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Persistent Pain 101 for Counselors

Because over 100 million Americans experience persistent pain, as a therapist, you are likely to encounter individuals with persistent pain in your practice. When I first encountered persistent pain, I educated myself on my client’s condition, and knew nothing about the science of pain. I’d like to share a few things I wish I’d known at the time.

Pain is a useful tool. We are designed to attend to pain, because by attending to tissue damage or internal distress, we would be able to try to fix any issues rather than exacerbating them. If you were a hunter or gatherer with a broken arm, it would make sense for your brain to produce pain so you would know you needed to attend to your arm before resuming your regular activity.

While we experience pain in our body, it is truly created by our brain. Our tissues can experience pressure, temperature, and toxins, and they send those messages to our brain through our nervous system. Within milliseconds, our brain decides how much pain to produce based on what it decides is most protective for us. For example, if a soldier’s arm is severely injured in battle, he or she will frequently not experience pain until in a safer situation.

Persistent pain is pain that persists even after the tissues in the body have healed as best they can. Persistent pain is diagnosed after experiencing pain for 3-6 months. The earlier people seek counseling and self-management tools in this process, the better their predicted outcome.

The best tools to teach individuals with persistent pain are:

1)  Movement is your friend. Find a gentle movement program that is led by someone who understands persistent pain. This could be an arthritis tai chi program, gentle yoga, or physical therapy. Make sure your teacher does not endorse the “no pain no gain” approach.

2)  Relaxation and meditation are more than just woo-woo experiences. By breathing at your ideal breath rate, your brain will release relaxation chemicals into your body that will help turn down the volume on persistent pain.

3)  Mindfulness is more than just meditation. It is important to be aware of the present moment and your body movements and breath, because you can move in ways that promote health, and you can also move in ways that flare pain. Find a way to develop an awareness of your body. Learn about pacing your activities based on how you are feeling.

4)  Acceptance is not giving up. Accepting your pain and becoming aware of the body you are experiencing today will help you to actually accomplish more of your goals than the idea of “pushing through the pain” (which often leads to an extended necessary rest) or living in a recliner.

5)  Your body hears everything your mind thinks. Your brain releases many chemicals and hormones based on your thoughts. It’s amazing how becoming aware of your thoughts and helping yourself to see things from different perspectives can start to ease the suffering that accompanies persistent pain. Even using the term “persistent pain” rather than “chronic pain” helps our mind see our pain differently.

6)  You can retrain your brain! Your pain is not in your head, and it is not imaginary— it is very real and very distressing. Knowing this and having new tools can help you to retrain your brain to experience pain differently and live a life congruent with your values.

Some common counseling modalities that are utilized to teach these lessons are Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT). If you are interested in learning more, Lorimer Moseley’s TED Talk is an excellent crash course on how pain works in the brain and body. The Association for Contextual and Behavioral Science offers a free podcast that helps explain ACT: .  Mindfulness Based Stress Reduction is another program that works with these concepts, and is widely available in the community, in workplaces, and free online here:


Kris Fant is an LPC/LMHC at Progressive Rehabilitation Associates. She specializes in working with individuals who have persistent pain or traumatic brain injury. You can reach her at When she's not at work, you'll find her riding off into the sunset on her motorcycle.