Explaining Chronic Pain to Family and Friends
Humans are social creatures, from our birth until the day we depart, we seek out groups to feel connected (research link). Relationships are part of our foundation for health and well-being (research link) and they can come in many forms including, family, friends, colleagues and intimate partners. What we have learnt from research, is that loneliness and isolation heighten our risk of almost every disease, both physical and mental. They also significantly impact on our life satisfaction, self-worth and life expectancy. They also plays a significant role in chronic pain.
Chronic pain is not just the physical “hurt” experienced by people living with it, it is all that the pain takes away from them, including the toll on their most important relationships. According to a study in the journal of Pain, chronic pain has a significant impact on a person’s social relationships and can be a key trigger for the development of anxiety, depression and anger. With 1 in 5 Australian’s living with chronic pain and over 60% of them suffering from anxiety or depression, the likelihood is that each of us knows someone dealing with the isolation and loneliness that comes from living with chronic pain. Research has shown that there is a strong relationship between higher levels of social isolation, lower levels of physical function, and pain interference. Pain interference is defined as how well a person living with chronic pain, is able to face the challenges of performing daily, social and/or work-related tasks.
So, how do we preserve these relationships by creating a shared understanding of what we are going through when living with chronic pain? In this article, we explore some important information that is worth explaining or sharing with your friends and family.
Painful Facts
Fact #1: Pain is all about protection
- Pain’s purpose is to protect us from hurt, damage and harm (link)
- Pain often originates from an injury, but chronic pain persists beyond the “normal” expected healing time (link)
- If pain persists, it affects our nervous system, making it better at detecting danger and threats and creating pain signals (link)
- Danger and threats can include anything that causes us fear, stress, anxiety or sadness e.g. interactions with family and friends, workplace stress, poor sleep, worries about money, our diet … the list is endless (link)
- Pain often occurs prior to tissue damage, as a preventative measure to protect us (link)
Fact #2: Chronic pain is not the same as acute pain
- Chronic pain lasts longer than 3 months and beyond the “normal” healing time, expected for recovery (link)
- Chronic pain may not be visible on scans or tests, but this does not mean it is not real (link)
- Chronic pain is complicated and is often not “fixed” by the treatments offered for acute pain e.g. medications, rest, time (link)
- Chronic pain is influenced by what is happening inside the body, inside the mind and around a person – biological, psychological and social factors (link)
- Chronic pain is caused by a pain system that is working overtime and detecting threats and danger everywhere (link)
Fact #3: Chronic pain turns the volume up on pain, even to things that aren’t usually painful
- Central Sensitisation is a condition in the nervous system responsible for the development and maintenance of chronic pain (link)
- Central Sensitisation occurs when the nervous system starts to adapt adversely to pain signals (link)
- This occurs after prolonged stimulation of the pain receptors and leads to changes in how we process pain signals (link, link)
- The nervous system goes through a process known as “wind up” which includes high reactivity of our “warning system” to less activities and sensations and amplification of pain signals: the volume on pain is turned up and more pain is felt (link)
- This increased sensitivity can also apply to other bodily processes:
- The two main characteristics of Central Sensitisation are:
Fact #4: Chronic pain feeds into every area of a person’s life
- Chronic pain is affected by more than what is happen where the pain is felt (link)
- Chronic pain is affected by our interactions with other people and whether these are positive or negative (link)
- Chronic pain is affected by our thoughts, beliefs, memories and values, as well as our understanding of our pain (link)
- Chronic pain is affected by our relationships with our health care team, including if we feel heard, acknowledged and understood (link)
- Chronic pain is affected by our mood, particularly feelings of depression, anger, frustration, fear, stress and anxiety, as these are registered in similar regions of our brain to pain and feed into this cycle (link)
- Chronic pain is negatively affected by poor diet, particularly diet’s high in sugar, transfats and processed foods (link)
- Chronic pain is negatively affected by poor sleep, causing pain levels to increase (link)
- Chronic pain is negatively affected by isolation and loneliness, causing pain levels to increase and interfere more with people’s quality of life (link)
Fact #5: Chronic pain can be managed through retraining
- There is a growing body of research worldwide which shows how increasing knowledge about chronic pain can assist in its management (link)
- Neuroplasticity is the ability of the brain and nervous system to adapt, learn and change overtime (link)
- Knowledge about chronic pain, allows understanding of all the factors which feed into it e.g. sleep, relationships, mood, diet etc (link)
- Once we understand the factors, we can work towards adjusting our “auto-pilot” responses to these to start reducing their influence over us and our pain (link)
- We can also start to reclaim parts of our life back from pain, through gradual exposure in a paced way to specific activities, planning and setting goals for ourselves (link)
Fact #6: Chronic pain tools are the best path forward
- There is an ever-growing body of research looking at ways to reduce the suffering people with chronic pain experience (link)
- This research supports the use of tools that are aimed at retraining the pain system – nervous system and brain – away from it’s dominant focus on pain signals (link)
- These tools involve:
- Pacing – breaking activities into smaller windows, with time for rest and recovery prior to pain flares (link)
- Pacing up activities – looking at current activity levels and gradually increasing these timeframes to allow our pain system to adjust and adapt (link)
- Graded exposure – repeating activities regularly to allow our pain system to “normalise” activities and reduce pain signals over time (link)
- Planning and goal setting – looking at current capacity (energy, pain levels) and where we are working towards, and planning this out on a day to day basis (link)
- Pleasant activity scheduling – reintroducing meaningful and enjoyable activities into our day, to promote positive emotions and experiences (link)
- Mindfulness – pulling ourselves back into the present moment and working towards acceptance of how things are right now (link)
- Acceptance – allowing ourselves to acknowledge how thing are now, working within the boundaries of our limitations and towards where we can realistically get to (link)
- Challenging unhelpful thoughts – working through unhelpful thoughts that feed into the pain cycle (link)
- Coping strategies – working out helpful and meaningful ways that help us manage the unpredictable nature of chronic pain (link)
- Flare management – having a flare plan and kit to assist with pain flares (link)
- Worry time – scheduling time each day to worry productively, helping to restrict worrying taking over your entire day (link)
- Self-compassion – finding ways to practice care, kindness and forgiveness towards ourselves to minimise the suffering we experience (link)
- Self- efficacy – finding ways to remind ourselves of our strengths, values and how many things in life we have coped with and survived, to build self-belief and resilience (link)
- Celebrating the wins – finding time to keep track of our progress and schedule rewards or celebrations along the way, this keeps momentum and motivation high (link, link)
- Health care team – finding a health care team that supports us with implementing all of the tools and encourages, hears and understands us (link)