Featured image for an article about decreasing the stigma around physical pain. Image is woman receiving a massage.

Shame often deepens the experience of chronic pain, creating a cycle that makes healing much more difficult. Many clients feel ashamed for having pain or not recovering fast enough, which can lead to isolation and discouragement. Massage therapists can help by recognizing signs of shame, listening without judgment, and fostering open, compassionate communication. Using empathy and mindfulness, therapists can help clients release shame and support both emotional and physical healing.

Key Takeaways

  • Shame can amplify chronic pain and create a self-perpetuating pain–shame cycle that hinders healing.
  • Clients with ongoing pain often feel ashamed for not improving or for how their pain affects their lives.
  • Recognizing and addressing shame during treatment helps build trust and promotes emotional resilience.
  • Massage therapists should listen with empathy, avoid judgment or labeling, and allow clients to guide their healing process.
  • Mindfulness, compassion, and clear communication are powerful tools for helping clients separate shame from pain.

The Link Between Pain and Shame

A primary reason people seek massage is pain relief1. When a client comes for help with acute pain, therapists assess the pain and work to resolve its source. Therapy becomes complicated when a client presents with ongoing pain that does not respond to treatment. Clients and therapists can get discouraged and feel shame when pain fails to resolve. Understanding shame and its effect on pain will help uncouple such secondary suffering from the healing process. 

Pain creates an environment that instigates and exacerbates the shame response. The word “pain” (peyn) derives from the Latin “poena” and Greek “poine” meaning “punishment or penalty” (also “torment, hardship, suffering”), indicating pain as punitive, deserved, and shameful.

Clients with chronic pain are especially prone to shame for many reasons. First, pain interferes with our normal activities and daily responsibilities. People living with ongoing pain worry how the pain will affect their job security, relationships, and health. Certain pain treatments, (e.g., medications and medical procedures) produce punishing side effects. Finally, to avoid anticipated flares, patients with pain withdraw from activities that used to bring joy. Together the lack of positives and overabundance of negative experiences create a climate that cultivates shame. Clients begin to view their pain and suffering as a product of their own doing. To help clients shift out of this mindset, we need to recognize shame when it arises in treatment.  

You are encountering shame when clients:

  • Express shame that they still have pain
  • Disclose they felt shame for contracting pain in the first place
  • Confess they were afraid to tell doctors about the extent of their pain
  • Speak about being ashamed for not getting enough done 
  • Vent frustration about pain on an innocent person (e.g., you)
  • Equate pain with feeling bad about who they are at their core

What is Shame?

Shame is an emotion, like fear or grief. Interestingly, shame lodges in the same location where the brain registers strong physical pain. When shame messages combine with signals stimulated by pain, each hurt builds on the last to create a pain – shame – pain cycle that can spiral out of control.

Shame is a social emotion, like shyness, guilt, or pride. To feel shame requires others to be around, at least in your imagination. Shame may once have served an adaptive group purpose by brutalizing individuals stepping out of group norms. But shame goes far beyond to become an ingrained habit that we imprint on ourselves.

Brené Brown, a University of Houston researcher and lecturer, calls shame an “intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging” (20182)
Brown, Brene. 2018. Dare to Lead. London, England: Vermilion.. Brown interviewed thousands of people about shame and found that, depending on how we deal with shame, we can shut down or move towards resilience and authenticity.

Understanding the Nature of Shame

Often people have a visceral reaction to shame, shrinking at the sound of the word. They try to avoid it, pretend they don’t experience it, and that it has nothing to do with them. Brene Brown argues that denying shame only adds to its power.

Looking at shame illuminates the experiences that make us feel alone. People who move through shame constructively feel braver, more connected, and more human.

Recognizing shame when it arises is a good first step. Small conversations with people we trust, acknowledging that shame that can be brought on by pain, can be healing. Expressing shame that comes up around pain can be life-changing.

Mindfulness helps you maintain perspective so that you don’t get swallowed up by your client’s shame.  Curiosity is another ally to manage its overwhelming nature. 

When clients recognize you as a therapist seeking earnestly to understand what it’s like for them on a daily basis, they may open up. They see you are seeking to understand the shame and isolation that contributes to and is fostered by pain. You may refer to mental health professionals or groups of like-minded people also struggling with pain and shame. SMART (Self-Management And Recovery Training) groups are one low to no-cost alternative for processing shame. SMART groups are popular and can be found online and in person.  

Clients can feel understood with just one person who is willing to listen. When one person dares to get real about struggling, others can exhale a “me too.” Writing about it, is another way to “talk to shame” and feel less alone. Owning shame increases resilience to being derailed by it in the future. Resilience counteracts yucky shame feelings and unlocks coping options that don’t rely on stuffing or avoiding those feelings (e.g., hiding, overeating, smoking).

Clear language helps detect when shame is happening, what triggers it, and what is needed to move through it with authenticity and courage. Naming shame is obscured when we use the words shame, guilt, humiliation, and embarrassment interchangeably. People who distinguish shame from guilt, embarrassment, and humiliation can more easily bounce back from episodes that trigger shame.

