For millions of people living with chronic pain, the hardest part isn't always the pain itself - it's the sense that it is taking over their life.
A new study from the University of Warwick has used a real-time, day-to-day tracking method to show that 'mental defeat' - the psychological state in which people feel worn down by pain and begin to lose their sense of self - shapes the day-to-day experience of chronic pain.
Published in the journal PAIN, researchers found that when people feel mentally defeated, they are more likely to focus on their pain, see it as damaging to their identity and future, and withdraw from everyday activities, making it a critical factor in reduced quality of life.
Professor Nicole Tang, Department of Psychology, University of Warwick and first author, said: "Pain is not something that can simply be taken away, it is someone's reality. But how people relate to their pain, and the meaning they attach to it, can add an extra layer of distress that we might be able target with the right interventions."
Chronic pain affects around 20% of people and is widely recognised as not just a physical condition. It is shaped by psychological, emotional, and behavioural factors that fluctuate throughout the day, making it difficult to target effectively with traditional approaches.
In this study, researchers used an innovative real-time sampling method to capture these fluctuations, analysing data from 137 adults living with chronic non-cancer pain. Participants reported their thoughts, feelings, and behaviours three times a day over two separate weeks.
Professor Tang continues: "You can think of this method like a scientific stop-motion animation captured over a two-week period. Each frame shows a snapshot of what someone is thinking, feeling, or doing, but when you put them together, you can see how those experiences unfold and influence each other over time."
The findings show that increases in mental defeat consistently predicted greater attention to pain and stronger beliefs that pain was harming one's self, relationships and future. These perceptions, in turn, are linked to reduced physical activity.
The study also identified a self-reinforcing loop: feeling mentally defeated leads to more negative self-perceptions, which in turn further increase mental defeat. This cycle may help explain why some individuals experience persistent pain-related distress even when pain levels remain stable.
Mental defeat appeared to operate independently of pain intensity, stress, and mood. It is not simply a byproduct of feeling worse or being in more pain, nor does it directly increase pain intensity, but instead represents a distinct psychological process influencing how pain is experienced and responded to.
These features make mental defeat a promising target for intervention. By addressing negative self-perceptions and attentional focus, interventions may help disrupt this self-reinforcing cycle, reduce its impact on daily functioning, and improve quality of life.
Professor Swaran Singh, Warwick Medical School, and co-author added: "By identifying when mental defeat spikes during the day, future digital tools, such as smartphone-based interventions, could deliver timely support to help individuals reframe negative self-perceptions, maintain activity, and reduce suffering. This kind of 'just-in-time' approach could offer more personalised support alongside existing treatments."
CASE STUDY
Fiona McNiven, 61, from Leeds, has lived with neuropathic and musculoskeletal pain for more than three decades and strongly resonates with the findings of this research. A former nurse, her pain began around 35 years ago after the birth of her first child .
"It was a nerve injury, and I didn't understand anything about it. I didn't know anyone who had the same symptoms and I was scared. Before that, I was a confident person, going here, there, and everywhere, working 14-hour shifts at a big hospital. I had tons of energy, even after four hours' sleep, I never felt tired. Now I'm the complete opposite. The pain has stopped me in my tracks, and I feel completely exhausted all the time."
"If I'm doing anything physical, bending, crouching, I can feel the nerve and get burning pain. If I walk too far, go uphill or upstairs, it kicks off. When I have a flare-up, it's horrific, I have to use ice, wear loose clothes, and I don't sleep well because it affects me through the night. At its worst, I couldn't sit down or stand up without pain, I couldn't wear normal clothes, and I carried ice packs everywhere. It completely overtook my life."
Fiona said the feeling of 'mental defeat', and the wearing down of one's sense of self, closely reflects her own experience, particularly in the earlier years of her condition.
"It's the hardest thing I've ever been through. It affected my mood and my confidence, and I felt like there was absolutely nothing I could do. Day to day, it's a mental slog. I would catastrophise about the future and couldn't see one for myself. I remember asking a specialist, 'if I can't sit down now without pain, what will my future look like?' I didn't believe a fulfilled life with pain was possible. It felt like I was being worn down and losing who I was."
Over time, this began to shrink her world and affect her daily life.
"I don't go to many places on my own now. Some days I'll have a bowl of porridge in the evening because that's all that's in the cupboards and I can't even face going to the shops or being around crowds. If I'm travelling somewhere new, I lose sleep worrying about how I'm going to get through it. And if I'm on my own, it can feel completely overwhelming, you've got no energy, nothing to distract you, and it just builds."
Despite this, Fiona continues to find ways to live a full life and uses her experience as a volunteer on the helpline for the charity Pain Concern.
"I do get out and do things. I've got three children, a husband, and a young granddaughter, and when I'm with them, I'm surrounded by pure joy - that's probably the only time I don't really feel the pain. But the people I speak to on the phone are often those who are living alone and socially isolated. If you're sitting in pain by yourself, it starts to beat you mentally and emotionally and some are so frightened of their pain that it stops them doing anything."
