Oct. 13, 2025 — People with chronic pain hear all about a fantasy world while living in a real one.
From social media to headlines, that fantasy world has never been more in our faces.
Fantasy: Research shows exercise helps chronic pain! Just get moving! Build strength, push through, all the data points to long-term pain relief from physical activity!
Reality: Every decision about movement can feel like a negotiation. Will this make me worse? Am I about to trigger a flare? Is five minutes even worth it?
Christynne Helfrich, a physical therapist at Hinge Health, mentions a recent patient, call him Kevin, who encapsulated the typical pain patient she sees: He’d already cycled through three other PTs, undergone imaging that revealed nothing, and still found himself in constant pain.
“To say he was doubtful before we even began would be an understatement,” she says.
Kevin’s complaint: Persistent and sometimes brutal neck and shoulder pain. But he also suffered the ripple effects — friendships fading because he was “too grumpy to be around,” activities he once loved slipping out of reach.
Helfrich listened. She asked questions about his daily routines, stress levels, sleep; she noticed patterns that no provider had walked him through before.
Over the next 12 weeks, Kevin’s relationship with movement began to change. The pain didn’t vanish overnight, and flare-ups still happened, but they no longer defined him. Instead of spiraling, he understood his triggers, adjusted, and kept going. The result was far from a miracle cure, but it was something more sustainable: confidence, resilience, and a path forward.
Helfrich’s story illustrates a bigger truth about the complicated intersection of chronic pain and exercise. The barriers aren’t just physical; they’re emotional, psychological, and deeply personal.
It’s true that physical activity can help reduce pain. But movement, as a treatment, is just one component of a larger plan. By educating yourself — and giving yourself plenty of grace — you can find your way back to a fuller, more active life.
Understanding Chronic Pain
First, it might help to understand what chronic pain is. The International Classification of Diseases (ICD-11) defines it as pain that lasts more than three months and is not caused by a condition, but rather pain is the primary problem.
It isn’t just sore joints or aching muscles. It’s a full-body, brain-driven shift in how your nervous system processes signals. “Because so many parts of the brain and so many systems of the body are involved, people's experience of pain is as unique as their fingerprint,” says physical therapist Jen Uschold, an expert in pain science.
You can think of it a bit like a hyperactive house alarm. “If your house alarm goes off when a brick is thrown through your window, that’s good,” says Uschold. “However, if a leaf sets off your house alarm, the problem isn’t the house — it’s the alarm’s sensitivity. With chronic pain, the amazing nervous system is doing its job, it’s just doing it a little too well.”
The good news? Research shows people can retrain how they experience pain. In pain neuroscience education (PNE), Uschold notes there are 22 evidence-based, nonsurgical, non-pharmacological strategies that help — and the most important are education and exercise.
“Patients need to understand how pain works to be able to effectively address their symptoms and improve their function,” says Uschold. “We have more than a dozen systematic reviews and meta-analyses showing us that when we teach people about pain, they have less pain.”
Helfrich has seen this firsthand. “In 15 years, the biggest shift in my practice is how I educate patients: why pain happens, how it happens, and how to change it,” she says. “Most of the time, chronic pain isn’t about injury or tissue damage, but with how our brain is interpreting information around us. Once people can start to understand this, it’s incredibly empowering. They realize they have permission to move.”
Why Movement Matters
When you’re living with chronic pain, the idea of exercise can feel like punishment.
Which gets us back to that fantasy world we mentioned earlier: chronic pain patients being constantly told that simply moving more will help them in the long run. True on paper, especially when you talk about building muscle to support joints. But for best results, research and patient experiences show that movement, done strategically, can reshape the way your body experiences pain.
“Movement is one of our top strategies to ease the sensitivity of the nerves,” says Uschold. Think of it like resetting that faulty alarm. “When we introduce blood flow and movement into the nervous system, the sensitivity of the nerves calms down. And when nerves are less sensitive, the alarm is less likely to go off.”
Exercise doesn’t just retrain the nervous system — it strengthens the whole body. “Through gradual stretching and strengthening, the brain learns that movement is safe again, which dials down the pain response,” says Helfrich. Over time, exercise also releases endorphins, improves mood, and boosts energy, helping break the depression-pain cycle.
The science backs it up. Dozens of studies show that regular activity reduces pain severity and improves function. A 2022 meta-analysis found that patients with fibromyalgia who followed aerobic, strength, or flexibility programs reported less pain, fewer depressive symptoms, and improved quality of life months later. And a 2017 systematic review even found that people who tolerated mild discomfort during exercise did just as well long-term as those who stayed pain-free, suggesting a little soreness isn’t harmful and may even signal progress.
Movement can also restore a sense of agency. A 2023 review of chronic low back pain found that consistent movement improves self-efficacy (the belief that you can manage your pain), which is one of the strongest predictors of long-term recovery.
But it hurts.
That’s why sticking with it is hard. In a 2024 study, every participant reported pain during exercise. For some, the sharp spikes of a flare-up felt like proof they were doing something wrong. For others, the frustration was quieter but no less corrosive: pushing through week after week without seeing any change in pain. If exercise seemed to make their pain worse — or at least didn’t lessen it — what was the point of keeping at it? That sense of futility became one of the most powerful barriers to adherence, often undercutting the fragile confidence participants were working to build.
“There’s no one-size-fits-all solution,” notes researcher Yannick Gilanyi, a PhD candidate at the Neuroscience Research Australia Centre for Pain IMPACT in Sydney, Australia. “Exercise has the potential to increase pain self-efficacy — or reduce it — depending on how it’s delivered.”
Building Confidence, One Step at a Time
The goal of exercise isn’t to conquer pain — it’s to move in a way that teaches your body and nervous system that activity is safe, even when it hurts.
