Since we are discussing the body, it is significant to address the fact that many with chronic pain have an altered body image (ABI). We want to remind you that you are still the same person inside that you were before you had chronic pain. Try learning new ways to do at least some of the things you enjoyed before. You may need to be creative. Don’t limit yourself with the label of “disabled.” The focus should no longer be on chronic pain and what you can’t do, but rather on enhancing function and doing what you can. Chronic pain can interfere with a healthy sex life in a number of ways. You may have difficulty being sexual because your self-esteem has plummeted and you feel bad about yourself. Changing roles or household patterns because of chronic pain may also affect sexuality. Another common problem is anticipation or fear of pain, which can interfere with performance or act as a trigger in causing you to avoid sex. Intercourse may be physically uncomfortable for a person in pain. Opiates and other painkillers can cause physiological changes that affect sexual functioning. According to studies, in men, opiates can lower testosterone levels, suppress sexual function, and cause erectile dysfunction. They can also contribute to low libido and difficulty with orgasm in both sexes. If you have chronic pain and take medications for depression such as Prozac (fluoxetine), Zoloft (sertraline), or others, side effects in both men and women may include decreased sex drive and difficulty reaching orgasm. There is no need to be celibate or ashamed. If these issues affect you, we encourage you to talk to your doctor, counselor, and sexual partner. If your doctor does not bring it up, ask about the side effects of your medication as a way to start the conversation. A pain journal may be useful when you are at home for jotting down points and reflecting on when you were intimate with your partner. At what point did your pain occur, and what was going on when your pain subsided? Once your doctor has a clear picture, he or she can work on helping you to plan for alleviating pain during sexual activity. Sexual activity is a normal part of intimacy and need not be given up. Reigniting intimacy can actually help reduce pain and suffering. During orgasm, the body floods with endorphins, and this helps relieve pain. Trying different positions or activities other than traditional intercourse may be satisfying and enhance intimacy without causing pain, so we encourage you to think creatively. Express your limitations and desires to your partner. Tell your partner what is pleasurable and what is not. Communication is the key, and may best be accomplished outside the bedroom. The body is one of the cornerstones of the experience of pain; therefore, balancing our physical life is a fundamental component of pain recovery. There are many ways to impact physical balance and enhance pain recovery. Next we will look at the other three points of balance—mental, emotional, and spiritual.

Remember, your loved ones are not mind readers. Healthy communication is the key to intimacy.

photo credit: Andreas Issleib via photopin cc