Approaching pain

Management · 13 min read · 15 Sep 2021

Approaching and coping with pain

Use this module to learn helpful strategies to manage and cope with your pain.

  • Carl Graham
  • Ellyn Bicknell
By Mr Carl Graham and Ms Ellyn Bicknell

In the information that follows, we make a distinction between who you are as a person, from some of the ways our brains can habitually respond to things that are threatening, like when you experience pain in your body. These are normal responses to have when you experience pain, and they can be hard for us to control.

Below we outline helpful ways to approach pain that can support you to engage in valued life activities, with small gains leading to significant positive change.


“Remember, pain is not your fault and you can get better”

When you have ongoing pain in your body, it’s hard to manage. From your brain’s perspective, its most important job is keeping you safe no matter what.  Your brain consistently monitors the world around you and sends you messages about the things it finds important. The things you enjoy might give you excitement (like when you see a friend). The brain might elevate your distress and anxiety when it sees things that could cause harm to you (e.g. a snake). Most of the time, having this built-in ‘problem finder’ radar is a really good thing and helps you avoid trouble or danger.

In the case where your brain finds potential danger, it is designed to want to protect you (the ‘flight’ response). Your brain will try to find a solution to control danger (the ‘fight’ response). The brain can elevate worry and raise emotions like anxiety or distress to help move out of danger.

Our personality is the history of all the things we have experienced over our life. These experiences and emotions, shape the patterns of our everyday habits. This includes those things we want to avoid and those we like to approach. The urge to get more of what we like and get away from problems we don’t like, can be irresistible and become habit-forming.

When we are living with pain for a long time, even if we try to focus on the positives and manage, we can be confronted with distress and struggle with our mood. This is a normal response to an abnormal situation. You may want to check out our Örebro questionnaire which will help you identify other factors, like your mood, that may be influencing your pain experience. 

The information below looks at the way the brain can be affected by living with pain, how that can impact us and what we can do to help manage pain.

Brains and pain

Our brains typically treat injury and the pain we experience as if it were all damage (or infection, inflammation). However, pain is a perception that lets us know there might be damage, not necessarily that there is actual damage. 

Imagine being at home making breakfast and you burn some toast. The smoke sets off a smoke detector. The alarm raises your stress levels, but you know that the smoke alarm isn’t telling you there’s a fire, and the house is not burning. When we experience pain, our brain treats the pain ‘alarm’ as if it were a fire. This means we are protected. While that is good initially, once any initial injury has passed and our tissues have healed, we can still experience pain. This is known as chronic or persistent pain.

In persistent pain, the alarm appears to be more easily triggered, it can stay triggered for longer, and it can be hard to switch off. While helpful when pain is associated with acute (short term) injury or infection or inflammation, this brain response is no longer helpful once tissues heal and recover.

Pain is a perception that might reflect a tissue injury and yet this same response can also be triggered even when there is not an injury (infection or inflammation). This might sound crazy, however, our brains can’t normally make this distinction well, especially when pain becomes persistent.

Anxiety and distress can help us to escape from the pain problem and avoid any perceived threat.

Think about this scenario: If there is a serious threat nearby, like a tiger, our brain notices this and can use distress and anxiety to help us to get away from danger. The issue is this same response can be habitual when pain persists – here, distress, anxiety and pain are often inter-linked in an unhelpful way. The more distressed or anxious we are, the more pain we can experience and this works the other way around too – ongoing pain can increase our distress or anxiety.

While this situation isn’t great, it does open up a way for us to learn how to deal with ‘faulty’ danger signals and this can be an important pathway to better pain management, reducing our distress and keeping us moving safely.

In this short clip, young people share their experiences of the impact of pain on their mood, their anxiety and a range of emotions. They describe different ways they have developed to cope and manage their pain, the importance of the mind-body connection and the value of a supportive health and social network to their quality of life.

Learning to chill with pain

Try these easy self-help steps for getting better control of your pain:

  1. Notice when pain interrupts you, when it’s grabbing your attention (when it’s right at the front of your thoughts)
  2. Give the pain all your attention for the moment, like you were staring at it (try and remember that it’s safe – pain is the alarm, not the fire. Frame this as “pain’s difficult, but it’s not dangerous”)
  3. Breathe in slowly and deeply, let your chest feel full
  4. Gently tighten the muscles in your hands, arms, shoulder, tummy and bottom (avoid trying too hard!)
  5. Let those muscles let go, breathe out more slowly than you breathed in
  6. As the muscles let go and the breath leaves, you imagine flowing with that feeling and feeling heavier and looser, softer…
  7. Remind yourself that pain is difficult, not dangerous…you are safe (remember, your brain is monitoring as you do this).
  8. Now, move your attention back to what you were doing before the pain interrupted…
  9. Repeat this each time you notice that you are noticing your pain. You can’t overdose!

