Chronic pain and relationships

HOW YOUR CHRONIC PAIN AND RELATIONSHIPS AFFECT EACH OTHER

The arrival of severe pain in my life affected many aspects of my relationships – that was abundantly clear.  What wasn’t so obvious was that my relationships with others could also influence the pain.  I didn’t realise it was a two-way street.  Here’s why.

Chronic pain isn’t just an issue in isolation, it’s an issue in relation.  Chronic pain can have a significant impact on your relationships, and your relationships with others can affect your experience of the pain itself, and how you are able to manage it.

Many of the problems expressed by people with chronic pain revolve around how it affects them in connection with friends, family, loved ones and other people in their social environment. 

The social problems associated with having chronic pain can then influence your thoughts and feelings about the pain, the way that you experience it and your sense of being able to manage it. 

(The biopsychosocial model – Explanation of chronic pain disorders, 2020)

In this article, I’ll be looking at chronic pain in the context of different kinds of relationships, from friendships to dating, from marriage and long-term relationships to family and pets.

I’ll cover the effects of chronic pain on socializing and the impact of social isolation, as well as having those around you understand chronic pain.

Firstly, let’s look at some of the ways that chronic pain can influence your relationship with yourself.

Chronic pain and self-identity

With chronic pain, chances are that you’re trying to maintain relationships while the pain is changing the way you relate to yourself and impacting your self-identity.

Chronic pain can cause physical limitations that impact a person’s ability to participate in social roles such as employment or parenting in the way they had before pain. Changes in social roles and the way a person perceives themselves in relation to others can affect their sense of self-identity.

When you first experience persistent pain, you could be in fight mode. 

You might be fighting to have medical professionals pay attention or understand what’s going on.  You could be fighting to get a diagnosis, or fighting to get the right treatment. 

You could be literally fighting for survival, if you aren’t able to go to work and have entered the process of applying for financial assistance through disability. 

You could also be fighting to come to terms with all the ways that the pain can create obstacles to living the ‘normal life’ that you were used to. 

If the pain severely impacts your ability to move freely and do the things you need to do to get through the day, you could be coming to terms with needing to enlist the support of others. 

You could be struggling to deal with losses, not least what seems like the loss of parts of yourself – the loss of how you’ve always viewed yourself. 

If the pain affects your ability to be who you’re used to being, it’s like losing your sense of who you are, your self-identity. 

In many ways, our sense of who we are is tied up in who we are in relation to others. 

For instance, if you’re a parent, chronic pain can impact the way you can physically interact with your children, potentially impacting how you view yourself as a parent. 

This can apply to any social role that makes up part of your identity, from your role of employment to your ‘role’ as a friend, partner or sibling.

Society’s general attitude around social roles can play into it.  Sometimes you may feel inadequate when pain is hindering your ability to participate in those roles in the ways that you had before.

Chronic pain can cause deep personal grief for the perceived losses in your life.  It can influence how you feel, think and behave.  It can affect how you relate to yourself.

Researchers in 2012 did an in-depth analysis of the experiences of people living with chronic pain. 

They found on the one hand, that people with chronic pain struggled with scepticism from those around them, which the researchers called the “social delegitimization” of chronic pain.  On the other hand, they found that people with pain struggled to identify with being disabled.

“With chronic pain, the assault on the self is doubled; the patient struggles with the new identity of ill-health and disability, whilst seeking to defend this new unwanted identity from their surroundings, which delegitimizes their pain.”

(Lavie-Ajayi, Almog & Krumer-Nevo, 2012)

So, you could be personally dealing with some or all of this, or more, and then we add relationships with other people into the mix.

One of the most troubling aspects about relationships for many people with chronic pain, is the issue of getting others to understand what you’re going through.

Having others understand your experience of chronic pain

Pain can be difficult to describe, difficult to explain and difficult for other people to understand.

One of the aspects of chronic pain that make it hard for people to understand is that it’s often invisible to other people.  Acute injuries are quite often visible – perhaps there’s significant swelling or bruising, or maybe the person has a cast on a broken bone. 

By the time pain becomes chronic, there can be no outward signs of it.  Other people can really struggle to comprehend how something can be so severe when they don’t actually see anything wrong.

It can really get to you if those around you just don’t get it.  People with chronic pain can be doubted, misbelieved or dismissed by some people simply because of the ‘invisibility’ aspect.

 If you have experienced those kinds of reactions in the past, worrying about being judged in that way again could make you feel less inclined to try explaining it to others, which can lead to further misunderstandings and issues in other relationships.

