Effects of chronic pain on mental health
Pain and the mind: why it’s not ‘all in your head’, but your brain does play a role
- Author: Dr Reza Feizerfan
- Updated
- First published:
Psychological impact of chronic pain
Effects of chronic pain on mental health
As a Pain Specialist in Perth, I often meet people who’ve been living with pain for years. Many have seen multiple specialists, tried different medications, had scans, injections, even surgery and they still are in pain.
When I suggest there might be a psychological or emotional layer to their pain, some patients feel uncomfortable. I understand because it can be interpreted as “it’s all in your head.” But that’s not what I mean.
In this article I explain why your brain plays a big role in pain and why that doesn’t make your pain imaginary. It makes it even more real, and more important to address properly.
Understanding the pain centre in your brain
Your brain has dedicated centres for everything: vision, hearing, touch, and pain. These centres process information sent from the rest of the body. For example, if you hurt your back, the nerves send a signal to the brain, which interprets it as pain.
But the brain doesn’t just receive signals; it learns from them. The more pain signals the brain receives, the more active and sensitive the pain centre can become. In fact, brain scans like functional MRI have shown that the pain centre can physically can expand in people who experience ongoing pain.
What’s more, the pain centre sits right next to the mood centre. These areas share nerve pathways and can influence each other. This is why people with chronic pain often also struggle with low mood, anxiety, or irritability.
“When the pain centre is active, the nearby mood centre can also be affected, leading to anxiety, irritability, or depression. For example, when someone experiences a migraine, they may also feel stressed or anxious, as pain pathways interact with mood pathways.“
Real pain, real symptoms, nothing imagined
When we talk about the brain’s role in pain, we’re not saying it’s imaginary. The pain is real. The symptoms are real.
Pain is always felt in the brain. Even if there’s a clear injury, like a disc bulge or arthritis, the sensation of pain is your brain interpreting those signals. In some cases, people continue to feel pain long after the original injury has healed. That’s because the nervous system has become oversensitive, like a car alarm going off at the slightest breeze.
This is called central sensitisation. It’s what happens when the volume dial for pain is turned up in the nervous system. And it can happen without major damage being visible on scans.
Chronic pain and mental health
Why mental health matters in pain
Living with chronic pain is exhausting. It disrupts sleep, affects relationships and reduces activity. So it’s no surprise that many people living with pain also struggle emotionally.
Research backs this up:
- Around 35-45% of people with chronic pain experience depression, compared to just 5% in the general population.
- In Australia, one in five adults with severe or very severe pain suffer from depression or mood disorders.
- People with severe pain experience psychological distress at three times the rate of those with mild pain, and six times that of people without pain.
- The relationship is bidirectional: chronic pain increases the risk of depression, and depression increases the risk of developing chronic pain.
This tells us something vital: treating chronic pain effectively means also looking after your mental health. Not because your pain isn’t real but because your body and mind are deeply connected.
People living with chronic pain are at heightened risk for mental health problems, including depression, anxiety, and substance use disorders. Chronic pain can affect sleep, increase stress levels and contribute to depression. An estimated 35% to 45% of people with chronic pain experience depression.
Depression typically affects 5% of the general population, but among patients with chronic pain, 30%-45% experience depression. Studies have shown that the relationship between depression and pain is bidirectional: depression is a positive predictor of the development of chronic pain, and chronic pain increases the risk of developing depression.
Almost a third of Australian adults with severe or very severe pain experience high levels of psychological distress; around three times the rate of those with mild pain and six times the rate of those with no pain.
- One in five Australian adults with severe or very severe pain suffer depression or other mood disorders.
- Suicidal behaviour is also two to three times higher in people with chronic pain than the general population.
If you or someone you know is struggling with thoughts of self-harm, please seek help immediately by calling Lifeline on 13 11 14.
Why we sometimes suggest psychological support
When I recommend seeing a clinical psychologist, I’m not saying you’re weak, broken or imagining your symptoms. I’m saying we need to retrain how your nervous system responds to pain.
One of the psychologists we work with is Dr Amy Mickelberg, who has a strong focus on helping people living with persistent pain.
I often explain it this way:
Imagine your nervous system as an alarm system. In chronic pain, that system starts to misfire, setting off the alarm even when there’s no real danger. A clinical psychologist trained in pain management helps you recalibrate that system.
“Clinical psychologists who work in pain management can help retrain the brain and nervous system; supporting you to reset the system that interprets danger signals, so your body can respond more calmly.”
Dr Amy Mickelberg
These professionals may provide tools, exercises, and strategies that can help calm your nervous system and support you to move more comfortably.
Changing beliefs and language
Another part of pain management is unlearning unhelpful beliefs. Some of my patients tell me things like:
- “My spine is crumbling.”
- “My disc is going to pop out.”
- “My bones are not aligned.”
These are common phrases patients sometimes hear, but they are not accurate medical descriptions. Hearing them can understandably make people more cautious about movement. However, avoiding movement can actually make things worse, leading to stiffness, muscle loss, and more pain.
That’s why education is such an important part of what we do. We help you understand what’s safe, what’s helpful, and what can actually make things better.
Pain management for chronic pain
Ready to explore your options?
Most people don’t want to hear that their brain is involved in their pain. They want a clear diagnosis and a quick fix. And I understand that.
But chronic pain isn’t simple and it’s rarely one thing. Often, the biggest improvements come when we look at all the factors: physical, psychological, emotional, and social.
So if you’re ready to explore what’s really going on in your pain, and open to treating both the body and the mind, we’re here to guide you.