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Living with Pain - Depression and Negative Self Talk

If you have chronic pain, you may also be depressed. For example, one study found that among a representative, community sample of men and women, 35% of the study's participants who reported chronic pain were also depressed. Risk of depression was not associated with any particular pain type or site. Pain and depression seem to have a “reciprocal relationship”: they tend to feed upon each other; more pain can trigger greater feelings of depression and increases in depression can make pain feel worse. If you think you may be depressed, you may wish to talk with your primary care physician, therapist, or other health care provider.

One action you can take now is to examine how you talk to  yourself.  What you are telling yourself everyday about your pain, about who you are now, or what the future may hold  has an important impact on your emotional life. Negative beliefs, thoughts, and self-talk play an important role in predisposing people to depression and can play a role in prolonging or worsening depression. When pain and depression co-occur, negative self-talk  has been found to be associated with more depression and greater pain interference. Depression makes chronic pain management even more challenging.

What is Negative Self-Talk?

The term negative self-talk refers to thoughts, ideas, beliefs, or even images that are overly negative and leave you feeling hopeless. This kind of self-talk takes a bad situation and makes it worse. Below are some examples:

  • My life is ruined.
  • All of my friends have forgotten about me.
  • I'll never work again.
  • I'm completely disabled.

  • No one understands what I'm going through.
  • There's nothing I can do.
  • I'm useless.
  • Nobody cares.

You may have said some of these things to yourself. They may feel true, especially on a really bad day. However, extreme thoughts, ideas, and beliefs are rarely completely true. Generally, if we challenge an extreme thought, we find exceptions (“Hmm…well, my sister understands what I'm going through”), possibilities (“I think I could work part time”), and hope (“There are a few strategies that really do reduce my pain”).

I am not suggesting that you lie to yourself or become overly positive. Instead, pay attention to how you talk to yourself and watch for those times when you may be overly negative. When you hear your negative self-talk, challenge it.  Why should you just accept it? If someone else said the same things to you, wouldn't you question their right to talk to you like that? When you notice a negative thought, ask yourself:

  • What is the evidence that this is true?
  • What is the evidence that this is not true, or partly true? Are there exceptions?
  • Is there a less extreme way to think about this that will help me to be hopeful?
  • Would someone who loves me talk to me this way? If not, why am I treating myself this way?

Living with pain is hard enough. Don't make it worse than it has to be. Pain and depression don't have to go together.

About the Author. Dr. Linda Ruehlman is a social/health psychologist and researcher, co-founder of Goalistics, and Director of the Chronic Pain Management Program, an interactive site that helps people with chronic pain to manage their pain and live richer, more effective lives.

DISCLAIMER: This blog is provided as an educational and informational resource only. It is not intended nor implied to be a substitute for professional psychological or medical advice.



  1. Nancy H says:

    Boy is this true! On my bad days it’s “I’m useless! or I can’t do anything”. Yet I get very upset with people, family especially, when they think they know what’s “best” for me and make decisions without any input from me! I know I can still do many things — slowly or piecemeal over several days sometimes — and there are days when I unrealistically push myself too hard and too far only to pay for it dearly over the next several days. All to prove to myself that I can still do things. Pain and sleep deprivation can sometimes make you do some very stupid things!! But, I’m working through things most days — it is and will always be a neverending journey for me. Most days I can accept that — other days maybe not so much. But, my “pity parties” are fewer and farther between now. It’s taken me “only” 7 years to get to this point!

    • Hi Nancy,
      I think that learning to live with pain is a long process for most people. As part of the process, we learn to expect some “bad days” and to create good ones. Thanks for sharing a bit about your own journey.

  2. Renée says:

    After almost 8 years & I’m getting worse , now instead of loosing weight I’m gaining at the rate of 30lbs a month ? What is left ? The one good thing from the pain was weight loss from 200-130lbs . Now I’m 170lbs for nothing ? What’s left ? No sex life , can’t do my own chores , can’t work even part time , I’m bed ridden . I’m not terminal ( severed nerves 1000’s) I’m 41 and I feel like my life is done ! Two grown kids & now I’m the thrid . So what good am I ? In all honesty what good am I ?

    • Renee,
      I am sorry you are feeling so bad. If possible, I think it would be helpful for you to talk to a counselor. We all need help from time to time from someone outside of our family and friends. In the meantime, I would encourage you to take a hard look at how you talk to yourself. For example, saying “What good am I?” sounds so harsh, unfair, and depressing. Everyone matters. Everyone has something to offer. You do too. By telling yourself that you aren’t good for anything, you leave no room for hope, no possibility for some new way of living or being, no chance for change for the better. You can start today, right now, in making a difference for yourself by promising to examine your thoughts and challenge them. Let your thoughts be fair, not devastatingly negative. Promise not to treat yourself badly. You don’t deserve it.

  3. lisa says:

    I can relate with NANCY and RENEE,everyday is a bad day,but on the really bad days its hard to see or feel the light at the end of the tunnel.then i can add that really dark depression i go through,you just cant turn it off.i do tell myself it will pass but getting through those horriable days are really hard.then you can add your family to the already unsettled emotions and pain,who think they know how to help you or know what you are going through makes it even worse.then add your doctor to the mix,which that is another story in itself,so you are left with your self,thinking i myself dont know what the answers are,how can i expect anyone else to know.we are all different and we all respond differently.all i can do is ride it out,waiting for my better days,which dont last long,but i can only thank god to have some mercy on me.What else is there to do,but only pray people around me can just have some compassion and understanding without judgement.not looking for pity just some understanding period.good luck to both of you,my prayers are for all who have to endure any pain physically and emotionally.

  4. Marti says:

    I can relate to all of them although with me I was dianosed with depression way before my Fibro, I have ADD so depression has been with me for a lot of years. I am pretty sure I have had Fibro and just put it off as getting older and such. I wake up in pain and go to sleep in pain. I have had 3 disc in my neck replaced and 4 in my lower back, if I try to do any house work then I walk like the hunch back for a couple of days. So I pretty much watch my husband (who is very understanding of my disease) he does most of the chores and kills me. I have gained alot of weight I’m 265 if not more and my heart doctor is saying I have pulmanary artery pressure in english my fat is pressing against my heart. Since I can not do major exercise he has suggest a lap-band which my insurance does not cover and now I have to weight for my medicare to kick in. I sit in the dark all day because the light gives me major migraines. I have no live i get depressed all the time because I feel like I need to help financially and physically. Yes I’m on disability but sometimes that is not enough. So any way I think or know their are alot of people out their that are worse off then me and that helps me get out of that depression mode..Thanks for listening the only family that believes me is my husband and my kids the rest don’t believe. It is a unvisable disease, some times I wish I had cancer just so they would treat me with some respect, and some days I don’t want to wake up and go through another day…This is my life. Soft Hugs to all. Marti

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