Chronic pain is one of the Number 1 causes of disability in the United States, and while the term refers to a wide range of disorders, the issues couples face when one partner is affected by chronic pain are strikingly similar. The unique relational challenges chronic pain presents largely result from activity inconsistency, which fuels resentment. Activity inconsistency can be addressed through education, pain management skill building, and intentional, non-judgmental communication.
What is chronic pain?
Any pain lasting 6 months or more, whether the result of an injury or a syndrome such as Fibromyalgia, is considered chronic.
Acute pain is the direct result of an injury, while chronic pain can persist long after an injury seems to have healed. Fibromyalgia is an example of chronic pain that is not linked to a specific injury or cause, and individuals with this diagnosis often spend years being told by doctors and loved ones that the debilitating symptoms are likely all in their heads.
How does all this play out in relationships?
Let’s define activity inconsistency.
Fibromyalgia is a prime example of how wildly unpredictable chronic pain symptoms can be. The pain symptoms, often described as a sensation of one’s skin being on fire, with deeper aching pain at trigger points, can range from incapacitating to barely noticeable in the course of a given day. For most, this results in a destructive pattern of overdoing it on low pain days only to “pay for it” with several days of severely increased symptoms.
If your spouse has fibromyalgia, you may be become incredibly frustrated to see your wife mowing the grass one day and barely able to get out of bed the next. This sort of inconsistency shakes up the established expectations, the give and take of daily chores and responsibilities in a way that often leads to resentment for the healthy partner and unjustified guilt for the partner with chronic pain.
What can be done?
Activity inconsistency can be addressed (preferably with help from a therapist who specializes in chronic pain) by learning activity pacing and maintaining rigorous self-care. Activity pacing helps people with chronic pain stay active to some degree regardless of pain level. Self-care, which includes sleep, diet, and stress management, serves as a buffer against flare-ups.
For recommendations on improving sleep, talk to your doctor, and/or give “sleep hygiene” a Google. Diet should ideally be addressed by a nutritionist who can assess for food allergies.
Chronic pain is often related to inflammation, which can be exacerbated by ineffective food choices. Stress management is too broad of a category to adequately address completely here, but personalized coping skills can be developed in therapy, which has been found to reduce pain levels and improve overall quality of life.
The relational impact of activity inconsistency can be addressed through intentional, non-judgmental communication. Many people with chronic pain learn to downplay their symptoms so as not to seem like a burden or to exaggerate their pain in order to be taken seriously.
Intentional communication is about being specific and accurate. Judgments are the values we assign to experience that help us to communicate what we like and don’t like. While judgments can be useful as short cuts that keep us from over explaining everything, they become problematic when used as a primary means of expression.
Non-judgmental communication around chronic pain requires a solid vocabulary of adjectives to describe physical sensations and ability in detail. Rather than saying you feel terrible today, which is judgment-laden and not very clear, try breaking down “terrible” into its bits and pieces perhaps describing the burning sensation in your legs, or the weakness in your hands.
A personalized pain scale
You can put principles of intentional and non-judgmental communication to practice by sitting down with your spouse to construct a personalized pain scale. A concrete scale developed using precise language can help the healthy partner understand what differing levels of pain mean in terms of severity and impact on functioning.
Decide what your pain looks like from 0 to 10 and describe how those levels correlate to your ability to complete certain tasks and requests you may make of your partner.
It is much more effective to say,
“I’m at a 5 today, so I won’t be able to do the dishes, but I can read the kids their bedtime stories”
than it is to minimize or over-state pain.
A collaborative pain scale helps couples navigate the unpredictability of chronic pain and ensures that both partners are contributing to the marriage in meaningful, manageable ways, reducing resentment and disconnection in the process.
Chronic pain is often associated with significant personal distress and increased negativity in relationships, but the problematic effects can be mitigated if both partners are willing to be proactive. When the target for intervention becomes the pain and its impact rather than the person experiencing the pain, spouses can become teammates in healing rather than adversaries in isolation.