techniques is simply to say “I’m having the thought that ______” when you notice negative thoughts arise about pain.

Some examples might include:

  • “I’m having the thought that I can’t go to therapy today.”
  • “I’m having the thought that my spine is damaged and weak.”

By placing “I’m having the thought that” in front of your thinking, it helps you create some space between the thoughts you have and the actions they sometimes dictate.

#2 Positive Self-Talk

There are lots of ways of slowing the waterfall of thoughts before they take you over the falls. Positive self-talk can help to change the narrative about yourself that has been building.

While ACT focuses on accepting pain, cognitive behavioral therapy (CBT) operates from the notion that our emotions and behavior are formed by our beliefs, thoughts, ideas, and attitudes. CBT for pain aims to reframe mental habits in order to provide relief and has been shown to be one of the most effective methods of treating pain catastrophizing.

If positive self-talk is like stepping foot into a foreign country without a map, you may need some help to get you going. It might be difficult to know where to begin in terms of effective positive statements and phrases to develop. It’s important to know that not everyone’s positive self-talk will be the same, and you should try a few different approaches to find the ones that ultimately work for you.

Here are three positive self-talk statements regarding pain to get you started:

  • "I am gaining knowledge to change my pain."
  • "I might still have some pain, but I am proud of how far I have come."
  • "Even though the pain isn’t gone, I learned a lot about myself and am rebuilding my resilience."

#3 Moving With Your Mind

This is one of my favorite techniques. It is beneficial for many people with pain, including those with fibromyalgia, chronic lower back pain, osteoarthritis, and rheumatoid arthritis.

As you rebuild your physical strength sometimes your mind will get a bit anxious and want to keep you safe from potential harm. The way it does that is constantly broadcasting doom and gloom or the worst-case scenario.

As a simple exercise, try this:

  • First, notice a negative thought that arises with activity.
  • Next, name the negative thought.
  • Finally, do the activity anyway.

It may look like this:

  • I’m noticing I’m having a thought that walking is bad for my knees.
  • This is the “negative knee story!”

Continue waking and notice if the thoughts subside.

You may be surprised how fast thoughts subside or change. They may even completely go away or morph into other related or unrelated thoughts.

This is a simple way to address the mind-body connection. Physical therapy exercises supplement CBT nicely, including the fact that exercising without disastrous consequences improves one's self-confidence and decreases pain-related anxiety and fear. Cognitive-behavioral techniques combined with physical therapy have some of the best evidence to help you overcome pain and live life to the fullest!

Learn more at the Integrative Pain Science Institute.


Schütze, R., Rees, C., Smith, A., Slater, H., Campbell, J. M., & O’Sullivan, P. (2018). How Can We Best Reduce Pain Catastrophizing in Adults With Chronic Noncancer Pain? A Systematic Review and Meta-Analysis. The Journal of Pain, 19(3), 233–256. doi:10.1016/j.jpain.2017.09.010.

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