Living With Chronic Pain: Psychological and Emotional Effects

With over two decades of experience in medicine, Melissa Flagg writes patient education articles, keeping you informed about your health.

Pain hurts, but chronic pain not only hurts, it also takes a toll on your mental and emotional well-being. Chronic pain can lead to a number of different problems including:

• Loss of enjoyment
• Chronic fatigue
• Depression
• Insomnia
• Headaches
• Irritability
• Anxiety

Both depression and anxiety exacerbate the sensation of pain, and this perpetuates a vicious cycle.

I’ve been suffering from chronic pain since 1999, when I had a car accident that left me with a permanent neck injury and migraines. The accident caused the muscles in my neck to tighten to the point of causing compression in my cervical vertebrae, specifically C1, C2, and C3.

Compression of these three vertebrae causes migraines because the vertebrae put pressure on the occipital nerve. The compression can also cause vertebrobasilar insufficiency - the main symptom of which is dizziness or lightheadedness.

The compression also puts pressure on the thecal sac. This sac surrounds the spinal cord and contains the cerebral spinal fluid that nourishes the brain and spinal cord. It is an extension of the dura mater, a tough skin-like covering that surrounds the brain.

Putting pressure on the sac cuts off the flow of fluid resulting in constriction and dilation of the blood vessels in the brain causing a migraine. Stress inevitably makes the compression worse.

My neck hurts constantly whether I have a migraine or not. On days I have a migraine, the pain in my neck is usually worse than usual or on the left side instead of the right side. Rainy and stormy days make the pain worse, and the winter months can be agonizing.

Some days are better than others, but even on good days I can’t turn my neck all the way to the right or left. I take several medications, but they only take the edge off the pain, making me able to get through my day to day life. In the past 20 years, I can count on one hand the number of days I’ve had without pain and still have fingers left over.

But I'm not the only one suffering from this type of pain. Approximately 116 million Americans also suffer from chronic pain on a daily basis. That’s 116 million people that suffer long-term pain, many of which suffer in silence. The pain itself is stressful and is compounded by any stress life throws at us. This extra stress has an extremely detrimental effect on a person’s overall mental status.

Cognitive Impairment Caused by Chronic Pain

Forgetfulness

Chronic pain can make already forgetful people even more forgetful. I’m an absentminded person to begin with, and the pain only makes it worse.

On days my pain is greater than normal, I do notice I suffer from aphasia, which is an impairment of language. I tend to forget words I would normally be able to think of readily, like medical terminology. Interestingly, aphasia is part of the prodrome I experience prior to a migraine.

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Inability to Focus

When the only thing you can focus on is the pain, it’s hard to focus on anything else. Right now, I’m sitting here trying to write this article, and the only thing I can really think about is my pounding headache.

Anyone with chronic pain can tell you the more they try to focus on something else, the greater the pain gets. Many chronic pain sufferers have arthritis which makes sitting for more than even a few minutes painful. I have a hard time sitting to write simply because my neck gets so stiff. I have to get up and walk around to relieve the pain, which breaks my concentration.

Sleep Disturbances

Not only can the pain interfere with getting quality sleep, but the depression can make it difficult to fall and stay asleep. After a day of severe pain, I tend to oversleep because I’m so tired of tolerating the intense pain.

Oversleeping just makes things worse, however. After 8 hours of sleep, my neck is stiffer than a board, and most of the time I wake up with a headache.

People with arthritis tend to have the same problem. Lying in a bed for 8 hours leads to stiff joints because inflammation is able to build up and muscles tighten because they aren’t being used.

Biphasic Sleep for Arthritis

I have found that breaking my sleep into segments has helped to alleviate the stiffness I usually have upon waking. I’ve been following a biphasic sleep schedule, which has given me more time in my day and has also alleviated almost all of the stiffness I used to get after a traditional night’s sleep.

Biphasic sleep consists of two sleep segments. One segment is three or 4.5 hours long, and the second segment is 1.5 hours long. If you'd like more information about the benefits of this type of sleep pattern, you may read my article: Biphasic Sleep Patterns.

