# Rethinking chronic pain: a dissociative framework for psychodynamic practice

## TL;DR

The paper suggests chronic pain is linked to a fragmented sense of self, similar to dissociation in trauma, and proposes a new framework for treatment.

## Contribution

Introduces 'stimulus entrapment' as a dissociative framework linking chronic pain to trauma and self-fragmentation.

## Key findings

- Chronic pain may involve a 'pain self' that is disowned, leading to self-fragmentation and sustained distress.
- Biomedical treatments alone may fail because the issue involves disrupted self-integration, not just sensory processing.
- Psychodynamic approaches focusing on narrative repair and emotional attunement could help reintegrate the self.

## Abstract

Chronic pain is increasingly recognised not only as a disorder of sensory processing but also as a disruption of self-experience. This article advances the concept of stimulus entrapment as a dissociative analogue in chronic pain, where consciousness becomes trapped in overwhelming bodily sensation, narrowing attention and preventing integration into coherent narrative or identity. This entrapment parallels dissociative states in trauma, where overwhelming affect fragments continuity of self. We argue that in chronic pain the “pain self” is often rejected and disowned, creating a split between the embodied, suffering self and the socially presented self. Such fragmentation amplifies distress, sustains alienation from the body, and fosters maladaptive coping. Conceptually, this framework links chronic pain to psychodynamic and dissociation theories, situating persistent pain as a disorder of disrupted self-integration. Framing chronic pain in this way clarifies why biomedical interventions alone often fail to restore function, since the problem lies not only in nociceptive signalling but also in fragmentation of selfhood. Psychodynamic approaches that emphasise narrative repair, emotional attunement, and restoration of self-coherence may reintegrate the “pain self” into the broader self-system, reduce alienation, and restore agency. We propose that stimulus entrapment offers a unifying conceptual bridge between chronic pain, trauma, and dissociation, opening new avenues for therapeutic engagement and future research.