Bob Allen, osteopath and co-host of the Pain Free Living podcast, and Clare Elsby, positive psychology coach and therapist, explore a subject most health professionals quietly notice — but rarely say out loud.

What happens when your pain becomes… comfortable?

In this episode, you’ll find out why long-term pain, whether physical or emotional, can quietly become part of your identity.

As Bob explains, pain starts as a warning signal. But when you’ve lived with back pain, joint pain, or unexplained symptoms for months or years, you often build routines around it.

Medication. Avoidance. “Safe” movements. Coping strategies. And over time, your pain stops feeling temporary; it starts feeling normal.

You’ll also hear how this shows up emotionally. Clare explores how negative self-talk, that relentless inner critic, can actually feel useful. You may believe it drives your productivity, your standards, and your motivation. But what if that “helpful” voice is also reinforcing stress, fear and vulnerability?

Don’t worry, awareness is the first step. If any of this resonates, it doesn’t mean you’ve failed. It means you’ve adapted, and adaptation is clever. But staying there forever isn’t your only option.

This conversation is aimed at challenging the “devil you know” mindset and opens the door to something better: appropriate support, fresh assessment, and safe therapeutic space — whether that’s manual therapy, cognitive behavioural therapy (CBT), or simply a new perspective.

5 Key Takeaways

1. Pain can shift from a warning signal into a lifestyle pattern.
2. Long-term back pain often has multiple contributing factors — not just one clear diagnosis.
3. Emotional pain and negative self-talk can become part of your identity.
4. Resistance to change often comes from fear and vulnerability.
5. With the right support, you can reduce pain — without losing who you are.

Resources Mentioned

1. Cognitive Behavioural Therapy (CBT) overview – NHS: https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/

Disclaimer - This podcast provides general information for educational purposes only. It is not medical advice and should not replace professional assessment, diagnosis, or treatment. Always seek qualified healthcare advice if you are in pain, have new or worsening symptoms, or have any concerns about your health before starting exercise or self-care routines.

Find out more about us and stay connected

😎 Learn more about Bob’s story https://bit.ly/BobsOsteoStory

🤩 Find out more about Clare’s work https://www.clareelsby.com/

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🎙️ Connect with us on socials & podcast platforms https://linktr.ee/Painfreeliving

Hello.

Welcome to the Pain Free Living podcast with me, your host, Bob Allen.

I'm an osteopath.

And this is my co host, Claire Elsby.

A little introduction, Claire.

Hello.

Yes, I'm Claire Elsby.

I'm a positive psychology coach and I also work in therapy.

Okay, thank you, Claire.

And one of the things that we pride ourselves on with the Pain for a Living podcast is we bring you topics that you're unlikely to find anywhere else.

So we like to talk about things like kinesiophobia, the nocebo and placebo effect.

This is our 41st podcast and there's a wide range of topics which we hope you have enjoyed.

If you haven't seen them, go back.

Our catalog's growing all the time.

And this episode we're going to be talking about when pain becomes comfortable and when pain is an area that you feel comfortable in.

Sounds a bit weird, sounds a bit paradoxical, but actually what we're going to do is we're going to look at how pain can become comfortable and we're going to talk about why and what you can do if you're in that situation.

So to start with, what is pain?

Pain is a warning mechanism.

Pain is something you, is your body's way of telling you that there's something wrong, that you need to do something about it.

As an osteopath, I see people that are in pain all the time.

When we're talking about pain and pain becoming comfortable, it's where they've been in pain for a long time and they have a routine.

They get up in the morning, they take their medication, they may do some exercises, they may not.

They will avoid doing things that can cause pain to flare up.

And yeah, basically they become comfortable with the pain that they're in.

It's usually people that have been in pain for a long time, they've usually got their routines worked out and they may have been to an osteopath, physiotherapist.

They may have been through the medical health services and had not found anything that can help.

Because one of the things that I found in my experience is that when you have a problem that is difficult to diagnose, low back pain is a good example.

I see a lot of low back pain.

Low back pain is a great term, but it doesn't really describe what's going on other than your back hurts.

But there can be 30 plus different things that can cause low back pain.

If you go to the nhs, they will go through their standard protocols, they'll give you medication, they may refer you to a physiological.

Ultimately, they may send you for an MRI scan, but if you go for a scan and nothing shows up on the scan, then they're not really sure what to do with you.

So what they'll do is, if you're lucky, they may bring you in for a review every now and then, but they will give you medication and if that doesn't manage the problem, they'll give you more medication.

I think they might now refer you to cbt, which is cognitive Behavioral therapy, which is Claire's Arena.

They may send you to a pain management clinic, which is where they teach you how to manage the pain, but they don't actually know what to do to help you resolve it.

So, yeah, so when I was saying that people can get comfortable with their pain, they've basically given up on being able to get rid of it.

So they're looking.

So they've found a way to manage it.

Examples that I see are I do free 15 minute assessments so I can have a chat with people, work out what's going on with them and then offer solutions, say, yes, I can help, or refer them back to their GP or another therapist because they may be able to offer help to them.

Now, I have had people where I've spoken to them, I've diagnosed what their pain problem is, I've told them what the potential solution is to that pain problem and I've never heard from them again.

Now, that could be because they don't like me.

That's a valid thing.

