I feel like you are being WAY too hard on yourself. Very hard indeed. I know what dealing with debilitating pain is like (forget the causes right now) and it is horrific and endless and rubs away at everything: joy, hope, enjoyment, plans, ambitions, and simple day to day things that others take for granted. Whatever reasons (and the reasons you say sound right, that the system gets triggered - but I have no idea) the first thing to say is dealing with the actual pain and symptoms is unbelievably hard and waring and grinding down. If not desperate at times, as we know (and as I certainly felt in moments: truly desperate). So first I want to correct you: you are an incredibly strong, brave person who every day is waking up and dealing with this - and wanting it to be different. And trying so many different things. What courage and perseverance. I understand the self criticism and disappointment that somehow you are part of where you are now, and how awful that feels. But that is just another stick to beat yourself with. You are also the person who is trying and wanting things to be different, who is examining your life and habits and physical patterns and being willing to look again, and be open. Not everyone is. I have huge admiration for you. The other thing that strikes me reading what you have put (and this is from my meditation approach which as I say has - over many years - helped a lot) is that: yes, you are right, you will 'never truly silence the inner voice of the ambitious achiever etc ' because trying to silence anything will never work. What you resist, persists! And the approach I am talking about is one where instead of hearing that voice and fighting it, hating it, trying to change it, being 'good' maybe for a day and then it coming back... we instead see the truth which is that our true selves are a much, much bigger 'room' that this, and that from there, we can listen to that other voice in one corner perhaps (rather than identifying 100% with it), and observe, and accept it is there and see what it says and does. And also be interested in what else is there? Because if you are listening to and watching that voice... then who are you? You are not it. That room is big, and if we go beyond the 'self' that is that voice, there is so much more in there. There is a place where you don't need to try, where you feel enough as you are, and where you trust that everything and anything can be different and change. Because it can. I truly believe that it doesn't matter how long things have felt one way (how many years or decades) there is always, always the chance for change, new, hope. I am not saying meditation leads to all this! But I am saying that maybe change begins with not identifying with all you say from that voice here, and exploring a different way. Less trying to 'get' well and more being right in the moment we are in, and starting from now, right now, to listen to the overachiever and also the self criticiser and realise that none of those is truly you. There are many books that have helped me, but I don't want to put them all down unless of interest. Also, the more I have gone on, the more it has become a kind of spiritual approach in that I know incredible change can happen if we can get out of our heads more and into our hearts. I know this may sound flakey for some. But I believe it, and I think the change is in world terms not just health. But I've gone on enough! I send you all the very best and just know that (a) you are amazing for what you have lived through and coped with and tried and (b) change is absolutely possible, not because you can change those thoughts (we all have them - even buddhist monks!) but because you are not those thoughts, and there is so much more beyond them - and that is the start of something else.. It is something exciting and full of possibiility about who we are. Mindfulness/Meditation is a long journey, and again the point is not to silence the thoughts! You never will. It is to start to listen to them / observe, as to someone else going on (your more insecure, stressed little brother maybe?) and to get interested in this bigger different self that is not that. Because healing lies here or many different kinds. I hope this is in any way helpful and send very supportive thoughts.