Chronic pain remains one of the leading causes of disability. The recently estimated point prevalence rates were 20% in the United States [1], 18% in developing countries [2] and 33% worldwide [3]. Chronic pain often persists long after tissues have healed, influencing physical function, emotional wellbeing, sleep, work and social relationships. As our understanding of pain has evolved, so have treatment approaches. What is the best therapy for chronic pain? As you will soon uncover, the answer does not actually rely on a single treatment.
What is the best therapy for chronic pain?
From psychological therapies to neurofeedback, explore evidence-based chronic pain treatments and how Neuromind contributes to this evolving field.
Overview.
Key takeaways.
Chronic pain is a complex neurological condition influenced by biological, psychological and social factors.
Effective management of chronic pain often combines exercise, psychological therapies, education and, when appropriate, medication.
Modern neuroscience shows that changes in brain activity and connectivity contribute to the persistence of chronic pain.
Neurofeedback is an emerging neuromodulation technique that helps individuals learn to regulate their own brain activity and support quality of life.
Neuromind combines EEG-based neurofeedback and immersive virtual reality to investigate new personalised approaches to chronic pain therapy.
01
Understanding chronic pain mechanisms
What is chronic pain?
Chronic pain is generally defined as pain that persists or recurs for longer than three months. It may continue after an injury has healed or develop without an identifiable ongoing tissue injury. Common examples include chronic low back pain, fibromyalgia, migraine, neuropathic pain and osteoarthritis.
Unlike acute pain, which acts as a warning signal to protect the body from harm, chronic pain often loses this protective function. Instead, it becomes a long-term health condition in its own right, affecting many aspects of daily life.
People living with chronic pain frequently experience fatigue, sleep disturbances, anxiety, depression and difficulties concentrating. These symptoms are not simply consequences of persistent discomfort, they reflect the close relationship between pain processing, emotional regulation and brain function [4][5].
Why does chronic pain persist?
The persistence of chronic pain is rarely explained by ongoing tissue damage alone. Instead, researchers have identified several mechanisms that can maintain pain long after the initial injury has resolved.
One of the best-known mechanisms is central sensitisation. In this state, the central nervous system becomes increasingly sensitive to sensory information, amplifying pain signals and sometimes generating pain in response to normally harmless stimuli [7].
Neuroplastic changes also play an important role. The brain continuously adapts in response to experience, and persistent pain can reinforce neural pathways associated with pain perception. Over time, these changes may alter how sensory information, emotions and memories interact, making pain more difficult to resolve [8].
Stress, anxiety, fear of movement and pain catastrophising are all examples of emotional and cognitive processes that can modulate pain processing [9].
How does the brain influence pain perception?
Pain is ultimately constructed by the brain. While sensory nerves transmit information from the body, the brain determines how that information is interpreted, integrating sensory signals with attention, memory, emotions and previous experiences [10].
Brain imaging studies have shown that chronic pain is associated with changes across several large-scale neural networks, including those involved in emotional regulation, cognitive control and self-referential thinking [11]. Among these, the Default Mode Network (DMN) has attracted growing scientific interest.
The DMN is typically active during internally focused thought, such as self-reflection and mind wandering. For people living with chronic pain, altered connectivity within the DMN has been associated with persistent pain, rumination and increased attention to painful sensations [11][12]. Therefore, chronic pain is not only a sensory experience but also involves changes in how the brain processes internal information.
02
Evidence-based therapies for chronic pain
Physical therapy and exercise.
There is no single best therapy for chronic pain. Current clinical guidelines recommend a personalised, multidisciplinary approach combining physical rehabilitation, psychological therapies, education and, when appropriate, medication [12].
For many people living with chronic pain, movement is one of the most effective long-term interventions. Although it may seem counterintuitive to exercise when pain is persistent, regular physical activity can help reduce pain sensitivity, improve mobility and restore confidence in movement.
Exercise also supports cardiovascular health, muscle strength and overall wellbeing. Importantly, it can influence the central nervous system by promoting neuroplasticity and reducing fear-avoidance behaviours, which are common in chronic pain conditions [13].
Depending on the condition, physiotherapists may recommend strength training, aerobic exercise, stretching, balance exercises or low-impact activities such as swimming, Pilates or yoga. The key is to introduce movement gradually and tailor it to the individual’s abilities and goals.
Psychological therapies: CBT and ACT.
