Many family troubles linked to chronic pain can be addressed by being open and honest. Problems generally develop over time and only escalate because members try to avoid acknowledging them. Communication is a two-way street and involves not only expressing what you are feeling and getting others in the family to see your point of view, but also listening to others and really trying to understand what they are experiencing. Ideally, when a member is in chronic pain, the family adjusts and continues life as a cohesive, successfully functioning unit. Unfortunately, however, this is often not the case. In many cases of chronic pain, the family makes changes, but then reality sets in. The family member in pain doesn’t get better. Life drags on, and “burnout” becomes as threatening as the painful condition.
Dr. Hanson describes three ways in which family members respond to expressions of pain:
- Punishing responses. Family members may ignore you or respond in ways that indicate a lack of care or concern, including irritation, frustration, or anger.
- Solicitous responses. Family members become extremely helpful (often too much so), getting your medicine, getting your food or water, or taking over your chores.
- Distracting responses. Your family tries to distract you from your pain. Members encourage you to do things like read, work on a hobby, or move around.
Of these three, punishing responses are the least desirable. Minimizing or disregarding the painful situation can make a person’s emotional condition all the worse. Responding with anger, resentment, or frustration can have a ruinous effect on a relationship, as it did with Lila and Paul. Concern and compassion are healthy, but solicitous responses may be overdone and actually reinforce helplessness. Experimental studies have found that the presence of a solicitous spouse increased pain intensity and more than doubled brain activity from an electrical shock administered to a patient with chronic pain. This shows that being rewarded for experiencing pain (receiving increased attention, for example) can increase the amount of pain one experiences. It is natural for someone in pain to occasionally react to his or her condition with a moan or groan, but some in chronic pain are continually calling attention to their condition. When this happens, the solicitous spouse (or child or parent) may find he or she is reacting not to the painful condition, but to the moan. The mate who consistently responds to the moans and groans is actually reinforcing the pain. The same principle applies to people in chronic pain who stand to gain from their pain disability. Receiving benefits for having pain can make the pain more intense and frequent. It is important to realize that these processes do not involve conscious exaggeration or deceit. They are simply learned responses from receiving a reward (attention, service, or money) for being in pain. It’s as simple as that. Conversely, rewarding function increases function. There is a fine line between compassion and codependence. Compassion is unconditional kindness for oneself and others. It is the healthy understanding that “I’m okay, and I care about you and want you and others to be okay, too.” Compassion is universal and based in the individual’s willingness to be caring, but not at his or her own expense. Codependency differs from compassion in that it develops from a need for the well-being of others. Codependency generates from an inner feeling of deficiency. “I can’t be okay if you are not okay.” One of the fundamental differences between compassion and codependency is in the ability for self-care. Compassionate people are gentle with themselves, so that they may better care for another. Codependent people lose sight of their needs in the needs of another. Distracting responses are of the greatest benefit to those in pain, as well as to their family members. As discussed in other areas in this book, doing some type of activity, even if it’s as slight as getting your own drink of water, is one of the best things you can do for yourself when you’re in pain. And the family that encourages any kind of activity that reinforces independence is helping the person in pain. Dr. Julie K. Silver, in her book, Chronic Pain and the Family: A New Guide, describes beneficial ways in which the person in pain and family members can reduce or eliminate maladaptive chronic pain behaviors.
The person suffering from chronic pain in pain should:
- “Use words to describe what you’re experiencing. Keep in mind, though, that people don’t need to hear exactly how you’re feeling. There are many times when ‘suffering in silence’ will be beneficial to you and your family members.
- Don’t hold your spouse or other loved ones responsible for your physical comfort. If you need something and can get it yourself, then do so.
- Try to avoid canceling plans with people—it’s disappointing for them and for you. If you can manage the activity, then go ahead and do it.
- Understand that the less active you are, the more pain you’ll have as a result of physical deconditioning. So try to remain as active as possible.
- If you’re unable to handle household responsibilities that were once yours, then take on new ones that you can manage in order to lessen the burden on your loved ones.
- Be your own advocate and seek legitimate medical treatment. Follow your doctor’s advice unless there is a compelling reason not to. If you don’t want to do something your doctor recommends, then discuss this with him so that an alternate treatment plan can be implemented.
- Engage in regular, but not incessant, honest and open communication with your family members about what’s happening to you and how you’re feeling. Ask them how they’re feeling and listen with empathy. Remember that just because you’re feeling the physical pain doesn’t mean they’re not suffering as well.”
- “Don’t constantly ask how your loved one is feeling—particularly when the person is not complaining or focusing on the pain.
- Encourage the person in pain to do whatever he can to help himself and the family.
- Avoid taking over all the responsibilities of the family—ask and expect the person in pain to help whenever possible.
- Don’t be the go-between for the person in pain and the doctor—they should have their own relationship, and the person in pain should be responsible for following through with all treatment plans.
- Don’t cancel your plans to do things just because someone else is in pain. Enjoy the things that you can do. Keep in mind that children often cope the same way their parents do. If your children see you shut down and become reclusive, they may do the same. On the other hand, if they see you enjoying yourself and having fun despite difficulties at home, they will likely respond in kind.
- Engage in honest and loving communication on a regular basis with both the person in pain and other members of the family who may be affected as well.
- Don’t respond to maladaptive pain behaviors. If you can, point out these behaviors in a loving way and try to reinforce the fact that they’re not useful.”
Healthy families take care of themselves—each individual enhances the family and does not become lost in the chronic pain of one of its members. This blog post is an excerpt from A Day Without Pain (Revised) by Mel Pohl, MD, FASAM; Published by Central Recovery Press (CRP).