Summary: Chronic pain affects about one in five adults, and medications alone often do not provide sufficient relief. A new review led by researchers at Aarhus University shows that psychological treatments—especially cognitive behavioral therapy (CBT)—can reduce chronic pain by producing measurable changes in brain activity.
By combining results from many smaller studies, the review finds that psychological interventions alter brain networks involved in pain processing and emotion regulation. These changes correspond with reduced pain intensity and improved daily functioning, supporting the potential of non-pharmacological approaches such as CBT and digitally delivered therapy to expand access to effective pain management.
Key Facts:
- Brain Changes: Psychological therapy modifies neural networks linked to pain perception and emotional response.
- CBT Effectiveness: Cognitive behavioral therapy has the strongest evidence among psychological approaches.
- Digital Access: Apps and digital programs may provide scalable, accessible ways to deliver therapy-based pain relief.
Source: Aarhus University
Conditions associated with chronic pain:
Back pain, migraines, arthritis, long-term concussion symptoms and complications after cancer treatment are examples of conditions that commonly lead to persistent pain. For many people, ongoing pain has a major impact on work, relationships and overall quality of life.
The new review, published in The Lancet and led by Professor Lene Vase from the Department of Psychology at Aarhus BSS, synthesizes neuroimaging and clinical studies to explain how psychological treatment can relieve chronic pain by changing the way the brain and spinal cord process pain signals.
“People often turn to medication when they experience pain, but for many with chronic pain, drugs alone are insufficient. Clinicians are seeking additional evidence-based options,” says Lene Vase, who holds both a doctorate in medicine and a professorship in psychology. “Psychological treatment is a viable alternative, and our review brings us closer to understanding the neurobiological mechanisms behind its effects.”
Scientific explanation
Psychological therapies have long been observed to reduce reported pain, but until now the link between therapy and physical changes in the nervous system has been less clear. The studies reviewed were individually small and varied, but taken together they reveal consistent patterns of neural change associated with symptom improvement.
The review highlights that therapy can change activity within and between brain networks involved in attention, emotion, and self-referential thinking. These alterations appear alongside measurable reductions in pain intensity and better functioning, suggesting effects beyond simple distraction or temporary coping.
“More targeted trials are still needed to determine precisely which therapeutic components drive these neural changes,” Vase notes. “Nevertheless, our analysis identifies promising mechanisms and therapeutic elements that clinicians can prioritize while further research develops.”
When the brain is on autopilot
Cognitive behavioral therapy stands out in the review as a consistently effective approach. CBT aims to identify and modify automatic thought patterns and behaviors that can amplify pain-related distress. These automatic processes are associated with activity in the brain’s default mode network—a system that is active during self-focused, inward-directed thought.
The default mode network interacts with other circuits that manage emotion and pain. The review shows that therapy-related changes in how these networks communicate can reduce the emotional reactivity and catastrophic thinking that often worsen chronic pain.
“Pain can dominate daily life, driving worry about work, family and future activities,” says Vase. “When therapy helps patients loosen these intrusive thoughts and re-engage with meaningful activities, we see corresponding shifts in brain activity, less reported pain and improved quality of life.”
Digital delivery and self-management
Access to trained psychologists is limited in many regions, and the review highlights the potential for widely available alternatives. Physicians, physiotherapists and nurses can support patients by teaching core psychological principles, and digital tools can extend reach where face-to-face therapy is not feasible.
The authors note there are already hundreds of apps designed for psychological pain management, though robust evidence for many of them remains incomplete. While awaiting stronger trial data, Professor Vase suggests choosing programs grounded in cognitive behavioral principles, given the current evidence base.
Funding and conflicts
External funding: Independent Research Fund Denmark, Lundbeck Foundation, Aarhus University Research Foundation, National Institutes of Health and the National Institute of Mental Health (USA), Medical Research Council (UK), National Institute for Health and Care Research (UK), The MayDay Foundation, Versus Arthritis, Arthritis Research and Southwood Family Donation.
Conflict of interest: Lene Vase has received fees for courses on pain and placebo and has served on the scientific programme committee for the World Congress of Pain. Her co-authors from the USA and the UK have also received teaching and consulting fees. See the scientific article for full details.
About this research news
Author: Mia Ulvgraven
Source: Aarhus University
Contact: Mia Ulvgraven – Aarhus University
Image: Image credited to Neuroscience News
Original Research: Closed access. “Opportunities for chronic pain self-management: core psychological principles and neurobiological underpinnings” by Lene Vase et al., published in The Lancet (DOI: 10.1016/S0140-6736(25)00404-0).
Abstract
Opportunities for chronic pain self-management: core psychological principles and neurobiological underpinnings
Approximately one in five people experience chronic pain. Psychological interventions reveal core principles that can enable effective self-management of chronic pain in primary care, across health-care settings and at home. This review outlines the different types of chronic pain and the psychoneurobiological mechanisms involved. It evaluates core principles for psychological pain management, assesses existing evidence, and describes the underlying neurobiology. Practical guidance is provided for facilitating pain self-management in clinical practice, and the review discusses scientific limitations and implementation challenges while suggesting potential pathways forward.