When we think about the emotions tied to chronic pain, the usual suspects come to mind: depression, anxiety, anger, and grief. But there’s one sneaky emotion that doesn’t get enough attention—shame!
What is Shame, and Why Does it Matter?
Shame is that little voice in your head saying, “This is all your fault.” It’s the feeling of blaming yourself for something you’ve done—or even worse, for something you haven’t done. Turns out, shame isn’t just emotionally heavy; it’s also linked to depression, pulling back from people, and even worse health outcomes (Kim et al., 2011).
Now, imagine dealing with chronic pain and having people—whether it’s a physio, a doctor, an insurance company, or even your own family—dismiss your experience. That’s what we call pain invalidation. It’s like someone saying, “Oh, you’re not really in pain… it’s all in your head.” And guess what? That invalidation fuels shame even more.
What Does the Research Say?
In a 2024 study, Coady and colleagues looked at 305 people living with persistent pain and found something important:
“Pain discounting is an especially harmful form of invalidation that denies the legitimacy of a person’s pain.”
They also discovered that shame is a major player in how social stigma about chronic pain turns into depression. As they put it:
“Pain-related shame may be an important pathway through which the social stigma of chronic pain is internalized to contribute to depressive symptoms.”
In other words, when people make you feel like your pain isn’t real, it’s not just hurtful—it’s harmful.
Why This Matters for Healthcare Providers
As healthcare professionals, we have a superpower—validation. By acknowledging and respecting what our patients feel, we can help them build confidence in managing their pain. This not only promotes acceptance but also protects them from the nasty cycle of shame and poor health outcomes.
Why Does Shame Hurt So Much? Shame doesn’t just hang out in your head. It sets up camp in your body and mind, whispering, “You don’t belong here.” It’s the feeling that something is fundamentally wrong with you and that you’re at risk of being rejected—by a person, a group, or even the world.
We often blame ourselves when things go wrong. For many, this starts early, whether it’s as kids or adults, exclusion and rejection can feel like a full-blown survival crisis. Shame in those moments can leave scars that last for years and worsen chronic pain.
Clinical Relevance: Tell your patients living with chronic pain, that their pain is real, and they deserve to have it acknowledged. As a physiotherapist, remember that your words have power. Validating your patient’s experience can be the first step to breaking the shame-pain cycle and helping them feel like they belong again.