When we talk about chronic pain and managing pain, we often think about physical therapies, and medication. Chronic pain is seen as a physical problem and the emotional impact is often shoved to the side.
But pain provokes an emotional response in everyone. Dealing with our emotional response is a significant part of managing chronic pain – sometimes bigger than the physical side. You might expect someone experiencing chronic pain to feel anxious, irritable, and agitated. All of which are normal feelings when we're hurting.
But, what isn’t so obvious when we have chronic pain, because the body is experiencing a constant stress, it also takes an emotional toll. People managing chronic pain often experience: grief, depression, and shame. This can impact self-esteem. Here’s the good news: even just understanding the emotional impacts of chronic pain can make a huge difference in how you manage your pain or how effectively you can treat someone with chronic pain.
We know living with chronic pain requires one to learn how to be able to adapt. Having to make these adaptations to life can also feel like continual loss. It is natural for us to compare ourselves to our “fully able selves” or to compare current selves to a time when we were “more able”.
Other areas of loss can be: employment, whether it is complete job loss or loss of hours, loss of relationships, loss of social networks, loss of physical abilities, and mobility and thus loss of confidence in reliability of the body, loss of leisurely activities with family and/or friends and loss of freedom to be spontaneous. Acknowledging the grief can help manage chronic pain.
Depression is more than a side effect of chronic pain: the two are often so interwoven that they can be difficult to separate. When they combine, it can be hard to tell where one ends and the other begins. Living with chronic pain is enough of a burden for anybody, but pile on symptoms of depression, one of the most common problems faced by people with chronic pain, and that burden gets even heavier.
Take for example the losses or grief experienced when managing chronic pain. The experience of continuous losses can fuel depression. Throw in sleep difficulties; isolation from social networks, hobbies, and routines, emotional isolation from others not understanding what it is like to live with chronic pain and it is easy to see how one could be depressed.
Further, depression can magnify pain, and make it more difficult to cope because depression itself can cause bodily aches and pains. Therefore, depression and chronic pain can be a vicious cycle that can be difficult to break.
Guilt and regret are feelings that can develop into shame. Very simply put, guilt has to do with feeling shame about actions for which we are accountable, and regret is feeling shame about something we wish was different, but is outside our control. When dealing with shame, we need to investigate whether it is guilt or regret fueling the shame and address the core underlying issues.
Shame is often experienced as the inner, critical voice that judges whatever we do as wrong, inferior, or worthless. Often this inner critical voice is repeating what was said to us by our parents, partners, relatives, teachers and peers. When living with chronic pain, we can experience shame because others are expecting too much of us, or evoking criticism about our performance.
Some people cannot understand the experiences of having to live with pain every day because they don’t live with pain, they can seem critical or not understanding. Unfortunately, these criticisms can become internalized, so it’s our own inner critical voice that is delivering the shaming messages.
Self-esteem is our emotional evaluation of our self-worth. It affects our trust in others, our relationships, and our productivity – nearly every part of our lives.
Chronic pain can be an invisible illness. People managing chronic pain don’t always look “sick” and so they encounter disbelief, suspicion, and stigma from others, which places the burden of proof on the person experiencing pain. There is also a level of self-stigmatization that can arise. As we become aware of the undesirable stereotypes that surround chronic pain, we sometimes accept them as part of ourselves and build our self-esteem on these perceptions. Thus, shame has important social factors and triggers. Shame can negatively impact how you see yourself, which can make it difficult to ask for help when you need it, or push you to try to do too much and hurt yourself.
The emotional impact of living with chronic pain can be tremendous and it plays an important role in being able to manage chronic pain. Grief, depression, shame and the overall impact on self-esteem are a few significant aspects of the emotional impact.
Exploring emotions and their impacts in psychotherapy can be helpful as it provides space and validation for the struggles of living with chronic pain. Having some control over a condition that feels like it is robbing you of control is empowering. And when we feel as though we have some ability to cope with the pain, it lowers stress levels and therefore, our perception of pain. Exploring the emotional impacts of chronic pain is a crucial part of managing chronic pain effectively.
The WRCPI is always looking for new ideas and new people to get involved to help provide better awareness and education regarding chronic pain within the Regional Municipality of Waterloo.
Please visit www.wrcpi.ca for additional information or to get involved with the WRCPI.