Consider a common wedding vow phrase: “…In sickness and in health, to love and to cherish, from this day forward…” most likely, the majority of people who repeat those words are sincere in their promise to provide their partner with unwavering affection, care and attentiveness in any situation. But when a person develops chronic pain, even the most solid of marriages can be tested. What’s more, pain can impact other relationships, both within families and among friends.
A ROCKY PATH
Health care providers, caregivers and those who live with chronic pain know that pain can affect every aspect of life. One of the most devastating casualties can be relationships — from an intimate partnership to a casual connection with a coworker. The primary reason for this, says Kevin E. Wilson, PhD, a clinical faculty member of Wake Forest University School of Medicine’s Pain Fellowship Program, is that chronic pain is a form of chronic stress.
“It’s a stress that affects all areas of life, including relationships,” explains Dr. Wilson. “It changes the rules on how a person interacts with spouses, families and everyone.”
When the constant stress of pain invades interpersonal relationships, the results can be damaging:
HIGH DIVORCE RATES: Illnesses like chronic pain are associated with higher-than-average divorce rates.
LOSS OF SELF-ESTEEM: “Many people [with chronic pain] will feel useless or unable to contribute,” says Dr. Wilson. “This causes families and couples to go through a lot of role changes.”
LACK OF SEXUAL INTIMACY: Whether it’s due to medication side effects or pain itself, sexual relationships often suffer. The loss of sexual intimacy may strain a couple’s sense of closeness and bonding.
FEELINGS OF GUILT: Guilt can afflict both the person with pain and his or her loved one. The person with pain may feel guilty for not being able to participate in formerly shared activities, from housekeeping to outings with friends. The loved one may experience guilt for being able to spend time away from home or do things the person with pain can’t.
LOSS OF FRIENDSHIPS: The isolation caused by chronic pain may cause some people to distance themselves or cut off ties, including friendships.
EMOTIONAL ISSUES: Depression and anxiety are common in people with pain. These conditions not only negatively impact the pain sufferer, but also alienate his or her loved ones.
Thus, a challenging dynamic often emerges. Pain can lead to stress. Stress can compromise relationships. Strained relationships lead to more stress. According to Dr. Wilson, “We know that additional stress aggravates pain. So this vicious cycle can form, and it’s one that’s difficult to break.”
SEVEN HEALTHY STRATEGIES
Fortunately, difficult doesn’t mean impossible. Consider these strategies for maintaining strong, healthy relationships.
SEEK OUT EFFECTIVE PAIN AND STRESS MANAGEMENT
It may seem like a no-brainer, but reducing your pain is the best way to limit its influence on your relationships. Therefore, successful pain management is critical. This can mean addressing the root causes of your pain condition, exploring possible treatments, seeing a pain specialist who can help you manage your symptoms and learning coping strategies. In addition, Dr. Wilson suggests incorporating stress management into your pain therapy program. Doing so will help you cope with pain and relationship issues better.
When it comes to how pain affects a relationship, there’s a big distinction between acute pain and chronic pain, says Linda S. Ruehlman, PhD, a health psychologist, pain researcher and co-founder of Goalistics, LLC, a service that provides online tools to those who suffer from chronic pain.
“With acute pain, as when someone breaks a leg, the person’s partner is going to be pretty solicitous with their help,” says Dr. Ruehlman. “But once pain becomes ongoing, that kind of response is often not helpful. It can put the person with pain in a position of weakness, almost an ongoing ‘patient’ role, and that’s not a good way to see oneself.” Dr. Ruehlman suggests an honest selfevaluation. “Use the mentality that the more you can do yourself, the better. And if there’s something that you really can’t or shouldn’t do, ask for help,” she says.
“The person with pain walks a fine line,” says Dr. Wilson. “You have to be assertive about your needs, but you don’t want to be too demanding. That kind of balance often takes some work between people.”
Dr. Wilson also points out that a person’s loved ones need to follow this advice as well. “Sometimes they mean well but are reinforcing the wrong behavior in the person in pain, which can only make that person feel helpless and useless,” he says. “If you’re a spouse or family member of someone with pain, try to meet their needs without smothering and being overly attentive. You don’t want to foster passive, dependent behavior. You want to encourage them to reach their potential, whatever that is.”
UNDERSTAND THE DIFFERENCE
BETWEEN “HURT” AND “HARM”
Spending time with those you care about is what makes life full and enjoyable. If you suffer from chronic pain, however, pleasurable moments can come at a price.
“It’s important to find some form of enjoyment with your spouse and family,” says Dr. Wilson. “This may mean choosing to participate in activities even though you may experience a temporary increase in pain. You really have to look at hurt versus harm. As long as you’re not doing anything harmful to your condition, tolerating a temporary pain escalation may be necessary to maintain closeness with those you love. Don’t let the fear of pain interfere with important life events.”
