When chronic pain becomes too much, it can feel like your whole day is falling apart. You may cancel plans, move carefully, and brace for what the evening will bring, thinking: I can’t keep doing this.
This is a common experience for people living with persistent pain. A flare can feel more challenging than usual, and the pain can start to feel like it’s running your life.
This guide explains what chronic pain is, why it can sometimes feel overwhelming, and what to do in those moments. It also explores evidence-based approaches that target the brain and nervous system, including the strategies we use in chronic pain therapy.
What Is Chronic Pain?
Pain is generally considered chronic when it lasts longer than 12 weeks, which is past the point where most injuries have healed. It can show up as back pain, migraines, pelvic pain, fibromyalgia, joint pain, nerve pain, or discomfort that doesn’t fit neatly into a single diagnosis.
One in five adults in the US lives with chronic pain, which is more than 50 million people.
The chronic pain that you feel is real, but what many people don’t know is that the amount of pain you feel doesn’t reliably tell you how much damage is present in your body.
You can have significant findings on a scan and very little pain. Or, you can have severe, life-altering pain with imaging that comes back clear. This is because pain is produced by your brain based on everything it’s taking in, and tissue or structural damage is only one input among many.
Why Chronic Pain Can Become “Too Much”
Pain intensity naturally fluctuates. It rises and falls in response to a wide range of factors, including:
- Stress and periods of high pressure at work or home
- Poor sleep or a few nights of poor sleep
- Emotions you’re holding down, like anger, grief, or resentment
- Illness, hormonal shifts, or general fatigue
- Nervous system sensitization, where the ‘alarm’ system stays turned up after the original threat has passed
Pain is a protective signal that your brain produces to keep you safe.
When pain has been present for months or years, the neural pathways involved in producing it become more efficient. Over time, your brain’s danger detection system can become increasingly sensitive, responding to smaller and smaller signals.
This doesn’t mean that your pain is imagined or that you’re doing something wrong. The pain is real. It comes from real changes in how your brain and nervous system process signals from your body.
What it does mean is that the overwhelm you feel during a flare isn’t produced by the pain alone. It also comes from your brain’s interpretation of the pain, the fear about what it might mean, and the heightened sensitivity of your nervous system.
If you want to understand how this works in more depth, my course Calm Your Brain, Heal Your Pain walks you through the science behind persistent pain and the steps to retrain your brain.
What to Do When Chronic Pain Becomes Too Much
1. Remind yourself that a flare is not dangerous
A flare is a temporary spike in symptoms. It isn’t proof that your condition has worsened, that the damage has spread, or that you’ve undone your progress.
If you’ve been evaluated by a medical provider and nothing new has turned up, a spike in pain intensity doesn’t necessarily mean your condition has worsened or that you’re in danger. Instead, it often tells you something about the current state of your nervous system.
Naming that in the moment takes some of the charge out of the pain. When a flare hits, you can tell yourself something true and calming, such as “I’ve been checked out, and I’m safe right now even though this hurts.”
Reminding yourself that you’re okay can help keep fear from amplifying the pain.
2. Notice what else is going on
Pain intensity responds to your life circumstances.
Look at the two or three days leading up to the spike and take an honest inventory of things like a short night of sleep, a difficult conversation, a deadline, a family visit, a low-grade illness, or a feeling that you’ve been pushing down.
You didn’t cause the flare by being stressed or not sleeping well, so there’s no need to blame yourself. You’re just looking for the pattern, because seeing the connection between your circumstances and your symptoms takes some of the mystery out of the pain.
Mystery feeds fear, and fear feeds pain. Understanding why you’re feeling worse all of a sudden (or at least some contributing factors) can help bring down the pain intensity.
And if you look back and can’t point to anything, that’s okay too.
Not every flare has a clear cause, and you don’t need to find one to feel safe. Hunting for a reason you can’t find often adds more stress, which can feed the pain. Whether or not you land on an explanation, you can remind yourself that you’re safe and let the flare pass.
3. Catch the catastrophic thought
When you feel chronic pain, these thoughts can follow close behind:
“This is never going to end.”
“Something must be seriously wrong.”
“How am I supposed to live like this?”
When you’re in pain, thoughts like these can feel incredibly convincing. But they also register in your brain as danger, and danger produces more pain.
