Mental defeat – the hidden experience fuelling daily suffering in chronic pain

For millions of people living with chronic pain, the hardest part isn’t always the pain itself – it’s the sense that it is taking over their life.

A new study from the University of Warwick has used a real-time, day-to-day tracking method to show that ‘mental defeat’ – the psychological state in which people feel worn down by pain and begin to lose their sense of self – shapes the day-to-day experience of chronic pain.

Published in the journal PAIN, researchers found that when people feel mentally defeated, they are more likely to focus on their pain, see it as damaging to their identity and future, and withdraw from everyday activities, making it a critical factor in reduced quality of life.

Professor Nicole Tang, Department of Psychology, University of Warwick and first author, said: “Pain is not something that can simply be taken away, it is someone’s reality. But how people relate to their pain, and the meaning they attach to it, can add an extra layer of distress that we might be able target with the right interventions.”

Chronic pain affects around 20% of people and is widely recognised as not just a physical condition. It is shaped by psychological, emotional, and behavioural factors that fluctuate throughout the day, making it difficult to target effectively with traditional approaches.

In this study, researchers used an innovative real-time sampling method to capture these fluctuations, analysing data from 137 adults living with chronic non-cancer pain. Participants reported their thoughts, feelings, and behaviours three times a day over two separate weeks.

Professor Tang continues: “You can think of this method like a scientific stop-motion animation captured over a two-week period. Each frame shows a snapshot of what someone is thinking, feeling, or doing, but when you put them together, you can see how those experiences unfold and influence each other over time.”

The findings show that increases in mental defeat consistently predicted greater attention to pain and stronger beliefs that pain was harming one’s self, relationships and future. These perceptions, in turn, are linked to reduced physical activity.

UK-based Fiona McNiven, 61, has lived with neuropathic and musculoskeletal pain for more than three decades. Reflecting on the concept of “mental defeat” she says it strongly reflects her experience, particularly in the earlier years of her condition.

Fiona said: “It completely overtook my life. It was the hardest thing I’ve ever been through, and it affected my mood and confidence. I would catastrophise about the future and couldn’t see one – I didn’t believe a fulfilled life was possible with pain. If you’re on your own, it can become completely overwhelming because you’ve got no energy and nothing to distract you.”

The study also identified a self-reinforcing loop: feeling mentally defeated leads to more negative self-perceptions, which in turn further increase mental defeat. This cycle may help explain why some individuals experience persistent pain-related distress even when pain levels remain stable.

Mental defeat appeared to operate independently of pain intensity, stress, and mood. It is not simply a byproduct of feeling worse or being in more pain, nor does it directly increase pain intensity, but instead represents a distinct psychological process influencing how pain is experienced and responded to.

These features make mental defeat a promising target for intervention. By addressing negative self-perceptions and attentional focus, interventions may help disrupt this self-reinforcing cycle, reduce its impact on daily functioning, and improve quality of life.

Professor Swaran Singh, Warwick Medical School, and co-author added: “By identifying when mental defeat spikes during the day, future digital tools, such as smartphone-based interventions, could deliver timely support to help individuals reframe negative self-perceptions, maintain activity, and reduce suffering. This kind of ‘just-in-time’ approach could offer more personalised support alongside existing treatments.”

ENDS

Notes to Editors

The article ‘Temporal dynamics of mental defeat in chronic pain: a longitudinal network analysis of ecological momentary assessment data is published in PAIN, DOI: 10.1097/j.pain.0000000000003981

The Pain Self Perception Scale has been created at University of Warwick; you can find more information here: https://warwick.ac.uk/fac/sci/psych/research/lifespan/sleeplab/psps/

For more information please contact:

Matt Higgs, PhD | Media & Communications Officer (Warwick Press Office)

Email: Matt.Higgs@warwick.ac.uk | Phone: +44(0)7880 175403

About the University of Warwick

Founded in 1965, the University of Warwick is a world-leading institution known for its commitment to era-defining innovation across research and education. A connected ecosystem of staff, students and alumni, the University fosters transformative learning, interdisciplinary collaboration, and bold industry partnerships across state-of-the-art facilities in the UK and global satellite hubs. Here, spirited thinkers push boundaries, experiment, and challenge convention to create a better world.