Chronic pain management with a psychologist, online across NZ

What is chronic pain?

Chronic (or persistent) pain is pain that continues for longer than three months, often after the original injury has healed or without a clear cause. It is common: in the 2024/25 New Zealand Health Survey, more than one in four adults (27.5%) reported chronic pain. Pain is real, and it is shaped by the nervous system, sleep, stress and mood, as well as by tissue damage.

Why see a psychologist for pain that is physical?

Being referred to a psychologist for back pain, fibromyalgia, migraine, pelvic pain or pain after surgery can feel like being told it's imaginary. It isn't, and no reputable clinician thinks so. In 2020 the International Association for the Study of Pain revised its definition of pain and added notes that are worth reading slowly: pain is always a personal experience influenced by biological, psychological and social factors, pain and nerve signalling are different things, and pain cannot be inferred simply from activity in sensory nerves.

In plain language: the amount of pain you feel is not a straight readout of damage in your body. It is produced by a whole nervous system, and that system is affected by how you've slept, how threatened you feel, how low your mood is, what you've been told about your scan, and what happened the last time you tried to do the thing that hurts. None of that makes the pain less real. It does mean there are more levers to pull than medication alone.

A psychologist works on those levers. That is why NICE, in its 2021 guideline on chronic primary pain, recommends psychological therapy (ACT or CBT) alongside exercise programmes for chronic primary pain.

How pain and the nervous system interact

Acute pain is an alarm. You stand on a nail at the bach, the alarm goes off, you stop and deal with it. The alarm is protective and proportionate. In persistent pain the alarm system itself changes. Healthify describes this as alterations in the way your nervous system processes sensory information, so that the system becomes more sensitive and fires with less provocation, or with none. Pain scientists call this nociplastic pain or central sensitisation; the everyday version is that hurt no longer reliably means harm.

Several things can turn the sensitivity up: poor sleep, ongoing stress, fear of movement, low mood, and a belief that something in your body is fragile or "crumbling". Several things can turn it down: understanding what is happening, restoring sleep, gradually reintroducing movement, and reducing the threat your brain attaches to sensations.

Learning about this is itself part of treatment. A 2016 systematic review of pain neuroscience education for chronic musculoskeletal pain found it helped reduce pain and disability and improve movement in people with chronic musculoskeletal pain. We are careful not to overclaim here: understanding your pain does not switch it off. It does change the way you respond to it, and that response is a large part of what keeps a pain system sensitive.

Pacing and the boom-and-bust cycle

Here is a pattern almost everyone with persistent pain recognises. You wake up on a good day. You mow the lawns, do the supermarket run, clean the bathroom and finally fix the fence, because who knows when the next good day will come. The next two days you can barely get off the couch, you cancel the thing you were looking forward to, and you feel like a failure. Then a good day comes, and you do it all again.

That is boom-and-bust, and over time it shrinks life, because the busts get longer and the fear of the next one grows. Pacing is the alternative: working out a level of activity you can sustain on a bad day as well as a good one, keeping to it consistently, and increasing it in small planned steps rather than in response to how you feel in the moment. Healthify recommends exactly this, breaking tasks into manageable chunks and keeping a consistent level of activity.

In sessions this gets very practical. How long can you stand at the bench before pain spikes? Then cook in two blocks with a sit-down in between. How far can you walk the dog before you pay for it? Start at two-thirds of that, every day, and add a few minutes a week. Pacing also includes a flare-up plan, written in advance, so that when a bad patch comes you follow a plan instead of panicking.

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ACT and CBT for pain: what the sessions involve

Both cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) are recommended by NICE for chronic primary pain. The honest summary of the research is this: a 2020 Cochrane review found CBT produces small improvements in pain intensity, disability and distress at the end of treatment, with some benefits lasting at follow-up. A 2023 overview of systematic reviews found ACT improves depression, anxiety, pain-related functioning and quality of life, with gains still present six to twelve months later. Neither usually removes pain. Both help many people get more of their life back.