GIVE UP EXPECTING OTHERS
TO UNDERSTAND YOUR CONDITION
Try explaining to someone who’s never given birth what the process feels like. How about trying to describe the impact of a car accident to someone who’s never been in a wreck? Some things just can’t be understood until they’re experienced. The same concept applies to chronic pain. That doesn’t mean that others can’t be empathetic; it just means that it’s pointless to try to make them understand something they can’t.
“It’s natural to want others to know exactly what you’re feeling,” says Dr. Ruehlman. “But you have to ask yourself, ‘Is it possible for them to truly understand what I’m going through?’ The answer is that no one can feel your pain the way you feel it.
“For example, if you have migraines but your spouse has never had one, it’s impossible to explain to him or her how it feels,” Dr. Ruehlman continues. “You need to provide information they can use. So instead of ‘this is how my migraine feels,’ you can say ‘I have a migraine and I need to go into the other room to lie down.’ Focus on the practicalities of living with pain, not the abstracts.”
There are times when people don’t want to know what you’re going through. In such situations, you should keep the details of your condition on a need-to-know basis. For instance, your adult children may want to better understand your pain and its source; your boss might not.
DON’T BE AFRAID TO TAKE ON NEW ROLES AND REDEFINE RELATIONSHIPS
Chronic pain can erode relationships, and sometimes friends disappear along the way.
“For the person with pain, it’s hard to keep friends longterm,” says Dr. Wilson. “If you can’t reliably show up for events or engage in the activities you used to, it becomes difficult to maintain a connection.”
Fortunately, that doesn’t mean you can’t redefine a relationship and find new ways to relate to the people in your life. Dr. Ruehlman suggests being flexible to the changing nature of relationships.
“If you used to be a cyclist, and you and your cycling buddies would have coffee after your rides, does that mean you can no longer hang out with them if your knee is shot and you can’t cycle anymore?” she asks. “Of course not. The fun wasn’t only in cycling, it was in spending time with friends. As emotionally painful as it may be at first, try a new version of that friendship. For instance, still meet them for coffee after their ride is over.
“Get past the black-and-white belief that you have to isolate yourself because you can’t do the things you used to do,” she continues. “Of course, not every relationship with every acquaintance will continue. A true friendship is about more than the activities you do together; it’s about a lasting relationship.”
Friendships aren’t the only relationships that need to evolve. You might also need to explore new or different roles within your family.
“If a partner is taking on household tasks that you used to do, maybe you can find something new that you’re able to do,” says Dr. Ruehlman. “There can still be give and take.”
Dr. Wilson says that people with pain need to realize that their spouse and family members often take on extra burdens, and they, too, need a break from the additional chores and responsibilities. “Often, they’re doing things the person with pain can no longer do, as well as their usual activities,” he says. “They need to be allowed their own time for relaxation, exercise and coping with stress.”
FIND CREATIVE WAYS TO INTERACT WITH OTHERS
Pain may alter one’s lifestyle — particularly when it comes to maintaining relationships — but advances in technology and ever-evolving social media outlets make keeping in touch (and even meeting new people) possible.
“Technology can really help people stay connected,” says Dr. Ruehlman. “Sending someone an e-mail or text or calling them provides a way to participate in a relationship. It’s not about how you used to do it. It’s about how you can still stay connected — and staying connected is important.”
Dr. Wilson agrees. “Online social networking on sites like Facebook can be very helpful, especially if someone’s isolated at home and doesn’t have other social outlets. Blogs and support groups can also be good.
“[These outlets] are helpful when people focus on positive things,” he continues. “They’re not helpful if the theme is how horrible the pain is or that there’s nothing that can be done for the pain. I think if the messages people send to one another are positive and centered on coping and managing, that’s potentially a very good way to stay connected with others.”
COMMUNICATE, COMMUNICATE, COMMUNICATE
It may seem obvious, but there’s a reason why communication is a universal prescription therapists give to people who want to improve their relationships: When used effectively, it works.
Communicating connects us. It helps us work out problems, keep resentment at bay and manage changes in our lives, explains Dr. Ruehlman.
But it can be challenging. “If a person with pain is out of work and isolated from their previous social outlets, they may bombard their spouse or family members with talk at the end of the day,” points out Dr. Wilson. “Meanwhile, the others have been at work or school all day and need some downtime. Life is always going to be very busy, and communication is important in marriages and families. So try to carve out some relaxed time to talk and spend time together.”
Dr. Ruehlman agrees. “Even though you’ve got a chronic condition, you can still take part in relationships,” she says. “You can still support your friends and family. You can still give. Frank communication opens up the door for this. Pain changes things; it doesn’t have to end things.”