ACT for Chronic Pain: Why Fighting Pain Often Makes It Worse
If you live with chronic pain, you have probably tried everything to make it stop. Rest, medication, investigations, treatments, lifestyle changes — often all at once. Many people come to see me exhausted, not only from the pain itself, but from the relentless effort of fighting it.
And yet, one of the most confronting ideas in Acceptance and Commitment Therapy (ACT) is this: the harder we fight pain, the more space it can end up taking in our lives.
This doesn’t mean giving up. And it certainly doesn’t mean that your pain isn’t real. It means changing how you relate to pain in a way that reduces suffering and helps you reclaim your life.
Why the Fight With Pain Becomes a Trap
Pain has a powerful way of pulling our attention toward it. When pain becomes chronic, the brain’s threat system remains switched on, constantly scanning for danger. Understandably, most people respond by trying to control, avoid, or eliminate pain.
Common strategies include:
Avoiding movement for fear of worsening pain
Constantly monitoring the body for symptoms
Pushing through pain on “good days” and crashing afterward
Waiting for pain to improve before living life
These responses make sense. But over time, they often lead to more restriction, more fear, and more distress.
From an ACT perspective, the problem isn’t pain itself — it’s how much your life begins to revolve around avoiding it.
The Difference Between Pain and Suffering
ACT makes a helpful distinction between pain and suffering.
Pain is the physical sensation — very real and often unavoidable.
Suffering is what gets added when pain dominates our thoughts, choices, and sense of self.
When life becomes organised around not hurting, the cost can be high: relationships shrink, meaningful activities fall away, and identity becomes reduced to “someone with pain.”
This is not because you are weak. It is because your nervous system is doing exactly what it evolved to do — protect you.
What ACT Means by “Acceptance” (And What It Doesn’t)
Acceptance is often misunderstood.
In ACT, acceptance does not mean liking pain, wanting pain, or resigning yourself to it. It means allowing room for pain to be present without letting it dictate every decision you make.
Acceptance involves:
Noticing pain without immediately reacting to it
Letting go of the constant struggle to control what may not be controllable
Making space for discomfort while choosing actions that align with what matters
Paradoxically, when the fight softens, many people notice that pain becomes less dominant, even if it doesn’t disappear.
Why Control Strategies Often Backfire
The brain is excellent at learning patterns. When pain is treated as an emergency that must be eliminated at all costs, the brain learns to stay on high alert.
This can lead to:
Heightened pain sensitivity
Increased anxiety and catastrophising
Greater avoidance and deconditioning
A narrowing of life
ACT works with the brain differently. Instead of asking, “How do I get rid of pain?” it asks, “How do I live well, even with pain present?”
This shift can be deeply freeing.
Reclaiming Your Life Through Values
ACT focuses on values — the things that give your life meaning, such as connection, contribution, creativity, or compassion.
When pain becomes the primary driver of decisions, values often get pushed aside. ACT gently helps you ask:
What kind of person do I want to be, even on painful days?
What small steps can I take toward what matters, without waiting for pain to improve?
These steps are not about forcing or pushing through pain, but about choosing a life that is bigger than pain.
ACT for Chronic Pain in Practice
In therapy, ACT for chronic pain may include:
Learning how to step back from unhelpful pain-related thoughts
Reducing the fear–pain cycle
Developing flexibility around activity and rest
Reconnecting with values and meaning
Building psychological resilience alongside medical care
ACT is not a replacement for medical treatment. It is a complement — one that addresses the emotional, cognitive, and nervous-system aspects of living with pain.
You Don’t Have to Win the War With Pain to Live Well
Many people come to therapy believing they must defeat pain before life can begin again. ACT offers a different path — one where life doesn’t have to be put on hold.
If you are living with chronic pain and feel stuck in a cycle of fighting, avoiding, or fearing pain, support can help you find a way forward.
I offer ACT-informed psychological treatment for people living with chronic pain, both individually and in group settings. You are welcome to contact me to discuss whether this approach may be right for you.