It can be difficult to know where or how to start when trying to talk to other people about it. I have an article on getting your family to understand chronic pain. that goes into more detail on this.

Another aspect of this, is that oftentimes people just don’t know what to do, or how to help.  My post on helping someone with chronic pain includes suggestions for friends and family members.

Communication about chronic pain can be tricky at times, but I think the biggest hurdle with this issue in relationships is being able to express what’s going on so that people can understand, and expressing what you need in a way that others can best help. 

Lack of understanding from certain others can often lead people with chronic pain to re-evaluate their relationships.  Having a life-changing experience can really teach you who your friends are. 

Chronic pain and isolation

Because of chronic pain’s debilitating effects, it can soon feel like your world is shrinking.  People with chronic pain can find themselves becoming more and more isolated.

The connection between chronic pain and isolation flows in two directions:

Chronic pain can be debilitating and affect people’s ability to interact with others socially, leading to loneliness and isolation.  Social isolation can lead to an increase in negative thoughts about the pain, and an increase in pain perception.  This in turn can cause further social isolation.

A large population study of people in the UK in 2020 found that loneliness was associated with almost a two-fold increase in chronic pain. 

Researchers in 2019 had also studied chronic pain and isolation.   They reported that patients who expressed greater feelings of isolation, loneliness or disconnection from their social circle viewed their pain as being more problematic than those who felt more socially engaged and included. 

Researchers explain that episodes of physical pain and perceived social exclusion share common circuits in the brain, so that,

“Increases in loneliness may increase vulnerability to physical pain.”

(Wolf & Davis, 2014)

It’s becoming increasingly clear that relationships with others can play a big role in our experience of chronic pain.

However, socializing can come with challenges when living with chronic pain.

Chronic pain and socializing

Chronic pain can make socializing more challenging, due to physical limitations leading to fewer opportunities for meeting people outside of the home, and also due to the effects that pain can have on a person’s mood.  Physical barriers can be overcome by using technology as a way to stay connected.

Almost every aspect of social life can be affected by having chronic pain. 

Pain can often dictate what, where, when and how you get to meet up with friends and family.

Though not strictly ‘social’, employment can offer a sense of connection with others as part of the working day.  Many with chronic pain find they have to reduce their hours or stop work completely.

It’s unlikely that you’ll feel like socializing at all while you’re experiencing severe pain.  Chances are, when your pain is at it’s worst, you’ll just want to find a way to get as comfortable as possible and stay there.

The opportunities for socializing (in the traditional sense) while being stuck on the couch or in bed, are likely to be slim to zero. 

Those who have access to technology find it provides some great ways to stay connected and feel less cut off from the world.

Although it’s not just the physical aspect of chronic pain that can hinder your social life.  Chronic pain can affect your mood and the way you think about things, which can also be barriers to socializing.

Finding ways to manage to socialize can help lift your mood, which can only be a good thing.

But trying to maintain supportive relationships with others can have its own challenges for many with chronic pain.

Chronic pain and friendships

Chronic pain and friendships, like other relationships, can both have effects on each other. 

I’ll explain here how chronic pain and friendships are connected.

Chronic pain can cause issues in friendships if misunderstandings occur around physical limitations due to the pain, or it’s emotional impacts.  On the other hand, positive relationships with friends can be a resilience factor, increasing a person’s ability to manage chronic pain. 

A big part of what seems to happen with friends, is that chronic pain can potentially impact on plans you have together.  If your friends don’t understand the way that chronic pain affects you, they can start to drift away and stop inviting you to meet up. 

Some people can take personal offense to your boundaries, and can struggle to believe your reasons for not being able to see them.

In other cases, you might find that you just don’t have as much in common with certain friends any more, if your lifestyle has been severely impacted.

A study in 2021 looked at how chronic pain affects friendship in later life.  The researchers explain,

“Severe pain predicted a decrease in number of friends… [while] moderate pain predicted more friends and more frequent in-person meetings.” (Yang & Grol-Prokopczyk, 2021)

They also found that chronic pain impacted men’s friendships more than women.

Many researchers have been interested in how chronic pain affects the friendships of children and adolescents.  A review of the available research in 2020 concluded that,

“Involvement in positive peer and friend relationships have been found to be associated with functional ability and might represent a resilience factor system to help them manage pain, [but] when adolescents are not involved socially, the lack of this support is a source of stress.” (Beneitez et.al., 2020)

Chronic pain can interfere with the amount of contact and that children and young people have with friends, and impacts their activities together.  They can have difficulties with self-identity and feeling different to others, and can experience lack of understanding and disbelief about the pain condition from others. 