What that looks like week to week:

• Making sense of your pain: building a shared picture of what turns your pain up and down, so you are working with your nervous system rather than against it.
• Unhooking from catastrophic thoughts: "my spine is crumbling", "I'll end up in a wheelchair", "I'm useless to my family". These thoughts are understandable, and they drive tension, avoidance and worse pain. CBT works on testing them; ACT works on holding them more lightly so they steer you less.
• Willingness and values: ACT asks what matters most to you (coaching your kid's rugby, keeping your job, being a decent partner) and helps you move toward it with the pain alongside, rather than waiting for the pain to leave first.
• Graded return to feared movement: gently, systematically doing the things you have stopped doing, often in step with a physio's plan.
• Attention and relaxation skills: practical ways to lower the body's threat response, including breathing, mindfulness-based practice and relaxation.
• Talking about pain: with employers, whānau and health professionals, including how to ask for what you need without the whole conversation becoming about pain.

Sleep, mood and pain feed each other

Pain disturbs sleep. Less well known is that the arrow runs strongly the other way: a 2013 review in the Journal of Pain concluded that sleep problems are a stronger and more reliable predictor of pain than pain is of sleep problems. A run of bad nights lowers your pain threshold and makes the next day's pain worse, which makes the next night harder. Treating the sleep problem directly, using CBT for insomnia, is often one of the most useful things we can do for pain.

Low mood and anxiety travel with persistent pain for obvious reasons: loss of work, loss of role, loss of the activities that used to make life feel like yours. They also feed the pain system. Psychological therapy for pain treats depression and anxiety as part of the picture rather than sending you somewhere else for them.

Working alongside your GP, physio and pain team

Mindwell offers online psychological therapy. We are not a pain clinic, we do not prescribe or manage medicines, and we do not replace your GP, physiotherapist or specialist. We work best as one part of a plan.

On medication: NICE's 2021 guideline found little or no evidence that many commonly used medicines help chronic primary pain, and recommends that certain antidepressants be considered. What that means for you is a conversation for your GP or pain specialist. Please never stop, start or change a medicine because of something you read here, including this page.

With your written consent, your psychologist can send a short summary to your GP or physio so that everyone is pulling in the same direction, for example aligning a graded activity plan with your physio's programme. If your pain comes from an injury covered by ACC, ACC may fund pain management services; Mindwell is not an ACC provider, so sessions with us are self-funded, and it is worth asking ACC or your GP what you are entitled to first.

Doing this online when getting out is hard

For many people with persistent pain, the hardest part of a clinic appointment is the appointment itself: the drive, the car park, the waiting room chair, the hour of sitting. Online therapy removes all of that. You can sit, stand, lie on the floor or pace during a session, change position whenever you need to, and use your own heat pack. If you live rurally or your mobility is limited, this may be the difference between getting psychological support and not.

The evidence supports remote delivery. A 2023 Cochrane review of remotely delivered psychological therapies for chronic pain, mostly internet-based CBT programmes, found small improvements in pain and disability at the end of treatment compared with usual care, although these benefits had faded by later follow-up. Sessions over video also let your psychologist see your actual environment, the stairs you dread, the chair you can't get out of, and problem-solve with it in view.

What to expect at Mindwell

Jeremy Mason, a Clinical Psychologist who has worked in specialist chronic pain and eating disorder services, lists chronic pain management among his areas of focus and works with CBT and ACT. Jake Meads (chronic illness and pain) and Candice van der Merwe (chronic pain) also list it among their areas.

In the first 50-minute session you'll go through the history of your pain, what you have tried, what has helped and what hasn't, how you are sleeping and coping, and what you would be doing if pain took up less room. From there you agree a plan together. Many people meet weekly or fortnightly at first and space sessions out as skills bed in.

Sessions are $199 + GST ($228.85 incl. GST) each, paid when you book, and you'll receive a receipt for any health insurance claim. No GP referral is needed, though we encourage you to keep your GP in the loop. After booking you'll get a confirmation email with your video link and a short intake form that takes about five minutes.

Related support: Insomnia and sleep · ACT therapy · Depression counselling · Health anxiety