The short version: Chronic pain can keep going after an injury has healed, because the nervous system itself becomes more sensitive to pain signals. That is a physical change, not imagination. Mind-body approaches work on that sensitivity. The evidence is real but modest: they can lower pain intensity and improve what you are able to do, and they do not usually remove pain. They work best alongside medical care, not instead of it.
A client once told me she had stopped mentioning her pain to doctors. Not because it had improved, but because the conversation always ended the same way: the scans looked fine, so there was nothing more to do.
She had been handed a false choice. Either the pain was in her tissues, or it was in her head. What she had never been told is that there’s a third possibility, and it’s the one the research actually supports.
Why pain keeps going after the injury heals
Acute pain is useful. You touch a hot pan, your hand moves before you’ve decided anything, and the soreness afterward keeps you from using that hand while it repairs. It resolves because the problem resolves.
Chronic pain is different. It carries on past the point where tissue has healed, and sometimes it shows up with no injury anyone can find. That’s why treatments aimed only at tissue damage so often fail. By then, the pain isn’t a report about your tissues. It has become a condition of its own.
What changes is the nervous system. When pain signals repeat over a long period, the system that carries them gets better at carrying them. Researchers call this central sensitization: the spinal cord and brain amplify pain signals, so it takes less to produce pain, and things that shouldn’t hurt start to. A 2024 review of neuroplasticity in chronic pain describes the nervous system’s capacity to change its own structure and function as playing “a significant role in the transmission and modulation of pain.”
Here’s the part worth sitting with. Sensitization is a physical change in a physical system. It’s not sensitivity in the sense of being delicate, and it’s not a sign you’re exaggerating. Your pain system is doing its job too well, and it learned to from doing it too long.
What that changes about treatment
If the problem is partly in how the signal is processed, then treatment can work on the processing. That’s the whole idea behind mind-body approaches, and it’s a narrower idea than the name suggests.
It doesn’t mean your pain is psychological. It doesn’t mean stress caused it. It means that the things that turn the volume up on a pain signal, including fear of movement, poor sleep, and constant alertness, are things you can get some leverage on. Not all of them, and not completely.
Two honest limits before the list. First, these approaches rarely remove pain, and anyone who tells you otherwise is selling something. The realistic aim is lower intensity and more capacity: more of your day available to you. Second, most of the research is on groups, and you’re not a group. What helped the average person in a trial may not be what helps you.
The approaches with the best support
Mindfulness-based approaches. Paying deliberate attention to the present, including to pain, without fighting it. That sounds counterintuitive, and the mechanism is reasonable: resisting a sensation and predicting its return both amplify it. For chronic low back pain specifically, the American College of Physicians puts mindfulness-based stress reduction among the treatments to try first, on moderate-quality evidence.
Cognitive behavioral therapy. CBT works on the thoughts and habits built up around pain, particularly the ones that drive the fear-tension-pain cycle. The same ACP guideline includes it in that first-line group for chronic low back pain. Worth knowing how that recommendation is built: the guideline’s advice to start with non-drug treatment is a strong one, while the evidence specifically behind CBT is graded low-quality. Strong advice, thinner evidence, and those are two different things.
Somatic therapy. Psychotherapy that works through the body rather than only through talking: building awareness of sensation, calming a sensitized nervous system, releasing patterns of bracing. This one is a whole subject of its own, and I’ve written it up properly in what to expect from somatic therapy for chronic pain, including what a first session looks like.
Movement-based practices. Yoga, tai chi and qigong pair gentle movement with attention. The clearest statement I can point to is narrower than it is usually reported: for fibromyalgia, NCCIH’s review of the literature finds “encouraging evidence that practices such as tai chi, qi gong, yoga, acupuncture, mindfulness, and biofeedback may help relieve some fibromyalgia symptoms.” That’s one condition, not pain in general, and “encouraging” is doing real work in the sentence. The ACP guideline above does cover tai chi and yoga for chronic low back pain, on low-quality evidence.
There is also active research on approaches that target the brain’s role in pain directly. Pain reprocessing therapy aims to help people reinterpret pain signals as less threatening. I’m describing what it sets out to do, not telling you it will work for you, and I’m not trained in it.
Where stress and trauma fit, carefully
Stress doesn’t cause chronic pain. But a nervous system already running hot has less room, and the overlap between post-traumatic stress and persistent pain is well enough established that researchers treat it as a starting point: a trial of a body-oriented trauma therapy for chronic low back pain with comorbid PTSD opens by noting that comorbid PTSD in chronic pain is associated with a more severe symptom profile “with respect to pain, disability and psychological distress.” That trial found the trauma therapy reduced PTSD symptoms and fear of movement, while pain and disability improved in both its groups, and its own authors say the overall effect was smaller than they expected.
What that means in practice is narrow and useful. If your body has spent years braced for danger, asking it to relax isn’t a matter of willpower. It’s a skill, and it’s learnable, and it usually needs another person in the room.
The part most pain content leaves out
Most of what helps here takes time, money, and the ability to keep appointments. Mindfulness takes practice you have to have the energy for. Movement classes cost money and assume a body that can get there. Therapy costs money, and I know that alone shuts some people out.
I mention it because the “mind-body” framing can slide into something uglier, where managing your own pain becomes one more thing you are failing at. If your pain is worse because you work on your feet and can’t afford to stop, that’s not a mindset problem. Naming that accurately isn’t a consolation prize. It’s the difference between a plan and a verdict.
And pacing isn’t a character flaw. Doing less on a bad day is a strategy, not a surrender.
How I work with this
I’m a licensed psychotherapist in Portland. With chronic pain I work somatically and existentially, which in practice means two things: attention to what your body is doing while we talk, and room for the harder questions pain raises about a life you did not plan for. For some clients that includes ketamine-assisted psychotherapy, which is a specific thing with its own risks and its own screening, not a next step for everyone.
I’m not a replacement for your medical team, and I’ll ask you to keep them in the loop.
If you want to talk about whether this fits your situation, get in touch and we can start with a 15-minute call.
Frequently Asked Questions
Does “mind-body” mean my pain is psychological?
No. It means pain is produced by a nervous system that can change how it processes signals, and that some of what amplifies a pain signal is reachable. Your pain is real and physical. Central sensitization is a physical change, not a belief.
Will this get rid of my pain?
Usually not. The realistic aim is lower intensity and more capacity for the things you want to do. Research reports improvements in pain and functioning, not elimination. Anyone promising you pain-free should worry you.
Which approach should I start with?
It depends on what’s driving your pain and what you can actually sustain. If fear of movement is central, movement-based or somatic work tends to matter most. If the loop is catastrophic thinking and sleep, CBT has the strongest guideline support. That’s a conversation, not a quiz.
Can I do this alongside my medications and physical therapy?
Yes, and that’s how it works best. These approaches complement medical care rather than replacing it. Tell each of your providers what else you’re doing.
How long does it take?
Longer than anyone wants. Skills that work on a sensitized nervous system are practiced, not installed, and progress is usually uneven rather than steady.
Peter H. Addy, PhD, LPC, LMHC is a Portland-based licensed psychotherapist specializing in psychedelic-informed and harm-reduction psychotherapy, ketamine-assisted psychotherapy, and chronic pain. His research background includes postdoctoral work at Yale School of Medicine on psychedelic substances. Learn more about my practice →