But it’s not a silver bullet. What works for one person might make things worse with someone else, says Helfrich. “Someone with low back pain, for example, might benefit from targeted strengthening and mobility exercises to support the spine and improve posture,” she says. “Those movements would look very different from the gentle, full-body mobility work that might support someone managing systemic inflammation from a condition like lupus.”
That last part is worth drilling down on a bit. Broadly speaking, managing localized chronic pain is more straightforward. If your knee joint is the issue, you can work to strengthen it, or work around it. If your wrists are riddled with arthritis, there are ways to change up your grip, or your equipment, to make certain exercises more manageable.
Conditions like lupus, fibromyalgia, and endometriosis, on the other hand, don’t just cause physical chronic pain — they often lead to punishing levels of fatigue. It’s one thing to find ways to “just do it” when your lower back is always bothering you. It’s an entirely other thing to push yourself to move when your body hurts and feels like it’s running on 3% battery.
“It’s important to recognize and acknowledge that engaging in physical activity is often easier said than done, especially for individuals living with autoimmune rheumatologic conditions,” says Saira Z. Sheikh, MD, the Linda Coley Sewell Distinguished Professor of Medicine at the University of North Carolina School of Medicine. “While physical activity is a powerful yet underutilized tool in managing these diseases, many patients, understandably, avoid it due to concerns about triggering flares or exacerbating fatigue.”
Given the unpredictable nature of chronic pain, Sheikh stresses that it’s crucial to approach movement with flexibility and patience, adjusting activity levels based on how the body feels at a given time — regardless of the root cause.
Flexibility: You can only manage a few minutes of physical activity at a time? It counts. It can help. Exercise is cumulative.
Patience: You’re worried you haven’t seen improvement after a few weeks? Think longer-term. Be consistent over time and see how you feel after one, three, and six months.
It’s an approach that helps build self-belief, trust, and agency, and researchers have found that developing a strong conviction that you can manage your pain and take control of your condition is critical to a patient’s long-term success. Some patients build this confidence slowly, often through cycles of trial and error. Others leaned on a more structured strategy, like pacing or graded exercise. By starting small and gradually increasing what they could tolerate, they found that confidence and strength rose side by side. The more they trusted their bodies to move, the more they moved — and with that shift, sticking to exercise became far easier.
“It is much less about the type of exercise and more about the pacing and intensity to create safety in the nervous system,” says Uschold. “A safe nervous system does not create pain experiences.”
What kind of exercise? The best exercise program is one that fits into your life, respects your limitations, and gradually expands what you’re capable of. Can you walk? Walk. Can you run? Do that. Strength training is especially good.
It’s not about pushing through pain; it’s about teaching your body that motion is an ally, not an enemy.
The Mind-Body Connection
Here’s the part we don’t talk nearly enough about: Chronic pain isn’t just a physical burden, it’s an emotional one as well. According to Uschold, roughly 40% of people with chronic pain also struggle with anxiety or depression.
“Stress, anxiety, depression, and social circumstances heavily influence how the brain interprets pain signals,” says physiatrist Jennifer Hankenson, MD, assistant professor of orthopedics and rehabilitation at Yale School of Medicine. “The most successful patients recognize the strong connection between mental health and pain perception.”
Luckily, some simple, research-backed mindset tools can help retrain this system. Take motivational interviewing, for example: a coaching technique that uses open-ended questions and goal setting to nudge people toward action. In one trial, older adults who combined motivational interviewing with supervised exercise not only moved more, but also reported less pain, greater happiness, and newfound confidence in their ability to cope. And a 2021 study found that using cognitive behavioral therapy (CBT) helped chronic pain patients reframe negative thoughts, accept pain without fear, and develop coping strategies — leading to less catastrophizing, better sleep, and more engagement in daily life.
Positive psychology tactics show similar promise. In a 2017 randomized, controlled trial, an eight-week internet-based program focusing on optimism and self-compassion significantly improved happiness and reduced depression in people with chronic pain, with benefits lasting at least six months.
An important caveat to all this: Positive psychology is not a panacea nor can it be rushed, explains the study’s lead researcher Madelon Peters, PhD, professor of clinical psychological science at Maastricht University in the Netherlands. And implementation matters.
“If someone is seeking help for his or her pain, they cannot start with an exercise requiring them to look at a bright future because the discrepancy with their current situation is too big,” she says.
Peters explains that they started with self-compassion exercises “to create a mindset where one learns to take care of oneself and be open to the subsequent exercises.” Gradually, over the course of eight weeks, participants engaged in practices like the “Three Good Things” exercise or savoring positive moments.
“The final step was looking with positivity to the future,” says Peters. “We did not plunge into this immediately.”
Keeping It Moving
Chronic pain doesn’t exist in isolation. Starting — or restarting — exercise can often feel as much of a mental battle as a physical one. For many patients, exercise prescriptions alone rarely suffice. The difference between giving up and pushing forward, more often than not, comes down to feeling seen — and believed.
“Chronic pain is often dismissed or misunderstood, which can lead to feelings of frustration and isolation,” says Hankenson. “Many people believe that if there isn’t an acute injury, the pain is imaginary or ‘made up.’ Biology, however, tells a different story. Pain is highly complex and doesn’t always have an easy fix, but it's important for people to know that their pain is real.”
Like Kevin, participants across studies emphasized how a trusted health professional or close personal support could make or break their willingness to keep moving. When a physical therapist, doctor, or friend took the time to listen, to acknowledge the complexity of living with pain, adherence (and overall attitude) improved dramatically.
It’s in those moments — when someone feels truly heard, believed, and supported — that the shift happens. The same movements that once felt threatening begin to feel manageable. Pain loses some of its power, and confidence grows alongside strength.
More reading: Our Fundamental Misunderstanding of Pain
