The Chronic Pain Treatment You Haven’t Tried Yet

My first migraine happened when I was 11. I was in math class when the numbers on the overhead projector started to blur and disappear. I remember thinking, That's weird. A few minutes later, I threw up. The headache lasted two days.

Since then, I’ve found a migraine medication that works wonders, and I’ve learned to keep an eye out for my triggers (chocolate, thunderstorms, stress). Now, when I see a storm in the forecast or notice that hazy, prodrome feeling, I can usually stop a migraine before it fully develops.

But in my teens and twenties, the possibility of having a migraine was always on my mind. I was always bracing for the next one, running through worst-case scenarios in my head: What if I suddenly couldn’t see while driving? What if I got sick during a job interview? My migraines came and went, but the anxiety around them was nearly constant.

At the time, I thought my anxiety was simply a consequence of living with chronic pain. What I didn’t understand was that the relationship also ran in the other direction. The mix of stress, hypervigilance, and fear surrounding my migraines was likely making them more painful.

Now I tell everyone dealing with chronic pain that mood and pain are intrinsically linked. And therapy for chronic pain can be one of the most surprising and powerful ways to get relief.

What is chronic pain and who does it impact most?

Pain is the body’s alarm system, a signal that something needs attention. Sometimes the message is straightforward: rest the ankle, see a doctor, take an Advil. But when that signal doesn't turn off, pain stops functioning as a warning and becomes a condition in its own right. Chronic pain is officially defined as pain that lasts longer than three months.

While chronic pain can happen to anyone at any age, it is far more prevalent in older adults. According to the CDC’s 2023 National Health Interview Survey:

• Nearly 1 in 4 U.S. adults lives with chronic pain.
• 36% of adults aged 65 and older experienced chronic pain — compared to just 12.3% of adults aged 18–29.
• An additional 13.5% of older adults experienced high-impact chronic pain.

For some people, the pain is constant. For others, it comes and goes, making it difficult to predict how you’ll feel from day to day. Chronic pain can take many forms, including back pain, joint pain, migraines, nerve pain, neck pain, and digestive pain.

What chronic pain does to your brain

Research has revealed that chronic pain and mood are connected on a biological level. Pain can have a serious impact on your mood, while anxiety and depression can heighten the brain’s sensitivity to pain. The two conditions reinforce each other through overlapping neural pathways and shared neurochemistry. This connection has major implications for how chronic pain is understood and treated.

In people without chronic pain, a balance is maintained between signals that excite the nervous system and signals that calm it down. That balance appears to be disrupted in people with chronic pain, anxiety, or depression. Excitatory signals — driven largely by a neurotransmitter called glutamate — become more active, while calming signals associated with another neurotransmitter, GABA, become less effective. As a result, the nervous system becomes more reactive overall, which can heighten both physical pain and emotional distress.

The brain’s natural pain-relief system is also closely tied to mood. The body produces its own opioid-like chemicals that help regulate pain, stress, and emotional well-being. Research suggests that in people with chronic pain, this system may not function as effectively, making it harder for the brain to dial down pain signals or maintain emotional balance.

The result is that chronic pain and low mood are not separate problems that simply happen to occur together. They influence many of the same biological pathways and can reinforce each other over time.

None of these findings are a comment on a person's resilience or attitude. Instead, they reflect the fact that chronic pain changes the brain's chemistry in ways that directly affect how a person feels.

What mental health therapy can do for physical pain

The vicious cycle between pain and mood can be frustrating, but it also introduces new possibilities for managing chronic pain. Because mood and pain are so intertwined, interventions that support mood can measurably reduce how much pain you experience. This is not about thinking your way out of pain, or convincing yourself it's not that bad. It's about understanding that mood is a physiological input into how your nervous system processes pain signals, and that that input can be changed.

Therapy can be an important piece of the puzzle when it comes to managing pain.

CBT for chronic pain

A 2025 systematic review and meta-analysis published in Frontiers in Psychology evaluated 14 high-quality randomized controlled trials involving 2,677 patients with chronic musculoskeletal pain. They found that cognitive behavioral therapy (CBT) significantly reduced pain intensity, functional disability, and pain catastrophizing (the pattern of rumination that often amplifies pain perception).

ACT for chronic pain

A 2024 overview of systematic reviews published in The Journal of Pain synthesized nine high-quality reviews — encompassing 84 meta-analyses of randomized clinical trials — examining the efficacy of Acceptance and Commitment Therapy (ACT) for adults with chronic pain. Researchers found that ACT consistently reduced depression and anxiety symptoms, pain catastrophizing, and psychological inflexibility, while improving pain acceptance, mindfulness, and pain-related functioning — with benefits that persisted at six- to twelve-month follow-up.

Neither CBT nor ACT require going to (or paying for) a specialized pain clinic. These are two commonly practiced forms of talk therapy. They can be done online or in an office with a licensed clinical counselor. These methods work in large part because they help individuals reframe negative thoughts about pain, reducing its emotional psychological impact, which can soften the intensity of pain.

Medicare for chronic pain therapy

If you use Medicare, your plan covers many outpatient mental health services, including CBT and ACT therapy. Ask your primary care doctor for a referral to a trusted therapist, or find a great therapist using Alma’s provider directory.

The pain can get better

Chronic pain is, by definition, persistent. It demands your attention. It asks a person to constantly recalibrate expectations, activities, relationships, and identity. That kind of sustained adjustment is exhausting in ways that go beyond the pain itself.

The science shows that mood and pain are not separate problems requiring separate solutions. They share biology and they influence each other in both directions. For anyone managing chronic pain who has struggled to improve with medication or physical treatment alone, this is an exciting opportunity. Mood is another major lever available for changing how pain is experienced. If you haven’t yet tried therapy to manage chronic pain, now may be time to start.