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Chronic pain – pain persisting for more than three months, or longer than is expected for a given injury – is a common problem. One in five Australians has some form of persisting pain. Conditions such as low back pain and arthritis are the most common.
Fortunately, most people with chronic pain manage very well, and lead relatively normal lives. However, a significant number, perhaps up to 10%, become disabled by their pain. They take large amounts of pain medication, seek treatment from numerous practitioners (usually with little long-term benefit), and struggle to maintain their involvement with work, social, leisure and domestic activities.
Why some cope, some don’t
A significant decider of why some manage with chronic pain and some are disabled is the way their partners respond to them.
Living with someone who is experiencing chronic, unrelieved pain can be demanding. Pain is often associated with depression, sleep disturbance, increased irritability and high levels of frustration, none of which make the person suffering the pain much fun to be around.
There are also the associated activity limitations that often accompany chronic pain problems. Having a partner who struggles to go to work, to help with childcare, to lend a hand with household chores or to accompany you on social outings is difficult.
Neuroscience now explains something we have always known: due to mirror neurons (brain cells that fire in response to observing someone else carrying out an action or experiencing something), it can “hurt” you – in a physical and emotional sense – to see your loved one experiencing pain.
What is less known is that while the patient can affect the partner, the partner can also play a very important role in how the patient copes with the pain.
Partner responses to patient pain behaviours (those expressions of pain such as limping, or grimacing or lying down) are basically divided into solicitous or punitive behavioural categories.
Solicitous responses are overly protective responses – where the partner does everything he or she can to prevent the patient’s pain from getting worse, including getting medications, encouraging rest and taking over jobs or duties.
Solicitous partners also tend either to not support, or actively dissuade, the patient from engaging in so called “well behaviours”, such as exercising, out of concern the pain may worsen.
On the other hand, punitive or negative responses to pain behaviours are the partner’s expressions of annoyance, exasperation or sheer frustration at the patient’s pain (“If I have to hear about your bad back one more time I am going to scream!”).
Over time, these response styles have markedly different effects on patients. The research evidence shows that patients whose partners tend to respond in consistently solicitous ways become more and more disabled by their pain over time.
They are less active, less functional, take more pain medication and are less likely to remain at work. While there may be depressive symptoms reported, these patients typically also report high relationship satisfaction and good social support for their condition.
In contrast, patients whose partners tend to respond to their pain with punitive responses are more physically functional. However, their reports of relationship satisfaction are very low.
Partners play a role
Partners walk a fine line between providing too much practical support, and promoting disability, and not providing enough emotional support, and their patient-partners feeling uncared for.
While partners often report feeling helpless in relation to supporting the person with pain, the data suggest they actually have a powerful role in patient adjustment to pain.
Given these difficulties, Relationships Australia NSW (the federated relationships counselling service) and I decided to explore the extent to which chronic pain issues played a role in couples seeking treatment for relationship difficulties.
After sampling 480 couples over a six month period, it turned out that in 32% of couples, one of them had a chronic pain problem. One-quarter (24%) of them said that chronic pain had a moderate to severely negative impact on their relationship.
While about 65% were taking regular pain medications and 30% had taken time off work in the previous six months due to pain, only 15% of the sample had actually been to a specialist pain clinic.
What all of this tells us is that far from being a helpless bystander to a loved one’s pain, partners play a crucial role in how successfully a patient manages his or her condition. Many couples find their relationships are strained by the effects of chronic pain, but our data showed relatively few patients obtain specialist pain treatment.
The key here, as in many aspects of health care, is early intervention. Specialist pain services should routinely include the partners of patients in their assessment process and screen for problematic interactions.
Couples should then be able to access pain counselling assistance early, before these exchanges become entrenched and add to the difficulties of living with chronic pain.