The following are 3 illustrations of how the cycle starts and is maintained:

1. If a person who pursues medical treatment is continually treated with acute pain methods, pain worsens. For example, while chair or bed rest is an appropriate interventional measure immediately following an injury during the healing phase, over time, muscles quickly become atrophied or weakened and the person loses stamina. Loss of range of motion and muscle atrophy also occurs with prolonged traction and bracing, measures meant to immobilize an area only during the healing phase. As a result, pain increases. Stress, frustration and anger from increased pain increase muscle tension, leading to more pain, leading to more anger. Chronic anger, stress, muscle tension and atrophy lead to feelings of fatigue, which in turn decreases motivation, which in turn leads to passivity, more depression and a sense of hopelessness and helplessness.

2. After trying a number of treatment options and medication trials with little or no success, the person with chronic pain often concludes that something must be terribly wrong and that doctors are "missing something." As a result, the person experiences increased emotional distress, which increases muscle tension, which in turn increases pain. Increased pain is then further misinterpreted as "proof" that doctors have missed something and/or that further damage is occurring. Additionally, because of fear that s/he might cause even more damage to him/herself, s/he may avoid activity and assume a sedentary lifestyle, which results in further deconditioning and pain, leading to more anger, stress, muscle tension, increased pain, and so on.

3. Another tendency of chronic pain patients is to overdo activities (during periods when their pain level is lower or in-between "flare-ups") resulting in increased pain later on, or to perform activities until the pain forces them to stop. They begin to associate activities that were previously pain-free with pain exacerbation and thereby avoid activity altogether, or they persist in this "reduced activity-overactivity" pattern. These cycles are often maintained by hopeful thoughts that "maybe the pain is going away" or self-expectations that one will or should overcome the pain and thereby avoid feelings of "defeat." In a larger sense, however, chronic pain patients may prolong the self-destructiveness of overdoing that leads to more pain, fatigue, and depression.