Doing this is like doing bungee jumps with pain. If you went for a bungee jump, you might be very scared at first. But every time you jump, your brain learns to be less scared. After a thousand jumps you likely won’t be very scared. This relaxation exercise is doing the same thing with pain. You can also do this technique with thoughts that make you anxious, or people who stress you out.

Quick summary

Notice pain is pushing on you - breathe in slow, at the top of the breath, softly tense your muscles - as you breathe out more slowly, let the muscles go - imagine sinking and feeling heavy as the air leaves you.

Moving with pain

Our brain will always try to make connections between things if it can. This is a big part of how we learn to understand the world around us. By learning ‘what goes with what’, we can make better sense of what is happening in our world. 

With pain, this can be challenging when fear about possible tissue damage is linked to our experience with persistent pain. This is tricky, as with some pain conditions (like inflammatory arthritis), we can have repeated bouts of inflammation. In this case, the inflammation means that being protective of our bodies during a pain flare up likely makes sense. In the short term, this can help to protect our joints. Once the pain flare settles, fear of pain can get in the way of getting moving again. Our system can learn to link any movement, even postures and simple habits, with danger signals and connect these movements and postures with the experience of pain. You are not at fault here: this is simply how our biology can work.

The most important information you need to know, is how to safely keep moving and doing the things you care about. Moving gently, relaxing and varying postures, can help to reinforce that movement is safe, and can help to ease the feelings of pain, especially if we do little bits at a time.


“Remind yourself that pain is difficult, not dangerous; I’m safe”.

Keeping moving is good on all counts

Pain is always real and can place limits on what you can do. It’s really hard to accept pain and there are times when you experience an exacerbation or pain flare.

One helpful way of managing pain flares is pacing your activity. Working up to more normal movements, postures and activities takes time when you live with persistent pain. Your physiotherapist can help here, guiding you in safe movements and helping support you to do the activities you enjoy.

Check out this scenario: imagine a person runs 100m in 12 seconds. They add a 50kg backpack and run the 100m again. This time, it takes 20 seconds – they can’t run as fast…the load is simply heavier. Sometimes pain feels like a heavy weight!

Here, it’s helpful to remember that there are many strategies that can help you move away from pain and move towards recovery. Learning ways to work with pain, rather than fighting against pain can help to reduce distress and mean that you move through a pain flare more quickly.

Your health professional is there to guide you in helpful ways to learn how to manage your pain and distress. Learning ways to work smarter with pain, rather than harder, can gradually help push back on the limits pain imposes and move back towards valued life activities.

Mood: getting worn down

Chronic pain can be a heavy load to carry and keep carrying. Coping with anything difficult over a long time can put pressure on our mood. Avoiding or withdrawing from valued activities is a really normal response to an abnormal situation (i.e. when pain persists).

For example, we can get a drop in mood that functions to protect us by pulling back from life and the things we used to do and like. This is our biology protecting us and in the short term, can be helpful as it means we save energy.

In the longer term, low mood can keep us away from school, study, work, sports, friends and other valued life activities. The good news is, there are ways you can be supported to manage and recover.

Keeping your mood up in the middle of a difficult life using the PPFM approach

There are a number of approaches that can help us with managing low mood. These are called cognitive behavioural approaches.

P is about staying productive. We need to have a focus or goal each day. Even though our low-mood brain tries to slow us down, we manage better if we can do something productive or valued every day. Productivity can be about work, it can be learning, and it can be about being creative. As long as it is something we can do and it matters to us.

P is about people. Depression and low-mood can make you feel isolated. Pain can do that too. Staying in contact and connection with those we love or enjoy hanging out with, can help lift our mood – even when we might not really feel like engaging.

It’s ok to talk about your struggles if you are ok with it and they are ok with that, too. It’s good to get some positive support. Other times, you might want to put the pain aside and talk about other stuff, or hang out and watch movies or listen to music together…these are small things that can really help lift our mood.

F is for fun. We all need fun times and that includes young people living with pain. Having fun is like adding psychological energy or mood calories.

Fun things help mood to improve. If you have experienced pain for a long time, it’s good to know that building your mood up, takes time. Gradually building up these valued activities is linked with improved mood followed by increasing feelings of fun. Remember, little gains week by week, result in longer-term changes over months.


“The trick with increasing your activity, is doing little bits often”

Working with a skilful health professional, you can sort out ways to do the things you love even with pain.

