My husband has a chronic pain condition, and it definitely affected his therapy appointments at times because sometimes the pain was just so intense that it was truly the only thing he could think about. The anxiety and depression that goes along with chronic pain is something that was part of the "issues" he talked about in therapy - How do you cope with the constant beatdown pain inflicts? How do you work past the pain? How does pain contribute to how you feel about yourself? How does pain affect how you are interacting with others? How does pain affect your activities, relationships, etc.? Pain is a very real issue that has very real psychological impact.