Psychological Effects of Chronic Pain

Depression and Anxiety

Chronic pain can break a person’s spirit. The idea of having to live life in pain is enough to depress anyone, but actually doing it can force the person into deep depression. It's essentially daily torture.

The pain makes it difficult to want to do things that were previously enjoyed. Playing with kids or grand-kids, outdoor activities, even household chores can exacerbate the pain forcing the person to avoid these activities. Often times, this makes the person feel even worse because they feel useless.

If they do engage in such activities, the enjoyment once felt is no longer a reality, which leads to further depression.

Many chronic pain sufferers, including myself, are on antidepressants in an effort to prevent the plummet to rock bottom, but it doesn’t always work. The pain inevitably surpasses the ability of the medication to alleviate symptoms.

Some chronic pain sufferers lose their job or are on disability because they can’t work. This not only leads to financial stress and being unable to provide for the family, it also causes feelings of worthlessness, and uselessness making suicide ideation become more commonplace.

Breakdown of Relationships

Many chronic pain sufferers live alone either because a marriage ended, or the pain has forced them to isolate themselves.

People who do not experience this type of pain have a hard time understanding and tolerating those who do. Chronic pain has no visible symptoms, meaning other people can't see that you are suffering. It's not like a broken arm or other visible injuries. Because of this, many people think that chronic pain sufferers are "faking it," and this can lead to further isolation and depression.

Trying to be a parent and living with pain is extremely difficult. The frustration that builds up from constantly being miserable inevitably gets taken out on those closest to you, including your kids.

Since I chose to homeschool my daughter and spend all day with her, she gets the brunt of my frustration (as does my husband) despite my attempts to contain it. This is the case with most families of chronic pain sufferers, and it typically forces the sufferer into isolation, or at least into feeling like they are isolated.

Isolation, or the feeling of it, causes the sufferer to withdraw from all social relationships, not just family ones. Intimate spousal relationships are often severely affected but not necessarily because of a lack of interest in sexual intimacy.

Although it’s hard to think about making love when your head is pounding or you can’t turn your neck at all, there is a definite need to feel intimate with your spouse if just to feel normal. Tolerating chronic pain takes a lot of energy, and most people who suffer with it also suffer from chronic fatigue. This tends to drive a wedge between spouses.

This is just a small list of some of the side effects of chronic pain. The psychological and emotional effects of chronic pain can vary widely from person to person. These effects are tempered by the sufferer's pain tolerance level and their resilience.

The longer you deal with chronic pain, the higher your pain tolerance becomes. On the flip side of this, tolerance to pain medications also becomes higher, making it necessary to take more medication to feel any relief. This, in and of itself, can exacerbate the psychological symptoms.

If you or someone you know suffers from chronic pain, seek help. Contact psychiatrists, doctors or support groups to help you or your loved one prevent the psychological symptoms of chronic pain.

Most importantly, keep in mind that chronic pain can't be seen, but that doesn't make it any less real. Anyone you come in contact with could be suffering chronic pain, and you should treat them accordingly.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers

Question: I was told the longer you have had chronic pain, the less tolerance you have and the greater the pain is. Is that not true?

Answer: It's not quite that simple.

In most cases, the person tends to build a tolerance to the pain, as well as their pain medication. This causes what is known as "breakthrough" pain episodes, which can be much more painful than their usual chronic pain levels. These pain episodes can also last for long periods of time and happen several times a day. They are usually unresponsive to pain medications.

However, in some cases, the person may build a tolerance to their medications and not the pain. This can make it seem like the pain is getting worse when really the pain medications are no longer working effectively.

In rare cases, the person may have developed a tolerance to their pain, but their pain has gotten dramatically worse because their injury or disease has progressed requiring them to take more and more pain medication. This, in turn, can cause them to develop a tolerance to their pain medication resulting in a vicious cycle of chronic pain that is not helped by medication and is getting progressively worse.

