Week 1: Understanding chronic pain

Week 4: Healthy thinking, healthy self

Week 5: Balancing your activity patterns

Week 6: Maintaining your gains and staying well

The vicious cycle of chronic pain

As mentioned above, the thoughts, emotions and behaviours associated with chronic pain can form a negative feedback loop that keeps people stuck. Chronic pain impacts various aspects of daily life and functioning. In this section, we introduce you to the vicious cycle of chronic pain. The vicious cycle of chronic pain provides a helpful way of understanding the factors that maintain and worsen chronic pain over time. This cycle represents a typical progression of chronic pain, but may not resonate with you completely. If this is the case, have a go at drawing your own chronic pain cycle to better reflect your personal experience.

The image depicts the vicious cycle of chronic pain. Let’s break it down by looking at each part of the cycle: 

Chronic pain. The cycle begins when ‘acute pain’ turns into ‘chronic pain’. To refresh your memory, pain is considered to be chronic when it persists for longer than 3 months and continues after an injury has healed.

Inactivity and deconditioning. Chronic pain often leads to decreased physical activity and physical deconditioning. In other words, people become less active and lose muscle strength, flexibility and physical fitness as a result. The process of deconditioning involves a decline in physical functioning, which can affect almost all systems of the body. For example, some people may experience constipation, impaired balance and coordination, and osteoporosis. 

Negative thoughts and feelings. When faced with chronic pain and unable to perform their usual activities, people often experience negative thoughts and feelings. Negative thoughts may include things like “I’m fed up with this pain” and “I can’t even do simple things now”. Common emotions include frustration, depression and hopelessness. Some people are irritable and feel angry with themselves, others or the pain itself.   

Self-isolation and withdrawal. Negative thoughts and feelings impact motivation and further reduce people’s activity levels. People with chronic pain tend to withdraw from family, friends and social outings. Increased irritability and depressed mood due to pain may interfere with relationships and make people more likely to self-isolate. Similarly, self-defeating thoughts like “I won’t enjoy myself” or “I won’t keep up with my friends” can also lead to withdrawal.  

Distress and disability. The end result of this cycle is increased distress and disability. At this stage, a series of other symptoms can emerge, including fatigue, anxiety and other physical symptoms that can’t be explained by a medical condition. The person’s ability to function as they used to reduces further. This means they may increasingly struggle to perform personal, social, occupational, and other important tasks of daily living. 

As a result of this cycle, people’s pain is maintained and worsened. The cycle may continue, unless it is interrupted by a change or intervention. Importantly, the cycle can be reversed with effective interventions. Each aspect of the vicious cycle of chronic pain can become a target for treatment. For example, the pain itself may be managed by medication, activity and deconditioning may be addressed by gradually reengaging with exercise, thoughts and emotions may be changed with psychological strategies and so on.      

Can you recognise this vicious cycle of chronic pain in your own life? Which aspects of the cycle ring true to you? Before moving on, think about each stage of the chronic pain cycle and come up with specific examples of it from your own life. For example, how has your activity decreased? How has your physical condition declined? What negative thoughts and emotions do you commonly experience? In what ways do you self-isolate and withdraw from life? And what impact has all of this had on your ability to function well?