Teen looking at her phone dealing with chronic pain

The Link Between Chronic Pain and Self-Harm

7 min.

Living with chronic pain has been linked to an increased risk for self-harm behavior, also known as nonsuicidal self-injury (NSSI). Learn more about chronic pain and its connection to self-harm here.

By: Ethan Cohen BSN, RN

Clinically Reviewed By: Don Gasparini Ph.D., M.A., CASAC

March 10, 2023

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If you have ever suffered from an injury or been sick for more than a couple of days, then you know how difficult these periods of time can be on your mental health. Not being able to engage with the world like you normally do, not feeling fully like yourself, and the loneliness and isolation that comes with trying to recover all create a situation in which using healthy coping mechanisms is critical. 

Without positive coping skills, the frustration, anger, sadness, anxiety, and fatigue that come with periods of physical illness and pain can be too much for us. Unfortunately, individuals who suffer from persistent and long-term pain (also known as chronic pain) know these feelings well and are tasked with the challenge of maintaining their mental health while dealing with their physical pain.

Over the past several years, the medical community has been exploring the relationship between chronic pain and mental health and has recognized that the two are inextricably connected. In fact, living with certain chronic pain conditions can put a person at higher risk for engaging in self-harm, also known as nonsuicidal self-injury (NSSI). Learn more about the connection between chronic pain and NSSI below. 

What is chronic pain?

We all experience pain. That being said, our body and mind aren’t built to experience pain that lasts for extended periods of time. Physical pain is meant to be a temporary sensation that signals our body to stop whatever it is that we are doing that is causing us discomfort. 

Pain that typically lasts less than three months is called acute pain. It is the type of pain that many of us have personally experienced, regardless of an individual’s pain threshold. Chronic pain, on the other hand, refers to pain that lasts beyond three months and negatively affects our overall quality of life, ability to function, and (as we are beginning to learn) mental health.

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Chronic pain and mental health

Chronic pain is a pain condition known to change the levels of stress hormones and neurochemicals within the brain and nervous system. Chronic pain patients may experience alterations in mood, thinking, and behavior. In some cases, these alterations can lead to self-harm behavior. 

Chronic pain has been associated with a wide variety of negative functional, emotional, and mental health issues. Some of the negative effects of living with chronic pain include but are not limited to:

  • Decreased ability to function
  • Difficulty with social activities 
  • Lowered self-esteem 
  • Sleep disturbances 
  • Fatigue
  • Lowered concentration
  • Decreased appetite 
  • Mood changes
  • Anxiety
  • Depression 
  • Substance use disorder 
  • Suicidal ideation 
  • Self-harm behavior

What is self-harm, or nonsuicidal self-injury (NSSI)?

Non-suicidal self-injury is defined as “the direct and deliberate destruction of one’s own body tissue in the absence of suicidal intent.” Some examples of NSSI are cutting, scratching, headbanging, hitting, burning, and picking at skin and wounds. Along with conditions of chronic pain, self-harming behavior is associated with major depressive disorder, bipolar disorder, anxiety disorder, borderline personality disorder, and general emotional instability

NSSI is more common than you might think, with 17.2% of adolescents, 13.2% of young adults, and 5.5% of adults reporting engaging in self-harm behaviors. 

Along with the risk of serious bodily injury, engaging in self-harm behavior puts a person at greater risk for death by suicide. According to a 2002 study by the University of Leeds, England, 5% of individuals that are hospitalized for injuries related to NSSI died by suicide within nine years of discharge. 

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Chronic pain conditions associated with NSSI

  • Arthritis 
  • Fibromyalgia 
  • Other rheumatic diseases
  • Multiple sclerosis 
  • Back and neck pain 
  • Chronic migraines
  • Irritable bowel syndrome 
  • Menstruation-related pain 
  • Sickle cell anemia 
  • Cancer 
  • Chronic Lyme disease 
  • Other autoimmune disorders 

Why do people engage in self-harm?