Living with chronic pain affects far more than the body. Persistent pain can alter mood, attention, sleep and daily behaviour, creating cycles that reinforce disability and emotional distress. Psychological therapies provide practical strategies to change the way pain is experienced and managed.
Cognitive behavioural therapy (CBT) is one of the most extensively studied psychological interventions for chronic pain. It helps individuals identify unhelpful thought patterns, develop healthier coping strategies and gradually resume meaningful activities. Numerous clinical trials have shown that CBT can reduce pain-related disability, anxiety and depression while improving quality of life [14].
Acceptance and commitment therapy (ACT) adopts a slightly different approach. Rather than focusing on reducing pain itself, ACT encourages psychological flexibility by helping individuals accept difficult experiences while engaging in activities aligned with their personal values. Research suggests that ACT can improve functioning and emotional wellbeing in people with persistent pain [15].
Mindfulness-based interventions.
Mindfulness has become an increasingly recognised component of chronic pain management. By cultivating present-moment awareness without judgement, mindfulness practices can help individuals change their relationship with pain rather than attempting to eliminate it completely.
Programmes such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) have demonstrated modest but meaningful improvements in pain intensity, emotional distress and quality of life for some people with chronic pain [16].
From a neuroscience perspective, mindfulness appears to influence brain regions involved in attention, emotional regulation and self-referential processing. Neuroimaging studies suggest that regular practice may modify functional connectivity within networks associated with pain perception, including the Default Mode Network [17].
Medication and medical interventions.
Medication remains an important component of chronic pain management for many patients, particularly during acute flare-ups or when symptoms significantly affect daily functioning.
Depending on the underlying condition, treatment may include non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants, anticonvulsants or other analgesic medications. In selected cases, interventional procedures such as nerve blocks or spinal cord stimulation may also be considered [12].
However, medication alone rarely provides a complete solution for chronic pain. Long-term use of certain drugs may be associated with side effects, tolerance or dependence, highlighting the importance of combining pharmacological treatments with non-pharmacological approaches whenever appropriate.
Why multidisciplinary care often delivers the best outcomes.
Since chronic pain affects multiple aspects of health, the most successful treatment plans typically involve professionals from different disciplines working together. A multidisciplinary approach may include physicians, physiotherapists, psychologists, occupational therapists and pain specialists.
Rather than targeting a single symptom, this model addresses the biological, psychological and social dimensions of pain simultaneously.
Research consistently shows that multidisciplinary pain management programmes can improve physical functioning, reduce disability and enhance quality of life, even when pain intensity itself changes only modestly [18].
03
Does neurofeedback work for chronic pain?
Active learning for the brain.
Unlike passive treatments, neurofeedback is based on active learning. By providing real-time information about brain activity, neurofeedback seeks to strengthen self-regulation mechanisms rather than simply suppress symptoms. Researchers suggest that this process may help individuals develop healthier patterns of neural activity, potentially influencing how pain is perceived and managed [19].
Several systematic reviews suggest that EEG-based neurofeedback may reduce pain intensity and improve quality of life in conditions such as fibromyalgia, neuropathic pain and chronic musculoskeletal pain [20][21][22].
Although further research is needed, this brain-centred perspective aligns with the growing recognition that effective chronic pain management should address both the body and the nervous system.
04
Neuromind’s innovative approach to chronic pain therapy
Immersive, closed-loop neurofeedback.
Growing evidence suggests that EEG-based biomarkers may contribute to a better understanding of chronic pain mechanisms and support the development of more personalised neurofeedback interventions [23].
Building on these advances, we have developed an immersive neurofeedback platform that combines real-time EEG biomarkers, adaptive virtual reality environments and mindfulness-based protocols within a closed-loop brain-computer interface.
Designed for clinical research and therapeutic applications, our platform continuously monitors the user’s brain activity and emotional state, adapting the virtual environment in real time to encourage attention regulation and self-regulation.
Our solution provides clinicians and researchers with objective neurophysiological data alongside immersive therapeutic experiences. Beyond chronic pain, we are exploring the potential of our technology across a range of clinical applications, including depression relapse prevention, addiction, anxiety disorders, ADHD and neurodegenerative diseases.
If you would like to learn more about our technology or discuss how it could support your clinical practice or research, request a personalised demonstration and discover our platform in action.
Acute pain is a normal response to injury or illness and usually resolves as the body heals. Chronic pain persists or recurs for more than three months and may continue even after the original injury has healed.
References
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