How the children and adolescents dealt with these challenges influenced whether they became isolated or involved with friend relationships. 

The research team advise helping children and young people to strengthen communication and assertive skills, and to avoid focusing on fears around rejection or judgement that can lead to avoidance of interaction with peers. 

Dating with chronic pain

With socializing often being more difficult with chronic pain, it can limit opportunities for meeting new people generally, and so making the chances less likely of connecting with someone you’d like to date.  The possibilities for meeting with new people online can help to overcome that hurdle. 

Social media platforms and community forums can be good places to make new connections and get to know people over time, with the option to message privately.

There are dating sites and apps which can be a fun way to find a date.  Certain dating apps, like Lemonayde and Glimmer, are made specifically for people with chronic health conditions or disabilities. 

The advantages of those specialist dating services are that you are meeting other people who have some form of personal experience and understanding of how it is to live with a chronic illness. 

Another advantage of specialist dating sites is that it removes a concern that people tend to worry about – if and when to tell someone that they have chronic pain.  You can choose to disclose these things on your profile if you want to.

It can also help prevent the interested person having to worry about what they need to consider when dating someone with chronic pain, if they already understand what it’s like to live with a chronic condition. 

Related post: Dating Someone with Chronic Pain: 10 Things to Consider

Chronic pain and marriage and family

Everyone’s experience is different, although there are common threads that run through the experience of chronic pain in a marriage or relationship with a significant other, and with family. 

“Chronic pain is not a pain of only one member of the family, but a pain of the whole family”

(Ojala et.al., 2015)

The topic of family and marriage and chronic pain has interested many researchers.  Based on the research, here is a brief summary of just some of the effects of chronic pain in a relationship with family and a significant other, and how a spouse can influence a person’s experience of chronic pain.

  • May become newly dependent on spouse or family for help with daily activities
  • Can feel distanced from family when unable to take part in family activities
  • Families can feel isolated from the community
  • Pain can create issues around intimacy and sex with spouse
  • Increased likelihood of divorce
  • Spouse’s response to pain can either hinder or help someone adjust to the pain
  • Spouse can help shift the focus off the pain
  • Spouse can help someone find the pain less threatening and cope better with stress
  • Higher emotional support linked to self-esteem and confidence in ability to achieve things
  • Most helpful when family members are supportive and understanding, instead of ‘babying’

(Sources: Almeida, 2020  and West et al., 2012 )

I’ve written more on the effects of chronic pain on marriage in my post on chronic pain and divorce, and on the influence of chronic pain on the family in my article on having a parent with chronic pain

It can be difficult for spouses and families to witness someone they care about experiencing severe persistent pain, and it can be just as important to be mindful of their own self-care when living with someone with chronic pain.

Pets and chronic pain

An important member of many households are the family pets, and relationships with pets can be very meaningful to people.  Researchers have started to take an interest in how pets can help people with chronic pain.

A 2011 study found that the pets of people with chronic pain were viewed as part of the family support system, providing comfort and companionship.  Researchers in 2020 have found that pets can help people with a variety of evidence-based pain management strategies.

Pets can offer a more uncomplicated type of relationship, where you are always accepted as you are, without question or judgement. 

My post on how cats can help with pain explains more about the recent research on how your pets can help with chronic pain.

Chronic pain support groups

People attending chronic pain support groups in 2018 were asked what kind of things they found helpful.

According to the research, some of the benefits of attending chronic pain supports groups are: 

  • Increased social contact
  • Sharing of pain self-management strategies
  • Increased life satisfaction
  • Enhanced self-esteem
  • Improved ability to function
  • Shared experience and understanding with others
  • A place where disability was not viewed as abnormal
  • Non-judgemental acceptance and inclusivity
  • Helping to explore and foster a positive new identity
  • Opportunity to meet a diverse range of people
  • Different life experiences within group provide new perspectives
  • Disruption of ‘pain-talk spiral’ by not making pain the central focus
  • Common humour and laughter about shared challenges
  • Fostering a sense of being capable and worthwhile, valued and appreciated
  • Providing practical, emotional and social support
  • Helping to discover new passions, purpose and perspective
  • Expanding social opportunities from starting off-shoot hobby groups
  • Helping fight against declining activity levels
  • Helping better manage mood and coping ability
  • Providing opportunities for problem solving with empathy

 Many chronic pain support groups are local to each region, but there are also chronic pain support groups online.  Many online groups are set up for people with specific pain conditions, such as fibromyalgia, where others cover chronic pain more generally.