Understanding the role of pain during NSSI is one of the most challenging questions facing the medical community today. It seems counterintuitive that someone would willingly engage in self-harm behavior when all of our evolutionary defense mechanisms are programmed to help us avoid or minimize pain. In the case of individuals suffering from conditions of chronic pain, it is even more difficult to conceptualize why they would engage in behavior that would cause them further pain, considering the fact that they are already suffering. Yet, research has shown that individuals with certain rheumatic conditions such as fibromyalgia, rheumatoid arthritis, and osteoarthritis are twice as likely to engage in self-harm behavior than the general population. Paradoxically, individuals that engage in NSSI report temporary relief from pain. Below are three theories that attempt to explain this phenomenon:

Pain analgesia effect

Analgesia means a reduction in pain. The use of self-inflicted pain creates a scenario of increased pain tolerance over time so that the baseline chronic pain experienced before the self-harm behavior begins to feel “more tolerable”. This analgesic effect could also be related to endorphins released during the act of infliction. 

Pain onset model

This theory can be understood as an attempt to use self-inflicted pain as a form of distraction from chronic pain or distress. This is the individual’s attempt to “short circuit” their experience of physical and emotional pain.

A young woman dealing with both self-harm and chronic pain searches for mental health resources on her phone

Pain offset relief

This theory can be understood as the temporary experience of relief provided by the subsiding of the pain from self-inflicted injury. The relief is experienced by going from a high level of pain (during NSSI) to a lesser level of pain while the pain from the injury dissipates. 

There are also other theories that propose that self-harm behavior is used as a form of self-punishment in individuals with low self-esteem or high levels of guilt. Other theories propose NSSI can, in some cases, constitute an individual’s attempt to gain attention from others. It has also been proposed that NSSI occurs as an attempt to feel emotional or physical sensation in individuals that report feeling “numb”.  

The “terrible triad” 

When a person experiences physical pain over an extended period of time, and it begins to affect their ability to go to school, work, spend time with friends, and engage in other activities that make them happy, they become a victim of a vicious cycle. The frustration and preoccupation with their pain may cause irritability, depression, and anxiousness, which leads to weariness and insomnia. The persistent sleeplessness and fatigue then lead to worsening emotional and mental states. John Hopkins Medicine refers to this state as the “terrible triad” of suffering, sleeplessness, and sadness. 

It is from this desperate state that many individuals that suffer from chronic pain begin to consider engaging in self-harm behavior. Whether you are a person that is suffering from chronic physical pain, persistent emotional pain, or both, if you are in a place where you are considering harming yourself, it is absolutely necessary to reach out to a mental health professional today. 

Through collaboration between your medical doctors, who can help better manage your physical pain, and mental health professionals, who can help you develop healthy coping skills to deal with your situation, a healthier and less painful way of living is possible. 

Treatment for chronic pain and mental health 

Treatment for conditions of chronic pain and the mental health challenges associated with them should be approached from a multidisciplinary perspective. It is important to note that chronic pain is oftentimes treated with medications, and that some of these medications, namely opioids, while incredibly effective and useful, are also highly addictive. This is why it is so important to collaborate with your healthcare provider to create a holistic approach to your pain management, one that not only includes medications, but also considers and incorporates other forms of treatment and therapy. Other such treatments include physical rehabilitation programs, stress reduction techniques, antidepressants, and talk therapy. 

How Charlie Health can help  

Chronic pain is a major medical condition that can be treated. Ensuring that you are taking care of both your physical and mental well-being is part of this treatment. Chronic pain and the emotional and mental pressures that come with it can lead to detrimental consequences if not treated properly. 

Engaging in self-harm behavior is an example of a negative consequence of untreated chronic pain that cannot be ignored. 

The trained professionals at Charlie Health can help you to better understand how to live with a condition of chronic pain, and work with you so your emotional and mental well-being can be maintained while you move towards pain relief and recovery. Several medications and several forms of talk therapy have shown promise in reducing self-harm behaviors, and the mental health professionals at Charlie Health would be happy to discuss treatment options with you today. 

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