Why “Just Stay Positive” Doesn’t Work with Chronic Pain (and What Actually Helps)

A client of mine — I’ll call her Maya — once told me about a moment at a friend’s gathering. Someone she’d known for years asked, warmly, “How are you doing?” Maya, who lives with chronic pain, answered honestly: “Today’s been a hard pain day.” Her friend, without missing a beat, said, “Well, you’ve just got to stay positive! Attitude is everything.” Maya told me she smiled, said something like “you’re right,” and changed the subject — but something in her quietly closed. She spent the rest of the evening in the room but not really in it, and drove home feeling not just unseen, but ashamed for having shared her true experience at all.

I think about Maya’s story often, because so many of my clients experiencing chronic pain have a version of it. Someone who loves you, a close friend, or even a stranger trying to be kind, tells you to “just stay positive.” 

If you also had a similar experience, and if you felt a flash of anger, or a wave of exhaustion, or just a tired little sigh — please know you were not being ungrateful. You were responding, quite reasonably, to something that didn’t match what you were actually living through. And that could feel very alone.

This kind of aloneness, on top of pain that’s already so hard to carry, is a lot for anyone to hold. 

Why toxic positivity backfires

Chronic pain is never a mindset problem to begin with. It’s a real, physiological experience — one that involves your nervous system, your personal history, your body’s alarm signals, and often years of medical uncertainty layered on top, sometimes years of not being believed. So when someone tells you to “just be positive,” the message underneath — even when it’s not meant this way — is that your pain is something you’re not managing quite right. Or worse, something you’re choosing.

This creates what’s sometimes called a “double burden”: the pain itself, and then the added weight of having to hide how hard it really is. Research on emotional suppression has well established that pushing difficult feelings away doesn’t make them disappear. It tends to make them louder. It can even amplify how intensely we feel physical pain. Forcing positivity often makes things harder, not easier — even though it’s usually offered with the best of intentions.

When positivity becomes the expectation, there’s less room for the very real grief, frustration, or fear that so often travels alongside chronic pain. And when you start hiding those feelings — from your doctors, from the people you love, and sometimes, saddest of all, from yourself, you become more lonely.

Clean pain and dirty pain

Here’s a concept from Acceptance and Commitment Therapy (ACT) that I find genuinely useful for making sense of moments like Maya’s: the distinction between what it calls clean pain and dirty pain. It’s one of the ideas that I get to share with clients that they often find relieving.

Clean pain is what’s actually, simply there. The ache in your joints. The sadness that shows up on a hard day. It’s real, and it doesn’t need explaining or defending.

Dirty pain is everything we pile on top of that. It’s the shame about still struggling after all this time. It’s the inner voice insisting you should be coping better. It’s the exhausting effort of performing “fine” for everyone around you, all day long.

It is important to note that here “clean” and “dirty” is not about good or bad. Neither is a moral category. It’s more about noticing what’s actually there versus what’s been layered on top.

Let’s go back to Maya for a moment, because her story shows this beautifully. The clean pain at that gathering was simple: her body hurt, and it was a hard day. That alone was enough to sit with. But the dirty pain was everything that piled on top of it on the drive home — the shame she felt for even admitting she was struggling, the sting of her friend’s well-meaning advice, the old, tired belief that she should be handling all this more gracefully by now, the loneliness of feeling unseen. By the time she reached her driveway, she wasn’t just carrying a hard pain day anymore. She was also carrying the weight of judging herself for having one. And it became a lot heavier.

When we talked about it in session, what helped wasn’t trying to talk Maya out of her pain, or convincing her the friend’s comment shouldn’t have stung. It was helping her gently separate the two layers — this pain in the body and the emotional pain of “I am failing for feeling this way”. Once she could set the second part down, the total pain became more bearable. Even though the clean pain was still there.

A different idea: acceptance in ACTion

This is where acceptance comes in. “Acceptance” is a word that is often misunderstood, so let me be clear about what it doesn’t mean. In ACT, “acceptance” doesn’t mean liking your pain, resigning yourself to it, or giving up on getting better. It means gently laying down the exhausting fight to not feel what you’re already feeling.