Conclusion

Having chronic pain can affect all of your relationships, including the relationship you have with yourself.  You might be dealing with changes in self-identity, while trying to maintain positive relationships with others. 

The way we interact with others and the way others respond to our pain, can influence how we experience the pain and ability to manage it. 

Chronic pain can mark the beginning of a period of re-thinking about your relationships, sometimes growing closer to and stronger together with loved ones, and sometimes becoming more distanced.

A common piece of advice across the topic of chronic pain and relationships, is that good communication is the key to staying connected and close to the people you love and care about. 

Counseling & issues around chronic pain and relationships

Finally, as a counselor with a special interest in chronic pain, I’d like to give a mention here to counseling for issues around chronic pain and relationships.

As we have seen, our ability to cope with and manage the pain can be influenced by psychological and social aspects.

Counseling provides a non-judgemental and accepting therapeutic relationship with a therapist, where people with chronic pain can work through any of the issues discussed here and more.

A therapist can work alongside you to work out where you want to be, and what steps you can take to get there.

People often find that once they’ve worked through the issues caused by the pain in their life, the experience of the pain itself becomes easier to deal with. If you are able to access counseling services, you might like to give it some consideration.

References

Allen, S.F., Gilbody, S., Atkin, K., & Van der Feltz-Cornelis, C., (2020). The associations between loneliness, social exclusion and pain in the general population: A N=502,528 cross-sectional UK Biobank study, Journal of Psychiatric Research, Volume 130, Pages 68-74. ISSN 0022-3956. https://doi.org/10.1016/j.jpsychires.2020.06.028.

Almeida, I. F. N., (2020). Social responses to pain behaviors: the role of friendship on the adaptation to chronic pain.

Beneitez, I., Hernández, E., Nieto, R., & Boixadós, M. (2020). What Mechanisms do Children and Adolescents with Chronic Pain Use to Manage their Friendships? A Review of the Literature. Clínica y Salud, vol. 31, no. 1, pp. 27-45.

The biopsychosocial model – Explanation of chronic pain disorders (2020) YouTube video, added by Deutsches Kinderschmerzzentrum [Online].

Finlay, A. K., Peacock, S., & Elander, J., (2018). Developing successful social support: An interpretative phenomenological analysis of mechanisms and processes in a chronic pain support group, Psychology & Health, 33:7, 846-871. 

Janevic, M. R., Shute, V., Connell, C. M., Piette, J., D., Goesling, J., & Fynke, J., (2020). The Role of Pets in Supporting Cognitive-Behavioral Chronic Pain Self-Management: Perspectives of Older Adults. J Appl Gerontol;39(10):1088-1096.  

Karayannis, N., G., Baumann, I., Sturgeon, J., A., Melloh, M., Mackey, S. C., (2019). The Impact of Social Isolation on Pain Interference: A Longitudinal Study. Annals of Behavioral Medicine, Volume 53, Issue 1, Pages 65–74. 

Lavie-Ajayi, M., Almog, N., Krumer-Nevo, M., (2012). Chronic pain as a narratological distress: a phenomenological study. Chronic Illness, 8(3):192-200.

Ojala, T., Häkkinen, A., Karppinen, J., Sipilä, K., Suutama, T., & Piirainen, A., (2015). Revising the negative meaning of chronic pain – A phenomenological study. Chronic Illness, 11(2):156-167.

Tollefson, J., Usher, K., Foster, K., (2011). Relationships in pain: The experience of relationships to people living with chronic pain in rural areas. International Journal of Nursing Practice, 17: 478–485.

West, C., Usher, K., Foster, K., & Stewart, L., (2012). Chronic pain and the family: the experience of the partners of people living with chronic pain. Journal of Clinical Nursing, 21: 3352-3360. 

Wolf, L. D., & Davis, M. C. (2014). Loneliness, daily pain, and perceptions of interpersonal events in adults with fibromyalgia. Health Psychology: Official Journal of The Division of Health Psychology, American Psychological Association33(9), 929–937.

Yang, Y., Grol-Prokopczyk, H., (2021). Chronic Pain and Friendship Among Middle-Aged and Older U.S. Adults. The Journals of Gerontology: Series B, Volume 76, Issue 10, Pages 2131–2142.