How Chronic Pain Changes the Brain—and What That Means for Your Mental and Emotional Health
Even in hard places, growth happens.
Chronic pain changes more than just your body—it can reshape your thoughts, energy, and emotions.
Living with chronic pain can feel like carrying around an invisible weight. It doesn't just show up in your back, knees, or joints—it can slowly change how you think, feel, and move through your daily life. And science backs that up: chronic pain really does change the brain.
In this blog post, we’ll explore how and why that happens, and what you can do about it.
Types of Chronic Pain—
And Why It’s Not One-Size-Fits-All
Before we dive into brain science, let’s talk about the different types of pain:
Acute Pain
This is the kind that hits fast and usually has a clear cause—like a cut, a broken bone, or recovery after surgery. It tends to go away with rest and treatment.
Chronic Pain
Pain that sticks around for more than three months is considered chronic. It can come and go or stay constant, and it doesn't always have a clear cause. If it interferes with your ability to work or enjoy life, it might be what's called "high-impact chronic pain."
Neuropathic Pain
This comes from nerve damage—either in the brain, spinal cord, or nerves throughout your body. It can show up as numbness, burning, or a weird tingling feeling.
Chronic Inflammatory Pain
Conditions like arthritis or autoimmune diseases can cause this. You might feel it as joint pain, fatigue, gut issues, or even mood changes. (Yes, pain can cause your whole system to feel off.)
What Happens in the Brain When Pain Becomes Chronic?
You might think of pain as just a signal that travels from your body to your brain. But with chronic pain, your brain actually starts to change in response.
Brain Areas Affected by Chronic Pain
Studies show that long-term pain affects:
Prefrontal Cortex (decision making, planning)
Amygdala (emotions like fear and anxiety)
Anterior Cingulate Cortex (emotional processing)
Nucleus Accumbens (motivation and reward)
Hippocampus (memory)
Your brain starts to behave differently. Emotional regulation gets harder. You might feel more anxious or down. Motivation can tank. It’s not in your head, but it is happening in your brain.
Neurotransmitters Get Thrown Off
Chronic pain doesn’t just wear you down physically—it also disrupts your brain chemistry.
Research shows that people with chronic pain tend to have lower levels of glutamate, a key neurotransmitter that helps regulate emotions, thinking, and motivation. When glutamate levels drop, it can feel harder to manage stress or bounce back from everyday challenges. Even small tasks can feel overwhelming or emotionally flat.
Another player is galanin, a lesser-known but important chemical involved in motivation and reward. In chronic pain, galanin activity in parts of the brain like the nucleus accumbens can get thrown out of balance. That’s the part of the brain that helps us pursue goals and experience pleasure. When it’s disrupted, you might still want to do things—you just don’t have the energy or drive to get started. It’s not laziness; it’s biology.
The result? Things that used to bring joy or excitement—like seeing friends, getting outside, or working on a project—might now feel effortful or emotionally distant. And when pain is always in the background, your brain starts prioritizing survival over reward.
When your brain is stuck in survival mode, joy can start to feel out of reach—even when you want to feel better.
How Chronic Pain Affects the Body
Long-term pain doesn’t just live in your nervous system. It impacts:
Sleep: Trouble falling or staying asleep
Fatigue: Feeling wiped out, even after rest
Hormones: Stress hormones like cortisol stay elevated
Muscle Tension: Your body braces constantly, which makes things worse
Immune System: Chronic stress from pain can weaken your immune response
Pain changes how your body operates day to day. You might not bounce back the way you used to—and that’s not laziness. It’s biology.
How Chronic Pain Affects Mental Health
Depression and Anxiety
It’s not just in your body—chronic pain affects your mind, too. In fact, up to 85% of people with chronic pain also experience depression. Why? Because the parts of the brain that process physical pain (like the anterior cingulate cortex, amygdala, and prefrontal cortex) also help regulate mood and emotions. When pain is always “on,” your brain has a harder time managing everything else.