M is about movement. Movement has benefits that include less worry about pain. Moving and being active also helps to reduce inflammation. This is good news as inflammation can sensitise our bodies and increase the experience of pain. Inflammation can also push on mood, while a gradual progression of activity can help to boost mood. Regular-paced activity or exercise can also help with improving sleep quality.

Finding an activity you enjoy is the key. If you enjoy it, you’re more likely to want to stick with a plan. This helps set you up for success.

Your health professional can work with you to help set up a plan to safely increase your movement and activity levels. They can also help you with how to plan for pain flares.

Setting goals with P P F & M can help get bring your mood back up. As your mood improves you will find you have more energy and keeping going gets easier.

Mood: helpful ways to think

Tips for prioritising using the 3Ds;

  • Do it – if you can do it today
  • Dump it – (for now) if you can’t do it today or the near future.
  • Delegate it – can you let someone else do it or get them to help you with it.

Being kind to yourself in a tough situation is so important. People may not understand what it’s like for you living with persistent pain. When others show compassion and empathy, that’s great. Remember, showing self-compassion is helpful, even when others don’t.

Focusing on one thing at a time and slowing things down can reduce pressure and lessen feelings of anxiety. Small achievements are still gains!

Sometimes we can get caught spending a long time thinking about our problems as a way of trying to solve them. This uses lots of energy. Sometimes diverting the energy to simple things that are doing rather than thinking, can be more helpful.

Your health professionals, family and friends can also provide positive support for you in different ways. We have created pain management content for friends and family to guide helpful support for you You might like to share this resource so they understand how they can best support you (link to ‘helpful communication’).

Getting the help you need

Support from friends, family and health professionals helps you better manage pain and move back towards the things in life you value. Knowing how to get the right support at the right time is important for your support and recovery. That’s why we created this website and the management modules including information for your friends and family.

Seeking support to help you tackle pain, anxiety and mood is a great way to set yourself up to move safely towards recovery and getting your life back.

Your health professional team should be supportive and work with you to sort out a plan that is focused on what your goals are.

  • Your GP is your primary carer and is there to listen to you and advise on all things about your health and mood. Your GP can also direct you to other health professionals
  • Health professionals (physiotherapists, clinical psychologists, occupational therapists, pharmacists, pain specialists, rheumatologists and others) can work with you to create integrated and coordinated plans to support your care. Getting positive guidance from your healthcare team should include holistic care – mind and body together.
  • Clinical psychologists can help you to learn pain-coping skills. Working with a psychologist is a very common strategy for young people to help gain further pain management skills and to feel more confident about their body, family, career or goals.

Many doctors, nurses, firemen, policemen and sports people regularly meet and chat with psychologists too! If you do ask to see a psychologist, ask to be referred to a clinical psychologist who practises CBT (Cognitive Behavioural Therapy).

They will focus you on practical ways to improve your ability to manage and also help you gain insight into the things that are tough for you. CBT that can help with pain and distress will focus on improving the way you manage, help you notice more of how your thoughts and emotions affect you and your behaviour, help you reduce the stress in your body and learn to relax, and help you make relationships work better with friends and family.

Medication may be indicated to support recovery but usually, it’s not prescribed for use on its own. The best evidence we currently have for managing pain in young people is the use of non-pharmacologic (medicines) and non-surgical / procedural care.

Medicine use may be indicated for certain pain conditions (for example, inflammatory arthritis, post-surgical pain, nerve-related pain), however, there is currently insufficient high-quality evidence to make strong recommendations. Refer to our medicines and procedures section for more information.

Want more information?

These are some useful tools for building your toolbox of strategies to reduce feelings of pain and anxiety. Alternatively, if you want to talk to someone, please seek further assistance.


  1. Efficacy and safety of pharmacological, physical, and psychological interventions for the management of chronic pain in children; a WHO systematic review and meta-analysis. Fisher, E. & Eccleston, C. PAIN April 19; online ahead of print. doi: 10.1097/j.pain.0000000000002297. [PubMed]
  2. Guidelines on the management of chronic pain in children. Geneva: World Health Organization; 2020. PMID: 33433967. [PubMed]
  3. Pain prevention and management must begin in childhood: the key role of psychological interventions. Palermo, TM. Pain September 2020;161 Suppl 1(Suppl):S114-S121. doi: 10.1097/j.pain.0000000000001862. [PubMed]
  4. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Fisher, E. Law, E. Dudeney, J. Palermo, TM. Stewart, G. Eccleston, C. Cochrane Database of Systematic Reviews October 2018;(9)1465-1858. doi: 10.1002/14651858.CD003968. [PubMed]