Chronic pain treatment depends on the kind of pain you have and how it is affecting your life. For people with chronic primary pain, where no underlying condition fully accounts for the pain, NICE guidance recommends considering Acceptance and Commitment Therapy (ACT) or cognitive behavioural therapy (CBT) for pain, delivered by an appropriately trained professional. ¹ The aim is not a cure. It is better for daily functioning and less distress alongside pain that may persist.
If you have spent time feeling dismissed or been through investigations that left you without clear answers, that experience is valid. Psychological support does not mean your pain is not real.
What is chronic pain?
Chronic pain is pain that persists or recurs for more than three months. ¹ Within that, a useful clinical distinction separates primary and secondary pain. Chronic primary pain means no underlying condition adequately accounts for the pain or its impact. Chronic secondary pain is explained by an underlying condition, such as arthritis, endometriosis or nerve damage.
Both can coexist in the same person, and the distinction requires clinical judgement, not a self-diagnosis. It matters because the right treatment plan may differ.
Which chronic pain treatment is right for me?
There is no single best approach. NICE recommends considering ACT or CBT for pain for adults aged 16 and over with chronic primary pain, provided the therapy is delivered by a professional with appropriate training. ¹ A clinical assessment considers the type and cause of your pain, how it affects sleep and daily activity, your emotional wellbeing, existing care, and your own priorities.
Why consider therapy for chronic pain if the pain is physical?
Being offered psychological support does not mean your pain is imaginary. Pain, fear and low mood can each make the others harder to manage, and therapy can address that without implying any single cause. ¹ Therapy for chronic pain does not require a diagnosis of depression or anxiety. NICE is clear that quality of life can improve even when pain itself does not change and that invalidating someone’s experience, including after normal investigations, is harmful. ¹
Psychological support works alongside physical assessment and treatment. It does not replace appropriate medical care.
CBT and ACT: what is the difference?
Both are forms of chronic pain therapy with an evidence base, and NICE did not find enough evidence to prefer one over the other. ² The right choice depends on what suits you and on your therapist’s training.
| Approach | What you might work on | Worth knowing |
| CBT for pain | Links between thoughts, feelings and behaviour; tailored coping strategies and activity goals | Not about thinking positively until pain disappears |
| ACT: Acceptance and Commitment Therapy | Making room for difficult experiences while taking steps towards what matters to you | Acceptance means choosing meaningful activity alongside pain, not abandoning investigations or tolerating inadequate care |
“Psychological flexibility” in ACT means being able to respond more flexibly to difficult thoughts and sensations while acting on your own values. ⁶ Both approaches can overlap in practice. For example, reconnecting with a friend in a way that respects your current limits is one kind of goal either approach might support. It is an example, not a promised outcome.
Does psychological treatment actually help?
The evidence supports modest, realistic expectations. A Cochrane review of 75 studies involving 9,401 people found that CBT produced small or very small average improvements in pain, disability and distress. ³ The benefit was larger when compared with usual care or a waiting list than with active treatment. Treating chronic pain with CBT does not produce uniform results across people; averages do not predict what an individual will experience.
A 2024 review of 21 ACT trials found medium effects on pain interference and functional impairment compared with waiting lists or usual care, with smaller effects on pain intensity. ⁴ That review did not compare ACT directly with CBT, so it does not establish that ACT works better. Daily function and distress are meaningful outcomes even when pain intensity does not change significantly.
What happens in chronic pain therapy sessions?
A first session typically covers your pain history, existing medical care, how pain affects daily life, and what you want to be different. From there, you and your therapist agree personally meaningful goals and a plan for building and reviewing tailored strategies. ⁶
Sessions might involve noticing distress patterns, adapting how you approach activities, or reviewing what is and is not helping. Tasks are adapted to your current abilities and medical situation. If therapy is not producing any benefit, the right response is to review goals and approach together, not to blame effort or motivation.
How does therapy fit with wider medical care?
Psychological support is one part of care. If managing pain is difficult, ask your GP about referral to a specialist pain clinic, which can offer various forms of support including multidisciplinary programmes. ⁵ Treatment for chronic pain involving medication should only be changed in discussion with a prescriber. New or changed symptoms need medical assessment rather than being assumed to be a usual flare-up.
Therapy does not replace physical assessment or condition-specific treatment. Both can run alongside each other.
Exploring support with Therachange
Therachange covers chronic pain under Acceptance and Commitment Therapy (ACT) service, with CBT also being available. Sessions are delivered entirely online by accredited UK therapists. If you are considering therapy alongside your medical care, get in touch to find out whether support is available for your situation.
Book Your First Session With Therachange
Taking the first step is often the hardest part. Your first session is a diagnostic conversation with a fully accredited UK therapist, not a programme you are assigned to. Together, you work out the right path forward. No referral, no waiting list, no commute.
Book Your First SessionFrequently Asked Questions
Can I have therapy online?
Online therapy removes travel and waiting-room barriers that can make access difficult for people in pain. Research on low-contact internet programmes for chronic pain shows some short-term benefit, though this evidence is not directly transferable to live video sessions with a therapist. ⁷ Convenience and access are real advantages; outcomes depend on the individual and the approach.
How many sessions will I need?
There is no universal number. Before starting, agree a proposed duration, fees, goals and a review point with your therapist. Needs vary by pain type, complexity and how you respond to the approach.
References
[1] NICE (2021). Chronic pain (primary and secondary) in over 16s: NG193. nice.org.uk/guidance/ng193
[2] NICE (2021). NG193 Rationale and impact. nice.org.uk/guidance/ng193/rationale
[3] Williams AC de C et al. (2020). Psychological therapies for chronic pain in adults. Cochrane Database, CD007407. cochrane.org/evidence/CD007407
[4] Ye L et al. (2024). ACT for patients with chronic pain. PLOS ONE 19(6): e0301226. doi.org/10.1371/journal.pone.0301226
[5] NHS (reviewed 2023). How to get NHS help for your pain. nhs.uk/live-well/pain
[6] Norfolk and Norwich University Hospitals NHS FT. Types of psychological therapy. nnuh.nhs.uk/pain-psychology
[7] Rosser BA et al. (2023). Psychological therapies delivered remotely for chronic pain. Cochrane Database, CD013863. cochrane.org/evidence/CD013863
