When I Am in Pain

“When I am in pain, I feel alone.”

So said a client, a mother of three children who experienced chronic pain. She was regularly with people, yet she felt alone, in her pain.

This reflection explores the complex relationship between chronic pain and loneliness. The relationship between chronic pain and loneliness is not frequently discussed. Yet, it is an important topic.

It is estimated that 3.4 million Australians live with chronic pain. The effects of chronic pain can be devastating both physically and mentally. For example, chronic pain reduces a person’s capacity to undertake activities of daily living. It effects their mobility. It disturbs sleep. There are many more consequences, physically, for a person with chronic pain.

Managing the physical symptoms of chronic pain has its own challenges. Medication can have side-effects. Surgery is risky and somewhat brutal.

Alongside the physical symptoms, there are frequent psychological consequences, such as low mood, anxiety and distress. Around 85% of people experiencing chronic pain experience symptoms of depression and anxiety. The physical symptoms of pain can lead to reduced social activities and social withdrawal, which further effects a person’s mental health and wellbeing.

Pain and Social Withdrawal.

The experience of pain is more than the experience of hurt. It affects what we do, including how we interact with others. Those social interactions play a vital role in the way in which pain is experienced. Research indicates that people who are more socially connected and who feel included also, subjectively, feel less pain. However, maintaining those social connections can be difficult. This arises for a variety of reasons.

Some of these reasons may appear straightforward. Living with unremitting chronic pain can cause the sufferer to develop symptoms of depression, including low mood, lack of desire, and social withdrawal. Anxiety can also develop both from the pain itself and consequences. The constant discomfort can raise stress levels. The combination of chronic pain, anxiety, and depression can lead to disturbances in sleep patterns, which further exacerbates symptoms of depression and anxiety. When people experience depression and anxiety it affects social relationships.

However, there are further psychosocial consequences of chronic pain, and it is those further consequences that I want to explore.

“Other People Don’t Understand”.

It has been my experience that people living with chronic pain often experience judgment from others. Typically, they report that others judge them for exaggerating their condition, being lazy, being dependent on medications, or not trying hard enough to get better. I have observed someone with very severe debilitating pain being told to get up and exercise, and then questioned why they could not, or would not, exercise.

Pain is real. It can’t always be observed. It is often invisible, but it is real enough to the person experiencing it. When people experience judgment from others, they question themselves. People in chronic pain may ask themselves if their experience is real. They question themselves because their experience is questioned and they feel questioned. They also feel rejected.

“Health Professionals Disempower Me”: When Helping Hinders.

There may be times when health professionals can inadvertently trigger feelings of rejection even when they are trying to do their best. I now want to talk about a client, Max. This is not his real name. I have his permission to publish his story.

47 years ago, when Max was in his early twenties, he was in an accident. His spine was fractured. He was lucky to survive, and even luckier that he was not a paraplegic. However, the consequences of the accident were such that it left him with severe pain. He described that the pain was so severe, it almost led him to suicide.

However, with time and through his own efforts, Max found ways of coping. He developed ways primarily through martial arts training that allowed him to manage the experience of pain, to separate himself from the experience of pain. He stated that the pain never went away, but he was able, through conscious practices, to move the pain away from being the focal point in his mind.

Max came to see me many years after the accident. He had developed other health conditions, and his experience of pain was worsening. His GP referred him to pain management specialists. They treated him in the way that they thought best, mainly by prescribing medication. Max had always said that he did not want to take medication. He would rather put up with the consequences of the pain. The reasons for not taking medication were valid. He had had previous experiences with medication and found the side-effects of medication more troubling than the pain itself. Those side effects, he said, would have been worse now given his other health issues.

He listened carefully to what the professionals had to say, but he declined their offers of medication. There was no doubt that he was and remains in a lot of pain, and he sought their assistance in other ways. But they were not able to provide alternative methods, and so they discharged him from their care.

Max responded to this with outward equanimity. However, he told me that he felt rejected, abandoned, by the establishment. He knew that medication has its place and that it was suitable for many people. However, he chose a different route for himself, one that was based on his own experience. He felt that that experience and his wishes were not being heard.

“I Am no Longer Me”: An Identity that is Spoiled.

We all have an identity, which is essentially the way that we see ourselves (or our self) and the way that we perceive others seeing ourselves. Our sense of identity can be formed by what we do and beliefs about what we do and what we can do. Thus, our identity can be formed through our awareness of our physical and mental capacities. For example, our awareness that we are good at solving cryptic crosswords tells us something about ourselves and our identity. Similarly, if we are enjoying healthy relationships with others, that also tells us something about us and our selves.

In our society, identity is often formed amongst adults through our occupation. How often have we asked the question when meeting someone for the first time, “What do you do?” Someone who is experiencing chronic pain often experiences physical and cognitive/mental limitations in their employment capacity. Chronic pain can render someone either under-employed or unemployed. If a person with chronic pain was to be asked the question posed above, how would they feel by answering it, “I am out of work and cannot work”?

Such alterations of identity can be described as stigmatisation. There is stigma attached to the experience and consequences of chronic pain. Individuals affected by chronic pain are vulnerable to stigmatising by the reaction of others. These reactions can come in many forms, such as “The pain is all in your head” or, “Well, you look healthy,” or “It’s just anxiety,” or “It must be nice not to work.” Feelings of being misunderstood by others can contribute to the process of stigmatisation.

Stigma is also experienced in the workplace. When someone’s productivity at work is decreased because of chronic pain, they can experience antagonism from their colleagues.

Stigma can also arise in clinical settings. Max felt stigmatised. He felt that there was a power imbalance between himself and the health professionals and that this power imbalance was being exercised by those professionals.

There is a connection between stigma and loneliness. People who are stigmatised, who feel that their identity has been spoiled, can feel lonely. This is not surprising given that the factors that contribute to stigmatisation, including social exclusion, also contribute to feelings of loneliness.

However, it goes further than this. The very fact that someone feels lonely can of itself be stigmatising. Stigma is heightened by greater feelings of loneliness.

The stigma of loneliness prevents people from talking about their experiences of loneliness and seeking help. In a study conducted in 2023, it was identified that, in Australia, 91% of people surveyed reported having experienced loneliness at some point in their lives, but only 38% of them had chosen to take action and talk to someone about their loneliness. 87% of them found it hard to talk about their feelings of loneliness.

Final Words

The experience of chronic pain is common. Similarly, the experience of loneliness is also common. There is a connection between loneliness and chronic pain. It can be difficult for people to talk about their experiences and to seek help.

Nonetheless, help is available. There are a range of evidence-based treatments and supports that are available.

Health professionals have a responsibility to ensure that they provide the right type of support in the right way. Simply being able to say that a correct modality of treatment is being applied is not sufficient. Health professionals must also ensure that they approach each person as an individual, respecting them, listening to them. By focusing on the therapeutic relationship, health professionals can foster an environment that makes it easier for people to talk about chronic pain and loneliness, in a way where they feel heard.

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If you want more information about this topic or if you feel the need for support in helping you to achieve your goals, you can contact Astra Psychology or any other experienced psychologist or psychotherapist. Be prepared to reach out for help. It is always available.