A large proportion of chronic pain is iatrogenic, or the product of maladaptive coping strategies. The canonical example is back pain; Standard medical advice was once a long period of bedrest, but this further weakened the supportive musculature of the back, creating a vicious cycle of pain and inactivity. The standard advice is now the exact opposite; Exercise is essential in spite of the pain, for both physical and psychological reasons.

There are often complex psychosocial factors involved, with access to disability benefits playing a substantial role in a large proportion of cases. Long-term use of opiates can cause hyperalgesia and rebound pain due to tolerance and withdrawal. Chronic pain is not simply a spontaneous biological phenomenon.

In the relational frame theory that underpins acceptance and commitment therapy, similar mechanisms are seen as integral to chronic anxiety and depression. Experiential avoidance is a common response to unpleasant emotions, but avoiding stimuli that trigger painful emotions tends to cause a paradoxical increase in the intensity and frequency of those painful emotions. Managed exposure to these stimuli is an essential component of a wide range of behavioural therapies.