Try naming the thought out loud or on paper and then answering it with something accurate. Not “everything is fine,” which your brain won’t believe, but something closer to: “This has flared before, and it settled. I’m okay right now, even though this is uncomfortable.”
4. Stop monitoring, and start calming the system
Checking the pain every few minutes to see whether it’s worse keeps your brain trained on the threat. Scanning is protective, and it becomes a constant signal to your nervous system that something dangerous is happening and it should stay on high alert.
Try approaching chronic pain with curiosity instead of assessment.
In Pain Reprocessing Therapy, this is called somatic tracking: you notice the sensation, observe its qualities, and hold it in a frame of safety instead of alarm.
Alongside that, use other approaches that help you settle your system. For example, slow breathing with a longer exhale, progressive muscle relaxation, a change of scenery, gentle movement, or time with someone you feel comfortable around.
5. Go back to your life now, not after the pain improves
You may have made a deal with yourself that once the pain settles down, then you’ll exercise again, see your friends, book the trip, and get back to doing the things you love.
However, every week your life stays on hold, your brain collects more evidence that pain is dangerous enough to shut everything down, and that belief is part of what keeps your system sensitized.
You don’t need to push through severe pain or completely ignore it, but consider picking an activity you’ve been avoiding and doing a smaller amount of it. For example, if you used to walk for two miles, walk to the end of the block and back.
As you start doing this, you may find that pain takes up less room in your day, and often feels less intense.
If you want to understand where chronic pain comes from and how healing works, watch my free webinar: 3 Steps to Understanding the True Cause of Chronic Pain and How You Can Heal.
Severe Chronic Pain Red Flags
A flare, even a severe one, usually isn’t a sign that something new has gone wrong in your body, especially if you’ve been evaluated recently.
That said, contact your doctor or seek urgent care if you notice:
- Sudden, severe pain that doesn’t resemble your usual pattern
- Pain that starts after a fall or injury
- New numbness, weakness, or tingling
- Loss of bladder or bowel control
- Unexplained weight loss, fever, or night sweats alongside your pain
- Chest pain, shortness of breath, or trouble speaking
Most flares don’t fall into any of these categories.
They’re a normal part of living with persistent pain, and they tend to settle as your nervous system calms back down. If you want to understand why they show up even when you’re doing everything right, learn why chronic pain flares happen during healing.
Therapy Approaches for Managing Chronic Pain
Chronic pain therapy helps you turn down the fear, hypervigilance, and stored emotion that keep your nervous system producing pain signals.
Three therapy approaches are used most often for persistent pain:
- Pain Reprocessing Therapy (PRT) teaches your brain to interpret pain signals as safe. It combines guided reappraisal with behavioral techniques that help you gradually return to movements and activities you’ve been avoiding.
- Emotional Awareness and Expression Therapy (EAET) helps people identify and process emotions like anger, grief, and unresolved conflict that may be contributing to nervous system sensitization and chronic pain.
- Intensive Short-Term Dynamic Psychotherapy (ISTDP) helps people identify and work through emotional patterns that may be contributing to chronic pain and other physical symptoms.
In a randomized trial published in JAMA Psychiatry, adults who had lived with chronic back pain for an average of 10 years completed four weeks of PRT.
Two-thirds of them were pain-free or nearly pain-free by the end of treatment, compared with 20% who received a placebo injection and 10% who continued their usual care.
In the trial, pain reductions came with a shift in belief. Participants stopped interpreting their pain as evidence of damage in their body. In other words, when you change the meaning your brain assigns to a sensation, the sensation itself can change.
What to Do When Chronic Pain Becomes Too Much
An increase in your chronic pain is frustrating, frightening, and often feels like “too much.”
However, recognizing a flare as temporary, looking at the stress and emotions around it, and calming your nervous system can all reduce your brain’s sense of threat and help relieve pain.
At DC Metro Therapy, our therapists work with the brain and nervous system patterns behind persistent pain using evidence-based methods such as Pain Reprocessing Therapy (PRT), Emotional Awareness and Expression Therapy (EAET), and Intensive Short-Term Dynamic Psychotherapy (ISTDP).
Learn more about chronic pain therapy, start our self-paced course Calm Your Brain, Heal Your Pain, or watch the free webinar on the true cause of chronic pain and how healing happens.