There’s accepting the clean pain — letting the ache, the fatigue, the sadness simply be physical and emotional sensations, without needing them to be different or smaller than they are in this moment. And there’s accepting the dirty pain, too — the thoughts and feelings that show up on top, like shame or self-judgment. Acceptance doesn’t mean agreeing with those thoughts or feelings, or deciding they’re true. It means noticing them, letting them be there without a fight, and not spending your limited energy trying to push them away. And paradoxically, that’s often what allows them to soften and take up less room.

That’s the heart of acceptance in this sense: making room for the clean pain instead of fighting it, so your energy can go toward living a life you care about — alongside the pain — rather than into a full-time battle against feeling it at all.

What actually helps

To be clear, the goal isn’t to dwell on the pain and the unpleasant emotions. Accepting pain is to make room for the hard stuff and room for hope. ACT offers a few tools for exactly this, and they were a big part of what helped Maya find her footing again.

1. Noticing thoughts instead of being swallowed by them. ACT calls this defusion — the practice of seeing a thought as a thought, rather than as absolute truth. In session, Maya realized that “I should be handling this better” showed up almost automatically after every hard pain day, so reliably it had started to feel like fact. We worked on her noticing it more like weather passing through — ah, there’s that thought again — rather than something she had to obey or argue with. She didn’t need to believe it just because it showed up. You can try this yourself: next time a thought like “I should be coping better” shows up, try mentally adding “I’m having the thought that…” in front of it. That small shift can create just enough distance to notice the thought rather than be swept up in it.

2. Acceptance, small step at a time. Acceptance doesn’t have to happen all at once, and it doesn’t have to start big. It can begin with letting one small thing be there — the ache in your body, or the wave of shame that follows it — without immediately trying to fix, fight, or flee it. For Maya, this looked like sitting in her car in the driveway and letting herself feel both at once: the physical pain of the day, and the sting of that evening’s comment, rather than rushing inside to compose herself or talk herself out of either. It wasn’t comfortable. But it was far less exhausting than the alternative she’d been living for years: white-knuckling every hard sensation and every hard feeling into silence. In a similar moment, you might try pausing for even thirty seconds — wherever you are — and naming, quietly to yourself, both what hurts in your body and what you’re feeling emotionally, without trying to change either one right away.

3. A short check-in, a small dose of kindness to yourself. When pain flares, try gently asking yourself: What would I say to a dear friend going through this? Then try offering that same kindness to yourself. It’s a small practice, but it tends to make the rest — the noticing, the acceptance, the small steps themselves — much more accessible. You might even keep a phrase on hand for hard moments — something like “this is hard, and I’m allowed to feel this way” — so it’s ready to reach for when you need it, rather than something you have to come up with in the moment.

What therapy offers that a pep talk can’t

A cheerful reminder to “stay positive” was never going to hold space for grief, fear, anger, and hope all at once — and yet that complexity is often exactly where real healing begins. Therapy isn’t about finding the right mindset to force your pain away, and it isn’t about achieving some final, permanent state of acceptance either. In ACT, acceptance isn’t a box you check once — it’s a practice you return to, pain flare after pain flare, day after day, the way Maya returned to it in her car that evening.

What therapy offers is support in learning that practice: gently noticing the thoughts that pile dirty pain on top of clean pain, making room — again and again — for what’s genuinely hard, and finding, each time, a little more space to breathe inside of it. Not because the pain has gone, but because you’ve stopped needing to fight it in order to keep living your life.

Fighting pain — both the clean sensations and the dirty pain piled on top — takes an enormous amount of energy, far more than most people realize until they finally set some of it down. That energy has to come from somewhere, and it’s often quietly borrowed from the very things that make life feel worth living: time with people you love, work that matters to you, small moments of joy or rest. When you stop spending so much of yourself on that fight, that energy doesn’t just disappear — it becomes available again, for whatever kind of life you’re actually trying to build alongside your pain. 

The heart of the work I do as a therapist is to support you find your way back to a life shaped by what matters to you, not just by the fight against pain.

If you’re having challenging time navigating your chronic pain and this article resonates, please feel free to reach out and I’d love to help.

About Judy Zhu

Judy Zhu is a registered clinical counsellor and a registered Doctor of Traditional Chinese Medicine. She is dedicated to helping people living with chronic pain and chronic health conditions, particularly those also navigating anxiety and depression. She offers compassionate support to help clients build a life of vitality and meaning alongside their pain or illness.