I am watching this webinar:

The Social Consequences of Chronic Pain: By Dr. Claire Ashton-James; hosted by Pain BC partner, the Canadian Institute for the Relief of Pain and Disability (CIRPD) Which is a source for the following blog post and a very interesting discussion on the topic. The sources for the webinar are within it but too small for me to source in this post as I can’t read them (And not listed outside of it and no transcript posted), but they are in there if you want to check them out.

The webinar begins with stating many people report the most distressing part of chronic pain is the social isolation.

The social consequences of pain are as important as the physical and psychological consequences. Things like ‘taking care of children, spouse or parents’, ‘relationships with friends’, ‘relationship with significant other’, ‘relationship with family and relatives’, ’employment’, ‘taking part in family events and activities’, and ‘participating in social/recreational activities’ all rank as high as the typical pain consequences such as emotional wellbeing, lack of sleep, and fatigue, poor concentration, ect.

This makes logical sense when we think about it. That is because all these things are participating in Life and Functioning. These are the things that are limited and reduced significantly. It is clear all of these have a significant impact on us all.

However, it goes on to state, they rarely address these social factors in multidisciplinary treatments.

Subtitle: The price of chronic pain on our social relationships
Title: Chronic pain: Social consequences
Image: second half of pin- picture in black and white of a crowd of people on a sidewalk

Anger and depression

In fact, the decrease in our social satisfaction predicts our level of distress, anger and depression in chronic pain because of the massive disruption to our social relationships. And maybe this isn’t that surprising since there is a lot of research into how loneliness (an epidemic even before the pandemic) has such severe consequences. Humans are social animals. Even I, an introvert, am aware of this. I love my alone time. I need it being an introvert. But I am a human being and as such, I need other human beings. I suffer without social interaction. Although I do not need an abundance of it, I do need it.

Part of my treatment for depression was increasing my social time with friends and family. My first therapist never did that at all. To treat my significant depression due to my unmanaged and untreated pain, all she recommended was walks outside. She worried I was not leaving the house enough. Not the isolation itself. Not the complete social isolation. It was much later my pain psychologist pointed out that yeah, even introverts, with introverted hobbies, need to socialize sometimes. And he was right about that. And I make a point of doing just that. Until the pandemic sort of screwed that idea up… and we all suffer the consequences of that.

The fact of the matter is, we have a difficult time with this. For many reasons. One basic reason is actually maintaining friendships. The other is having the capacity to socialize. Weight the cost and the benefits of it. Doing social activities we actually can for durations we can handle. With people that have the capacity to understand, that means we cannot do other activities that we simply can’t do and for durations that are impossible. Or locations that do not work. Or many other factors we have to turn down. Or bad days. A lot of people do not get that, so that means very few friends indeed.

The cycle

When social satisfaction tanks, our anger and depression increase. So it is our pain intensity that impacts our functionality and often mobility. This then affects our ability to do the social roles I mentioned, leading to much lower social satisfaction. Because of lower social satisfaction, we get depressed or angry, or both.

I tend to get depressed. And that makes me less motivated to even try to socialize. I get into hermit mode. And why even try? People just… disappear.

This makes sense to me because the more disconnected we become from all aspects of our lives in society, the more frustrated (leading to anger) and lonely/isolated (leading to depression) we become.

The positive social consequences of pain

One positive social outcome to Acute pain is that is mentioned in the webinar is that it brings out empathy and care in others. They care about the pain the person in acute pain is experiencing and want to help. It can even strengthen bonds between people. I get this. When we see immense suffering in others, we are inclined to want to help ease it.

This is not something that exists with chronic pain. I find the fact the webinar points this out amazing. We all know this fact. Persistent pain doesn’t have the same Persistent care and empathy associated with it. And it then has a negative impact on relationships.

Text quote "Pain is always new to the sufferer, but loses its originality for those around him" Alphonse Daudet

Impacting relationships, such as:

Our peers:

It has a strong negative effect on our peer relationships. We have fewer friends and a lower level of social support. I mentioned this above. It is difficult to maintain friendships with chronic pain. Empathy is not something that is an endless supply. If a person doesn’t recover or heal, then empathy wains. We become tiresome. We are too negative. We talk about our illness ‘too much’. We never ‘come out’ or ‘do things’. Certainly, we do not get the support someone with an acute illness would. Hell, I wouldn’t even expect that. I sort of find a way of trying not to mention my chronic pain much while at the same time ensuring I do not exceed my limits by doing things I cannot just to keep friends.

Our colleagues/employer:

This is a category I think we all know there is a huge negative impact. Man, the impact on my life was horrific. Absenteeism causes co-worker conflicts. Research shows we face suspicion, mistrust, and job insecurity. We are perceived as lazy and unreliable. Expressions of pain are often perceived as disability… no matter the actual level of functionality. We are literally perceived differently based on our expressions of pain or pain behaviours. The webinar stated from one study ‘Chronic pain is only associated with lower workplace performance when accompanied by with low perceived organizational support’- not pain intensity or actual poor performance but lack of actual support within the company. And what will affect performance and absenteeism is how we are then treated. That was my experience and to see research backing up my experience is validating but also very sad, actually. It makes me quite sad that I had to endure that experience.

Our significant other:

There are risk factors we would expect, such as the financial insecurity, unemployment, sexual dysfunction, mental health concerns, and our altered social functioning and roles. But actually we’re more likely to stay married than healthy couples. That surprised me actually. I had always heard differently. Maybe because we hear the terrible stories. And we all know of those.

Perhaps because of increased emotional closeness, the ability to be vulnerable and accept help (50% report strengthening of relationship and 20% a weakening). And there is also the mutual adapting to adversity. Those are the potential offered reasons for the enduring relationships even in the face of the additional stressors.

Parent-child relationship-

Chronic pain can have a negative impact sometimes where the child can report increased reports of pain, decreased physical and psychological functioning, and worse family relations according to the webinars reported research (But the presenter notes that is a subjective perception of family relations but an outside observer report could be different- because those children may believe it made things harder but they have no comparison to make). But, on the other hand, also can view it as an opportunity for social development, learn more independence, learn more about empathy.

So we can say for social consequences of pain,

The research is really clear that chronic pain negatively impacts our peer and work relationships. But it is really mixed when it comes to our significant others and children, as one might suspect, because those are the people who truly see us as we are. So it really depends on our coping skills and our partner’s coping skills, combined, when it comes to that area.

I will have to do another post for the rest of the webinar since this post is getting a wee bit long, but it gets into some interesting things.

Effects of social isolation
Social isolation and mental wellbeing
Chronic pain: How we are socially unacceptable

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