Treating chronic pain is an art form, and because of recent changes to opiate prescribing limitations, it is becoming more and more difficult for doctors to be able to manage their patients' pain.

Question: Excellent and totally relatable article. Misery is contagious and that's the main reason we isolate ourselves from friends and family. My heart goes out to those of us who need to raise children while dealing with chronic intractable pain. When after seventeen years of searching for a fix fails, what options are left to go from existing, back to living?

Answer: This is a difficult and very personal question, meaning the answer will be different for everyone. But it's all about mindset. When I made the decision to cut ties, my entire mindset and outlook on life changed. No one chooses to be born, we are brought into this world on someone else's whim. That said, I have found life to be a gift, and it's a choice to live yours instead of just going through the motions.

Choosing to really live is easy, but making that happen is the difficult part. When you have lived on autopilot for most of your life, how do you switch gears and change your life path? This is what makes this question difficult to answer. What works for me may not work for anyone else. But in my experience, doing some soul searching is necessary. What do you want out of your life? When you're 65, where do you want to be? What experiences do you want to remember? These answers may not come to you right away, and that's ok. Your brain isn't used to thinking about what it wants, it's been programmed to survive. Take the time to research things you are interested in whether that's traveling to the Netherlands or becoming an author. The sky is the limit, you have a clean slate ahead of you and the choices you are about to make are truly your own. Revel in that.

Make a plan for your life. Plan to do things you want to do and how you will make those things happen. Practicing mindfulness can help you be present in the moment which can help you find your path. To use a cliche, life is what you make it. One of my favorite motivational quotes is: "if you don't like where you are in life, make better choices." Because it's really all about how you perceive your life. Perception is everything, if you choose to see the good things in your life and the things that make you happy, when you look back on your life at 65, you'll smile. But if you choose to dwell on the negative things, at 65 you'll wonder what happened. Make choices the future you will be proud of.

And relish the fact that you made those choices, not your mom.

© 2012 Mel Flagg COA OSC

Comments

Edith L Behm on January 31, 2018:

I have suffered from severe TMJ pain 25 years. I have tried every pain moda;ity including pills, Botox, prozin for nightmares, etc. I am currently on amytriptyline, restoril (30 mg), valium (30mg), thyroid replacement. I have had an extrememly stressful life. My father was a orrible abuser. I became very close friends with a wonderful man who also had to care for his family. He had type 1 diabetes. He was in the Army 7 years, and received wonderful care at the VA in West Palm Beach. Sadly, I lost him on July 26, 2017. We were married on 05/23/15. I am now 69. I swore I would never marry because of the hatred I have for my father. David was different. He was the kindest, most gentle man I ever knew. Losing him was the worst thing that could have happened. We both were animal lovers and I now have 2 wonderful cats. All my life I cared for others, but I have no one, except my cats. I really would prefer to die, but I want to be here for my cats. I do have a wonderful person to take them if something happens to me, but they are so attached to me. I have always been a high achiever. I was my high school Valedictorian, and I have 4 college degrees, 3 of which were free. I became an 8th grade art teacher, and the Director of student art teachers from a nearby University liked the way I taufght art and handled discipline, so he sent me 6 student teachers to mentor. I was awarded with a great deal of free credit at the University. I thought I would like to get a doctorate. After my M.ED. in Adminsitration and Supervision, I was so discouraged with every teacher but one, as they taught me nothing, I did not want to waste anymore free credit, so I switched to Finance, an interest of mine since childhood. I loved it! The work was really tough, but I managed to get a "A" in every class through the graduate level, I have been an excellent scuba diver for 37 years, but I did not go last summer, and I don't think I ever will, as the pain is so bad now. I have been to specialists all over the state of Florida, and they all agree that surgery would not be a possibility for me. I was getting stellate ganglion nerve blocks from a wonderful anesthesioligist. I switched to another pain specialist for Botox. The 1st treatment was like a miracle. I thought I was cured. For 5 months I did not need an a