It’s exhausting to be in pain and still try to function. Over time, this can lead to feelings of sadness, hopelessness, irritability, or anxiety about when the pain might strike next. Even joyful things can start to feel flat or unreachable.
Cognitive Symptoms
Pain doesn’t just slow down your body—it can fog up your brain, too. Many people with chronic pain report what’s often called “fibro fog” or pain fog—a cluster of cognitive symptoms that make it hard to think clearly.
Common cognitive effects include:
Trouble with short-term memory (forgetting names, appointments, or tasks)
Difficulty concentrating or focusing
Feeling mentally slow, spacey, or disconnected
Emotional blunting—feeling numb or quickly overwhelmed
These aren’t personality flaws—they’re nervous system effects. And they’re real.
Sleep Problems
Chronic pain and poor sleep go hand in hand—and not in a good way. Insomnia is common in people with long-term pain, whether it's trouble falling asleep, staying asleep, or waking up unrefreshed.
To make things more frustrating, lack of sleep can actually increase pain sensitivity, creating a loop that’s hard to break. You’re tired because you’re in pain, and the pain gets worse because you’re tired. It’s the definition of a vicious cycle.
But understanding this cycle is powerful—because once you name it, you can start to work with it.
You’re Not Imagining It
If you feel more anxious, withdrawn, or pessimistic since your pain began, you're not being dramatic. A study in Frontiers showed that people with chronic pain have actual physical changes in the brain areas that regulate emotion.
And these changes don’t mean you’re broken. They mean your brain has been adapting to chronic stress and discomfort for a long time. There is good news, too: With the right care and support, the brain can change again—toward more ease, connection, and clarity.
How Chronic Pain Affects Daily Life
Pain doesn’t clock out when you go to work or sit down to dinner. It can:
Limit your ability to exercise or move
Affect your social life
Cause financial stress from missed work or medical costs
Make simple tasks like grocery shopping feel overwhelming
You might also deal with stigma or judgment from others who don't understand invisible illness. That can add to the emotional toll.
The Science of Motivation and Chronic Pain
Let’s talk mice for a second…
In a study from Stanford University, researchers examined how chronic pain affects motivation by observing mice. The mice were trained to perform a task—nose-poking—for a food reward. As the task became more effortful, healthy mice continued working for the reward. But mice with chronic pain stopped trying much sooner, even though they were still hungry and still wanted the food.
So, what changed? The pain had altered activity in the nucleus accumbens, a brain region involved in motivation and reward-seeking behavior. Essentially, the mice’s brains adapted to persistent pain by dialing down their motivation system.
Even when researchers gave the mice pain-relieving medications, the lack of motivation remained. This suggests that chronic pain can lead to longer-term changes in how the brain processes effort and reward—changes that aren't easily reversed just by reducing pain intensity.
For people living with chronic pain, this helps explain why daily tasks—work, socializing, even enjoyable activities—can start to feel draining or distant. It's not about a lack of desire or willpower. It's about how the brain has been shaped by pain over time.
The Connection Between Pain and Personality Changes
Some people with chronic pain are told they’re “too sensitive,” “negative,” or “not trying hard enough.” These kinds of comments can feel dismissive—and damaging.
But research tells a very different story.
Recent brain imaging studies show that these so-called traits may actually be responses to the brain’s adaptation to long-term pain. In one study published in Frontiers, researchers found that individuals with chronic pain had lower levels of glutamate in the medial prefrontal cortex—a part of the brain responsible for emotional regulation, decision-making, and social behavior.
Lower glutamate in this region was linked to increased emotional reactivity, pessimism, and difficulty processing stress. In other words, people weren’t experiencing changes in mood and behavior because of their personality—they were experiencing them because their brain chemistry had been altered by pain.
