Chronic Pain and Mental Health

Caroline was trying her best to be upbeat and not grimace in pain. Her husband had lovingly prepared her favorite steak and baked potato for dinner, but it was hard to use a knife to cut the steak. The chronic pain in her hands from years of arthritis made something as ordinary as dinner really difficult.

Dave was frustrated. His back was killing him, but it seemed that no one understood why he couldn’t sit through a movie on the couch with his family. He felt that it would be easier for them if he was wearing a cast or had some other visible reminder that he was in constant pain.

It is likely that we all know someone like Caroline or Dave who are living with chronic pain. Dealing with daily pain is not only exhausting, but the loss of ability to enjoy activities, and the social isolation from withdrawing adds heavily to the emotional toll. 

Research has shown that when people are in pain, they very naturally limit their physical function, this leads to fewer interactions and results in many losses, including those activities which have brought joy. The result can be a mixture of anxiety, depression, and anger. When arthritis forces a lifelong knitter to stop her craft, or degenerative spinal or disc disease makes joining in a favorite sport, or just taking a long walk impossible, this is life-changing. 

Pain can shrink your world, and managing it takes a lot of physical and emotional energy.

High Impact Pain

In a 2016 survey, approximately 50 million US adults (20 percent) had chronic pain, and 20 million (eight percent) had what is called “high-impact” chronic pain.

High-impact chronic pain is pain that interferes with the activities of daily life. In contrast to people with lower-level pain, those with more debilitating pain report more mental health problems, cognitive problems, and more medical interventions.  

Although there is always hope for new medical interventions, all chronic pain is by definition incurable. At best it can be managed with various treatments. This is one of the most discouraging aspects of living with pain–this is what I’m stuck with! 

Here are the most common causes of chronic pain: 

• Low back pain is one of the most significant health problems. Back pain is a common cause of activity limitation in adults.
• Arthritis pain affects more than 50 million Americans each year.
• Headaches affect millions of US adults. Some of the most common types of chronic headaches are migraines, cluster headaches, and tension headaches.
• Other pain disorders such as fibromyalgia, neuralgias and neuropathies that affect nerves throughout the body.
• Pain due to damage to the central nervous system (the brain and spinal cord).
• Cancer pain affects most people with advanced cancer.
• Psychogenic pain, where no physical cause can be found.

Maya loved being a caregiver and had worked with the same family for 6 years providing in-home care for an elderly parent. She loved brightening up his day by cooking his favorite foods and making sure he could do the activities he enjoyed. Then one day, while helping him transfer out of bed, she hurt her back and was unable to work for several months. The toll was enormous, as Maya was the sole source of income for her family. She didn’t want to complain, and yet she needed to work, which she did despite the pain and the added toll it was taking on her body. 

The Emotional & Physical Toll

The mental stress of pain affects our biology all the way from sleep and blood pressure to our moods. Aren’t we all more likely to be irritable and crabby when we have a headache? Daily pain that is untreated leaves people open to psychological effects like mood swings and depression. We all must adapt as we age to our lessoning abilities but this usually happens over decades and we have time to adapt. But the onset of chronic pain can occur long before old age, and the pain-affected person feels robbed of their old self, and frustratingly at the mercy of pain and various medications. Also, without support, chronic pain can lead to changes in blood pressure and digestion. 

New Research into Pain

A new study by Associate Professor Sylvia Gustin from Neuroscience Research Australia and University of New South Wales, has discovered that one of the brain’s key chemicals, glutamate, is lower in those with chronic pain. This neurotransmitter plays a part in controlling thoughts and emotions. 

“People with chronic pain are often unfairly labelled as having certain personality traits that make them more likely to experience pain,” said Associate Professor Gustin. But the new findings indicate that is not the case. Associate Professor Gustin adds that it is the pain itself that has led people to be…“more negative, fearful, pessimistic or worried.” Gustin will now test to see if increasing glutamate levels will reverse negative personality effects caused by pain.

How Can Partners and Loved Ones Help?

Being the partner or loved one of someone in chronic pain is challenging, it is hard to know how best to be helpful and supportive. Remember, you have not been in their shoes and there are no visible signs of pain, which can lead you to have unrealistic expectations. Here are some things you can do:

• Study up. Learn about chronic pain. The more you know, the more you will understand what is going on with your loved one and gain empathy. You also can be supportive by staying involved in treatment and being the note taker at appointments. 

• Check-in. Ask how they are doing and indicate that you are there if they just need to vent or grieve, or if you can do any research or help out in any way.

• Be flexible and creative. If this is your partner you may need to rethink tasks and household responsibilities. Adjust your expectations; things may have to be done in smaller time chunks. You may have to switch responsibilities, someone who used to mow the lawn, may now pay the bills. Set your loved one up for success.

• Help keep up the social connections. Keep the opportunities to socialize and engage in interests going–even if you get a “no,” keep asking.

• Try not to hover. Encourage independence and look for ways to adapt your surroundings so that the person can do as much as possible, which will boost self-confidence.

• They may not be able to do the grocery shopping and carry in heavy bags, but they may be able to sit at a table and do the food prep with chopping and mixing. Standing at the sink can be problematic to wash the dishes, how about finding a tall stool to sit on?

How to Live with Chronic Pain 

• Meditation and Mindfulness has been shown in numerous studies to help people manage their pain. I would encourage you to watch this video from Dr. Jon Kabat-Zinn:

           And if you like that, check out this longer video from Dartmouth: 

• Talk therapy, group support, and psychotherapy of various kinds can help in coping with pain.

• Stress-reduction techniques, physical activity, exercise, seated yoga, biofeedback, and other strategies also may help.

• Explore pain rehabilitation programs. Your healthcare provider may have a team approach to treatment, including medical and psychiatric interventions.