Shame vs. Humiliation 

The ingredient that separates shame from humiliation is whether you feel you “deserve” to feel bad. If you spill milk and a stranger berates you for being clumsy, you could think, “that is a nasty reaction, I didn’t deserve that!”. That is humiliation. Shame talk would be, “She’s right, I’m so clumsy.” 

Shame vs. Embarrassment  

Embarrassment doesn’t leave you feeling utterly alone the way shame does. If you tell me that I have spinach on my teeth, I can swipe it off with my tongue and laugh. The situation is not about me. I can step out of embarrassment knowing that I am not the only person in the world who has had food stuck on their teeth. 

Shame vs. Guilt 

Guilt is also milder than Shame. People who experience guilt feel that they have done something bad, but not that they are bad. Guilt is a focus on behavior while shame is a focus on Self. Shame offers no hope for fixing the problem or forever being forgiven.

Breaking the Pain-Shame Cycle

Secrecy, silence, and judgment propagate shame. Unfortunately, the pain experience fosters all of these.  No one wants to hear about troubles with ongoing pain. Even friends and loved ones get tired of hearing about struggles with medications, side effects, painful procedures, and health or job worries.  People don’t want to hear “NO” when they ask “Are you better?”.  To protect themselves, clients give a standard response, “I’m fine” when they are not fine at all. Therapists need to see past this and earn their client’s trust. 

Linda Hartling (20043), found three typical responses to shame: moving away, moving toward, and moving against it. Moving away involves keeping secrets, not talking, and just wanting to disappear. Moving toward shame is people-pleasing to the degree of denying self. Moving against means striking back against the person who triggered shameful feelings with something hurtful. All three strategies keep your client feeling isolated and alone.  

The antidote is shining your light of awareness on dark, murky, unconscious stuff that arises to undermine the therapeutic process. You help your clients when you are present at the moment and resilient to shame responses that come up in you. Look to these processes to build your own shame resiliency. 

  • Notice when shame is at work. Cultivating mindful awareness and reflection through practices of meditation, qigong, or journaling prepares you for catching shameful thoughts when they arise.
  • Observe and work against knee-jerk reactions ­to run, hide, avoid, or shut down.
  • Tell someone or journal or question to diffuse the power of shame over you. What story are you telling yourself about the shame? Is it true?
  • Inquire what could be kinder and truer than the Shame belief. (e.g., “Instead of I’m not good enough to get rid of the pain, try “I am worthy of love regardless of my level of pain.”)
  • Recognize that you are human, doing the best you can. Forgive yourself for being imperfect; everyone else is imperfect, too.
  • Treat yourself as you would treat a friend. Extend yourself the same compassion you offer friends.

In conclusion, shame keeps clients focused on what is bad about them and blocks healing. Massage Therapists can go far to counteract the shame that their clients feel. Some concrete actions you can take:

  • Listen to your client. Clients have a story to tell about their pain and the shame it may cause.
  • Believe your client. If they say they have pain, they do. Pain is a subjective experience: The only way to find out the severity, location, onset, and duration of Pain is to ask.
  • Do NOT Label clients as “psychosomatic.” It is disempowering to say, “It’s all in your head.”
  • Do not label clients as “drug-seeking.” It is not even in the scope of practice to diagnose or prescribe.
  • Meet clients where they are, without shrinking from or pushing past resistance.  If you feel their muscles tightening up or see facial grimacing in response to your touch, that is enough. Go to the edge, without poking or pushing further.
  • Be flexible: Do not insist on an agenda or “fixing” your client as if they were a machine. Research shows that involving clients in health decisions helps heal quicker and lasts longer. Allow clients’ choice.
  • Encourage your client’s efforts to get well.
  • Do not promise unachievable cure-alls. Big promises get hopes up and set your clients up for disappointment and despair when boasts are not achieved. Focus on attainable goals: show outcomes before and after to anchor in changes you achieve together.

With awareness, compassion, and caring, you are well on your way to helping your clients get the shame out of their pain.

About the Author

Marian Wolfe Dixon is a licensed massage therapist, clinical hypnotist, and health educator in Portland, Oregon, with master’s degrees in psychology and health education. She helps adults with chronic pain, complex medical conditions, and injury recovery, while also offering pediatric sessions. Marian is the author of Body Mechanics and Self Care Manual and Body Lessons, and focuses on empowering clients through personalized, mindful care.

Image of the headshot of author Marian Wolfe Dixon

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  1. https://www.amtamassage.org/publications/massage-industry-fact-sheet ↩︎
  2. Brown, Brene. 2018. Dare to Lead. London, England: Vermilion. ↩︎
  3. Hartling, L. M., Rosen, W. B., Walker, M., & Jordan, J. V. (2004). Shame and Humiliation: From Isolation to Relational Transformation. In J. V. Jordan, M. Walker, & L. M. Hartling (Eds.), The complexity of connection: Writings from the Stone Center’s Jean Baker Miller Training Institute (pp. 103–128). The Guilford Press. ↩︎