Do you ever feel trapped in a loop of negative thoughts about your pain? Worrying about symptoms, fearing they’ll never go away, or analyzing every sensation in your body? This cycle, called rumination, is incredibly and understandably common in chronic pain sufferers, but it can actually make pain worse.
Why Rumination Fuels Chronic Pain
Your brain is wired for survival, which means it naturally fixates on discomfort, scanning for danger. But when you ruminate – constantly analyzing symptoms, predicting worst-case scenarios, or Googling endlessly – you’re reinforcing the brain’s perception of pain as a threat. This keeps your nervous system in a state of high alert, and the pain-fear cycle continues.
Pain can easily trigger feelings of fear, and as we know, fear makes the brain more likely to misinterpret safe signals as dangerous, which causes more pain. More pain leads to more fear, and more fear leads to more pain. When we overthink, ruminate, and catastrophize, we only contribute to the perpetuation of symptoms.
You are not alone in how you may have become accustomed to responding to symptoms – it makes a lot of sense to respond to pain with fear. But it is nearly impossible to recover when stuck in this pain-fear cycle – so we’re going to show you how to break it.
“We often confuse determination with its evil twin: fixation. – Venugopal Gupta” ~ John E. Sarno
How to Stop the Rumination-Pain Loop
Notice the Pattern – The first step is recognizing when you’re stuck in overthinking. Pay attention to thoughts like “What if this pain never goes away?” or “I should have done something differently.”
Shift from Thinking to Feeling – Instead of engaging in more thoughts, check in with your body. Where do you feel stress, tightness, tension, or anxeity? Breathe into that sensation and try to observe it without judgment.
Practice Self-Compassion – Many people respond to rumination with frustration (“I shouldn’t be thinking this way!”), but research shows that self-kindness helps rewire the brain in a much more effective way.
When you engage in a familiar pattern like preoccupation or rumination, you can try using the 3 C’s or the 3 R’s!
Tool #2: The 3 R’s
- Recognize: Recognize what fear thoughts your brain gravitates toward and why.
- Reappraise: Actively choose not to buy into the fear thought and take the road less traveled. Chances are you have been paving the path of fear toward your pain for a long time. It is no wonder why those neural pathways are strong and, so to say, easy to travel on. The more you begin to take a new path, the road less traveled, the more that road becomes paved, and the less the other.
- Replace: Use messages of safety. This may be self-directed messages of empowerment, attending to physical sensations without judgment or ulterior motive, or leaning into pleasant sensations!
Tool #2: The 3 C’s
- Catch: Catch your brain gravitating to a familiar negative behavioral pattern or thought.
- Congratulate: Be proud of yourself for catching this instead of feeling shameful or guilty for engaging in this pattern.
- Carry On: Lean into something positive!
Podcast Spotlight: A Real-Life Breakthrough 🎙️
In this week’s PRT Podcast, therapist John Gasienica, LCSW works with Leslie, a new mom struggling with chronic pelvic pain and relentless rumination about her symptoms. John, alongside expert therapist Callie Klebanoff, LCSW, breaks down the PRT blueprint for disrupting rumination and retraining the brain to feel safe. They discuss:
– Why rumination is one of the biggest roadblocks to pain recovery.
– How overthinking reinforces pain pathways in the brain.
– Practical strategies for shifting from fear-based thinking to self-compassion.
– A real-time session where Leslie learns to calm her nervous system and reduce pain.
If you’ve ever felt stuck in your thoughts about pain, this episode will give you the tools to break free from pain fixation and start healing.
🎧 Listen to the full episode here!
Research
Pain rumination has been linked with higher pain levels and poorer clinical outcomes in multiple chronic pain populations. Rumination involves excessive attention to distressing thoughts, often seen in mental health diagnoses like depression, but the specific fixation on pain can uniquely affect brain networks associated with attention, pain perception, and pain modulation.
Brain changes in chronic pain are connected to the specific cognitive factor of pain rumination. According to The Journal of Neuroscience, people with chronic pain have abnormal connections in their brain – specifically between the medial prefrontal cortex and the default mode network. In patients with temporomandibular disorder (like TMJ), pain rumination is linked to brain activity in areas related to the emotional side of pain, like the thalamus, and to systems that help modulate pain. These brain changes, most apparent in those who constantly think about their pain, influence pain perception and regulation.
Many patients ask, “Why am I ruminating even when I know it is bad for me and my recovery?” The simple answer is, it is just a habit. And anything familiar, at a primitive level, feels safe to our brains.
If you know what your brain is doing and why it is doing it, you can also reassure yourself that just because a thought appears in your head does not mean you have to listen to it and it does not mean it is true. Try looking at racing thoughts like a train whizzing by. You can get on the train, or stay on the platform and watch it pass by, actively choosing not to buy into the negative thoughts.
Kucyi, A., Moayedi, M., & Davis, K. D. (2014). Default Mode Network Functional Connectivity in Chronic Pain: Association with Pain Rumination. The Journal of Neuroscience, 34(11), 3969–3975. https://doi.org/10.1523/JNEUROSCI.5055-13.2014