Translation? Your brain may be doing its best to adapt to persistent pain, even if those adaptations show up as heightened emotions, reduced optimism, or feeling more easily overwhelmed. These are not character flaws—they’re neurobiological consequences of living with ongoing discomfort.
Measuring the Impact of Pain on Mental and Emotional Health
You don’t need an fMRI to get meaningful answers. While brain scans can show us how chronic pain changes the nervous system, there are accessible, evidence-based tools that help track how pain is affecting your mental, emotional, and cognitive health day to day.
Some of the tools we use include:
PHQ-9 to screen for depression, including symptoms that often overlap with chronic pain like fatigue, sleep changes, and loss of interest
Pain and function trackers to monitor how pain affects daily activities over time
Cognitive assessments to check for difficulties with memory, attention, or processing speed
The Pain Self-Efficacy Questionnaire (PSEQ) to understand how confident you feel managing pain and staying active despite discomfort
The Concerns About Pain (UW-CAP) Scale to explore how much pain-related worry or helplessness may be affecting your nervous system
At Alcove Mental Health, we use secure, online tools to help you track these areas over time—because pain isn’t just a number on a scale. It’s an experience that can shape your mood, motivation, and decision-making. The more clearly we can map that impact, the better we can tailor your care.
Hope for Healing: Your Brain Can Change
Here’s the good news: brains are adaptable. This is called neuroplasticity—and it means the same brain affected by chronic pain can also heal over time.
Research shows that with the right tools, your nervous system can calm down, your motivation can return, and your mind can start to feel clearer. Healing doesn’t always mean pain disappears—but it often means that life becomes more manageable, more meaningful, and more you again.
Therapies that support this kind of brain-based healing include:
CBT for chronic pain, to reframe pain-related thoughts and strengthen your ability to cope
Somatic practices and nervous system regulation, to ease physical tension and help your body feel safer
Pain neuroscience education, to better understand what’s happening in your brain and why it matters
At Alcove Mental Health, we integrate these approaches with compassion and science, helping you move toward relief and resilience at your own pace.
We also offer Empowered Relief™, a 2-hour, single-session pain coping skills class developed at Stanford. It’s a low-cost, research-backed group class designed to help you build practical tools quickly—and feel less alone in the process. You can learn more about the class here.
If you’re wondering what this actually looks like in everyday life—or what makes this kind of care different—you’re not alone. Keep reading for answers to the most common questions we hear from people navigating chronic pain, mental health, and healing.
FAQs About How Chronic Pain Changes the Brain
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Yes. Studies show changes in the prefrontal cortex, amygdala, and nucleus accumbens, which affect emotion, memory, and motivation.
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Some of them, yes. Through therapy, movement, pain education, and lifestyle changes, many people improve their brain function and mood.
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Absolutely. Pain and mood share brain pathways, so it’s very common to feel low, tired, or emotionally flat.
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Cognitive therapy, pacing your day, sleep support, and nervous system work can all help.
If you're curious about how mind-body therapy might support your chronic illness journey, you can learn more about working together here.
🌿 Or, if you’d like to keep exploring, check out the posts below for more on how mind-body support provides relief for fibromyalgia, CRPS, migraine, and other complex conditions.
FAQs About Alcove Mental Health
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We specialize in mind-body therapy for chronic pain, burnout, and complex health issues. This includes CBT, pain reprocessing therapy, clinical hypnosis, and more. You can learn more about our individual therapy services here.
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Yes! We offer online therapy in over 40 states through secure video sessions. Learn more about the locations we serve.
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We focus on the connection between physical symptoms and emotional health. If you’ve ever felt dismissed by providers, this is a space where your experience is taken seriously. And if you’ve been given tools without context—or just space to talk without real support for change—you’re in the right place. Learn more about Dr. Kalianivala’s approach.
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Absolutely. We offer 15-minute consults to see if we’re the right fit. Click here to schedule.
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That’s okay. We’re here to help you figure that out. You can start by visiting our Start Here page for more info.