Learn ways to stop negative thinking that can intensify pain.

Living with pain can be hard. This can lead to negative feelings and thoughts, particularly if the pain starts affecting your sleep, ability to work and do everyday activities. But negative thinking and expecting worse case scenarios can make your experience of pain worse.

Focusing on pain sensations, thinking constantly about your pain and feeling helpless can make your pain worse­. Sometimes pain can become all-consuming and can prevent you from doing the things you enjoy.

Pain levels and remission can be affected

Unhelpful ways of thinking don’t just dampen your spirits. Having these kinds of thoughts can increase your level of pain. If you can distract yourself, engage in relaxation exercises or take your mind off the pain, you can help to reduce the level of pain you experience. 

Unhelpful ways of thinking are also associated with poorer outcomes. According to a 2017 study that followed 209 patients with inflammatory arthritis, people who focused heavily on their pain were less likely to achieve remission when compared with individuals who did not worry about their pain as much.

It is important not to blame yourself if you struggle with these emotions as it can be a natural reaction to your situation. What is important is that you recognise when you may be having unhelpful and/or negative thoughts and make efforts to stop this line of thinking for your health and wellbeing.

Suggested ways to use healthy thinking to cope with pain 

1. Catch up on your sleep

Sleep and pain are linked. If you have poor sleep you may have more pain; and if you are in pain, you are less likely to sleep well. The combination of negative thoughts and poor sleep compounds the pain experience, Here are some tips for improving sleep.

2. Modify your activities

Don’t let pain prevent you from doing the things you love. Talk to your doctor about which activities are safe for your arthritis and find creative ways to enjoy them. You may not be able to plant and tend a one-acre garden, but perhaps you can enjoy raised-bed gardening.

3. Practice mindfulness

Mindfulness is a form of meditation that teaches you to be present in the moment. It helps you pay attention to your thoughts and feelings about pain without judging them or making them the only focus.

Start by sitting quietly for 10 minutes a day. Focus on the sensation of your breath. When your mind starts to wander to other thoughts, simply return your attention back to your breath. There are mindfulness apps that can help you make this part of your daily routine.

4. Stop black-and-white thinking  

Notice when you are having negative thoughts or ‘self-talk’. Ask yourself whether your thoughts are helpful or unhelpful. Types of unhelpful thoughts are:

• Focusing on the negative. Also, known as filtering. This is when you ignore the good and only focus on the negative parts of a situation. For example, you only focus on the days that are bad. Having pain-free days is possible and not just a one-off.

• Believing that things ‘should’ be a certain way.Believing that a situation or the way you feel should be a certain way can put unreasonable pressure on yourself or others. For example, it is unreasonable to believe that your medications will get rid of all your pain. While expecting your medications to work is not unrealistic, managing chronic pain can sometimes take a combination of measures (e.g., exercise). There is no set way for things to be done, as different measures will work for different people.

• Overgeneralising. This is when you take one instance and believe it is true for every situation. For example, believing that your pain will never be managed. Some days your pain may be overwhelming. This can make you focus on the pain and start a trend of unhelpful thinking. It is important to try focus on strategies to help you cope with the pain. Ask yourself – were there days when your pain wasn’t so bad? Were there things you did that helped you cope with the pain better?

• Stop black-and-white thinking. This style of thinking involves seeing one extreme or the other. Things are either wrong or right; good or bad. This type of all-or-nothing thinking makes unhelpful thinking worse.

5. Keep a diary of your thoughts 

Keeping a diary of your thought patterns can help you to stop your unhelpful ways of thinking. A thought diary can make you aware of when you are having negative thoughts and help you to change your way of thinking. For example, write down:

1.  When you have a negative thought (e.g., there is nothing I can do about my pain)
2.  What type of negative thought it was (e.g., overgeneralising)
3. How you can change that thought into something more helpful (e.g., there will be days where my pain will be harder to manage then other days. There are things I can do to help my pain)

6. Talk to a professional 

If you are struggling to keep negative thoughts at bay, get help. See your GP or rheumatologist and they can refer you to a psychologist to help you manage. Goal-oriented treatments, like cognitive behavioural therapy (CBT), can help you develop new coping skills and change patterns of behaviour that lead to negative feelings and thoughts.

This resource has been developed based on the best available evidence.  A full list of references is available upon request.