Updated: Jan 30, 2020
Chronic pain affects the lives of approximately 100 million Americans (IOM, 2011). While prescription medication is the most common form of pain management for chronic pain, only 23 percent of patients with chronic pain found opioids effective, according to a 2006 survey carried out by the American Pain Foundation (The CHP Group, 2014). It’s a challenge for health care providers to treat it because the cause is sometimes unclear and medical treatment, including medication, is often not completely effective (MacDonald, 2017). For people with chronic pain, this is extremely frustrating and often results in them feeling hopeless. I decided to write this as a caregiver of someone with severe chronic pain, to: (1) educate those who are relatively pain-free about what people with chronic pain experience and its effects on their quality of life; and (2) to share research on helpful and effective things that chronic pain sufferers can do as well as ways their loved ones may be able to help.
What is Chronic Pain?
Chronic pain is any pain that lasts more than six months, versus acute pain, which is pain that last less than thirty days (MacDonald, 2017). When we experience pain, the pain signal travels from the physical site of the pain to the brain via a sensory pathway, enabling us to be aware of the sensation and emotionally react to the perceived “threat level” of the pain (Borgini, 2011). Pain levels for chronic pain suffers can fluctuate due to a number of factors, including an increase in inflammation, hormonal cycles, and emotional stressors, which can cause changes in pain levels lasting hours, days, or weeks (Gatchel et al., 2007).
Our pain experience is influenced by our emotional state and our perception of the severity and nature of the cause of pain. For example, chronic stress involves the release of the cortisol hormone, which can lead to atrophy of muscle tissue, impairment of tissue growth and repair, suppression of the immune system, and even changes to brain structure that would set up conditions for development and maintenance of chronic pain (Gatchel et al., 2007).
How Does it Effect Quality of Life?
Some people with chronic pain often experience cognitive problems such as forgetfulness, difficulties in performing everyday tasks, problems with communicating, difficulty concentrating, reduced attention span, and the inability to respond with any quickness or adeptness when performing certain tasks (MacDonald, 2017). These difficulties can make it more challenging to cope with the other impacts of chronic pain. For example, people with chronic pain often have difficulty sleeping, a critical time when the body heals and purges toxins from the brain. Insomnia can then further contribute to the problems with thinking and communicating clearly, which can make them feel even more isolated.
Along with cognitive functioning problems, a very common issue for people with chronic pain is developing pain-related fear. Pain-related fear is the fear that emerges when sensations that are related to pain are perceived as a main threat (Leeuw et al. 2006). The body’s response to fear includes physiological (e.g. heightened muscle reactivity, increased heart rate), behavioral (e.g. escape and avoidance behavior), as well as cognitive (e.g. catastrophizing thoughts) elements. The fear response toward feeling pain often leads a person to avoid behaviors that could lead to feeling pain.
However, pain avoidance behaviors are unhelpful strategies for long-term pain as they offer only temporary relief from pain symptoms and also increase disuse (and chronic pain), occupational difficulties, depression, and social withdrawal (Norton and Asmundson, 2003). Researchers also found that pain-related fear sometimes may be related less to pain severity and more to fear of physical disability or other concerns such as inability to work, having surgery, having to sell the house, being a burden to family members, and social isolation. Furthermore, some have reported that isolation is sometimes self-imposed because social interactions deplete them of energy they need to cope with pain and ability to function. Studies have also shown that sensitivity to pain and sensitivity to social rejection were mutually reinforcing (Leeuw et al. 2006).
In addition to anxiety about feeling pain and seeking to avoid it, people with chronic pain often feel rejected by the medical system, believing that they are blamed or labeled as complainers by their physicians, family members, friends, and employers when medical treatment is ineffective. Chronic pain sufferers may be worried that, on the one hand, people will not believe that they are suffering or are exaggerating it or they may be told that they are beyond help and will just have to learn to live with it (Gatchel et al., 2007). In response to these reactions and their own internal self-judgments, people with chronic pain also often feel hopeless, unwanted, demotivated, and unable to take care of themselves, which over time can lead to depression. Over the long term, depressive symptoms can increase other problems such as reduction in energy level or fatigue, decreased activity level and libido, as well as unhealthy coping methods such as use of drugs or alcohol to manage the pain (MacDonald, 2017).
It should not be surprising that anger is also found to be common among sufferers of chronic pain, given the frustrations related to persistence of symptoms, possible confusion about the causes of their pain, and repeated treatment failures. They may have anger toward others (employers, insurance companies, the health care system, family members) and anger toward themselves (the most common) for not being able to control their pain and allowing it to take over their lives (Gatchel et al., 2007). However, frequent anger may exacerbate pain by increasing physiological arousal and muscle tension.