In my early days as a therapist, that used to really, really upset me.

As an older therapist, I don't get upset anymore because I may not be everybody's cup of tea.

I work in a particular way.

If you don't resonate with the way that I work, then we're probably not going to have a mutually beneficial relationship.

So, yeah, I'm perfectly happy if somebody goes away and finds another therapist who suits them better.

But the other type of person that does that is somebody who, they've had pain for a long time, they've got their routine, they're managing their pain and the last thing I want is somebody to come along and disrupt their process because they'll have that because they've been failed by others, they don't want to risk the disappointment of having another failure.

That's one possibility.

Or they just live off the story of their pain.

It's rare, but it does happen.

So that's Kind of my take on it from the physical therapy side.

And I'm sure Claire's got a few examples from the therapy coaching side as well.

When Bob first proposed this as a topic for the podcast, I really had to dig deep and think, well, why would someone prefer to live with their symptoms?

But a lot of reflection later and I thought actually I do have examples of this in my own practice with clients and one that I can think of that comes up fairly often is to do with thoughts, really is managing thoughts.

So for me as a, you know, in terms of psychology, pain is about signals.

So what is our brain actually trying to tell us?

And that's what I'm asking.

So when someone is in so for example, emotional pain, one of the things can be is it's because of either a belief system they have or it's thought processes.

And some of those thought processes can actually be when we have things like negative self talk.

A negative self talk, I would name it as our inner critic.

If we think about the thoughts we have, actually if we really do think about them and we can think about different personalities and they will have different reasons for having their being able to talk to us and tell us, you know, certain things.

But I actually if we think of the inner critic, that particular avatar or that particular personality talks to us often in such a way that we would not talk to family or friends, we can actually be really quite nasty to ourselves.

And what that does is it undermines our self worth.

It's our self esteem gets affected.

And if we keep doing it, our belief system keeps doing this, then actually it can have a really detrimental effect on our, on how we behave and how we live our lives.

So you'd sort of think, and this is counter intuitive that actually someone would want to get rid of that.

But when I've discussed this with clients who come up with this issue, I have been met with a response.

Well, actually my self talk, I believe that it helps me.

I believe that one of the reasons I get up in the morning or one of the reasons I'm so productive at work or one of the reasons that I can motivate myself is because I've got this self talk.

And if I didn't have that self talk going on in my head, I wouldn't be the person I am.

So what that then feeds into is the individual's identity and who they are and how they show up in the world.

Yeah, it's reinforcing who they think they are.

They're constable in that position.

Yeah.

And it's so how do you get out of that?

One of the things is you, you talk, you, you investigate the resistance.

Yeah.

And the resistance tends to come out of fear.

And it's not necessarily fear of the unknown, it's just a general fear.

And what that would mean for that individual is they have to become vulnerable to get through it.

And our brains don't like to be vulnerable because that is unsafe and it's stressful and it's very stressful.

So actually there is the old adage, the devil you know.

And I think this is what is exactly at play here.

But you can work through the resistance.

You can help with reframing thoughts.

Cognitive behavioral therapy, which is what you mentioned earlier, is actually brilliant at being able to do this.

But the individual has to be open to the thought that actually they're prepared to do it.

To make that change.

Yes, make that change.

And this is the bit that's scary.

But with a good therapist, with someone who's.

And it's a safe environment, then they should be able to work together and make a difference.

You won't get rid of negative self talk completely, but you can certainly mitigate it and recognize it for what it is.

And there are techniques to be able to do that.

Yeah.

Which maybe we'll have some time to talk about.

Or is that, is that something for another episode?

That's probably something for another episode because that's all CBT in action.

Okay.

Okay, so we'll look forward to that.

Yeah, yeah, yeah.

So, yes.

So what we're talking about then is we're talking about not just physical pain and people being comfortable physical pain as long as they have some management tactics for it.

And also from a mental health perspective, people can become very comfortable with emotional pain as well.

Because like you said, it's, it's that, that interplay, it's that voice in the head that gets them up in the mornings and gets them to do things.

So yeah, it's an interesting topic.

We, we human beings are bloody complicated and we don't always do things, the best things to help ourselves.

Having said that, if you can function with the pain that you have, then I don't, I'd say fair play to you for doing that.

But actually if you're in, if you're, if what we've been talking about kind of resonates with you and you're in a position where you've had this long term pain, you've worked out strategies to cope with that pain, but you'd actually like to make a difference.

You'd like to find a way to move beyond that and find some help and support.

I mean, if you can contact, if you want to contact either myself or Claire, then we can either point you in the right direction or we can help.

You know, we may be able to help you ourselves or we may need to point you in the direction of somebody who can help.

So if you're one of those people that is in pain, that has had pain for a long time, and you're not sure what to do next, then, yeah, we're here to help.

People should know there is help out there and we are more than happy to sign post, as Bob says.

So just contact us.

Yeah.

Okay.

So, as always, if you found this podcast useful, if you'd like us to do more on this, because there's a lot more we can talk about, then drop something in the show notes to help spread the word about the podcast.

You know, like share, subscribe to the YouTube video, subscribe to the audio.

And yeah, let's help get this message out there that this is one of those topics that nobody talks about, but actually it's quite important to general health.

So that's goodbye from Bob and goodbye.

From, from me, Claire.

See you at the next one.