Dave Gavel, PhD
A few nights ago, I was talking with my wife about something fairly benign – probably weekend plans or paying the light bill – when she suddenly got a look on her face that I know very well. It was that solemn, glaze-eyed look that says, “I’m so over this.” Like any good spouse would do, I asked, “What’s wrong? Are you ok?” Her eyes snapped to and she gave a slight smile accompanied by the quietly murmured, “I’m fine.” This was obviously not the case so I interpreted her response to mean that something was wrong, but she was not interested in a sharing hour so it would probably be best for me to leave it alone. So naturally, I asked again, and again. This did not go over well but she was neither unkind nor amused by my inquiries. I spent the next two hours introspectively scanning memories of the last two days for anything offensive I could have done while she sat quietly watching a movie. Then, just before we nodded off for the night, the truth came out with an emotion that only someone who has ever sat quietly in agony could express. She informed me that while we were talking, her jaw, compromised by severe temporomandibular joint disorder (TMJ), slipped out of socket and caused excruciating pain to shoot through her face and into her head. I am aware of her TMJ condition and the pain flare ups it causes during more days than not. So why did she not just tell me? “I didn’t want you to know because you treat me different when I’m hurting and I didn’t want that,” she exclaimed. This is not a new concept to me. I hear evidence of it from my patients nearly every day. But this was the first time it hit home, and it hit like a ton of bricks.
Since then, I have been reflecting on the perspectives of individual with chronic pain within their social relationships. Naturally, individuals with chronic pain grow accustomed to living their lives and adapting their world to accommodate significant physical discomfort. Social relationships are not exempt from this influence. Like any physical ailment, chronic pain often leads patients to the natural conclusion that they must prioritize their activities to preserve their physical and emotional resources for only the most important aspects of life. For many, this means that any non-essential social contact becomes limited. Church social hours with casual friends, annual family reunions, and monthly outings with coworkers become expendable. The primary reason for many is that pain makes these events less enjoyable. But a close second reason is that many get tired of answering questions like “how are you feeling?” or “can I help you with that?” Every social interaction with people, especially those who were in a patient’s life before pain began, becomes a fresh reminder of how pain has changed their lives for the worse and it is simply easier for the mind and the body to avoid these interactions. But what about relationships that are not so easily avoided like spouses, children, or even co-workers?
Social norms and common decency typically dictate that individuals in pain or discomfort are provided with special comforts or considerations from those around them. That is why children recovering from tonsillectomy get to eat ice cream for 5 days straight and a spouse who pulls a muscle gets a break while the rest of the household picks of some slack. However, unlike these temporary conditions, chronic pain is an enduring condition and to apply the same social laws would mean that an individual living with chronic pain is to be treated differently as a rule, rather than the exception. In the example with my wife, her sentiment struck a chord with me because it shined a big fat spotlight on the ugly truth that what I perceive as well-meaning actions can actually be adding insult to injury (pun intended). The logic goes like this. I love my wife and do not want to make her pain worse. I know my wife’s jaw hurts with increased movement. Thus, I try not to engage her in as much conversation when I know it is bothering her. This makes sense, right? Here is another one. My wife is in pain. I know from professional experience that pain increases the likelihood for one to become irritable or frustrated. Thus, I walk on proverbial egg shells to prevent contributing to worsening her mood and call it “giving you space.” In both examples, I can describe my actions as logically well-intended. But logic has little to do with the emotions of interpersonal relationships and reality is that my actions can have a negative impact on her emotional and physical condition.
The implications of the social phenomena discussed above are rooted in the reality that the human experience is best conducted in the presence of others and to deprive that nature has unintended consequences. Researchers have documented that a lack of satisfying social relationships can directly affect negative changes such as emotional discomfort (e.g., sadness, longing, loneliness), physiological distress (e.g., sleep disturbances, unhealthy appetite/eating patterns), and mental anguish (e.g., depression, anxiety). Other research studies have shown that individuals with positive social support and healthy interpersonal relationships are at a lower risk for certain chronic health conditions, tend to heal faster from acute medical conditions, and are less prone to chronic forms of mental health problems. Researchers have even demonstrated that one of the strongest indicators of the likelihood of an injured workers to return to work is not the severity of their injuries. Rather the nature of their relationships with supervisors at the time of injury is a driving factor such that those with hostile or non-supportive relationships are less likely to return to work.
In summary, it is important as providers, spouses, children, and friends engaged in the lives of individuals with chronic pain that we recognize that patients are social beings in need of adequate social support. Such support may involve a helping hand or simply understanding the need to skip an event. At other times, it may mean remembering that the person in pain is still the person we knew before the injury and he or she likely still wants our time and attention, even if it comes in different forms.