Those who have not experienced chronic pain themselves likely do not understand how impactful living in constant pain truly is. Living with chronic pain presents challenges every day, but often times people are so good at masking their reality that no one would never ever guess how much they are struggling. As society rejects and fears the human experience of being ill, along with the fact that patients often become very stoic, others rarely recognize what it’s like to live on a daily basis with chronic pain. Chronic pain not only affects how you physically feel, but it also impacts every aspect of your life. Chronic pain is agonizing, emotional, isolating, frustrating, exhausting, and so much more. It can make you feel like your identity is taken from you, along with everything else that you love. Chronic pain takes an aspect of freedom away that people without chronic pain rarely appreciate. The pain manifests life alerting ramifications that leaves individuals at a loss of freedom as they must work around their pain severity to decide what they can and cannot do. With chronic pain, you fight to stay in control, but your body is fighting back with pain. You struggle as the pain forces you to adapt all aspects of your life and leaves you incapable of doing things previously able to do. No matter how optimistic and positive you try to be, the pain still has an impact on your body, mind, and health.
When the body experiences pain, the attentional resources are disrupted to prioritize actions and warn the body that something is wrong. However, when the pain is persistent, it causes physiological, cognitive, and emotional disturbances. This leads to cognitive impairment, a lower quality of life, anxiety, clinical depression, avoidance and withdrawal behavior, and heightened suicidal tendencies. All of these aspects either influence each other or intensifies the pain severity, ultimately worsening the conditions for the individual. Therefore, there is often a cycle of worsening pain which then exacerbates the emotional and cognitive circumstances.
Neurocognitive Paradigm
Chronic pain directly affects the neurocognitive paradigm, a paradigm in which memory, attention, and pain share neutral networks and therefore must compete for limited resources.
Effects:
Diminished mental capacity
Inference with executive functioning- inability to focus (diminished selective and sustained attention), memory issues, difficulty recalling information on demand, inhibitory control
Slower processing and psychomotor speed
Difficulty organizing, planning, learning, or problem-solving
Increased anxiety and depression
Relationship or professional issues
What it means: This is known as brain fog, where signals are so focused on warning the body of pain that it interferes with the ability to think, remember, and focus. Those who experience chronic pain must compromise their primary attention and use split-attention to complete daily tasks. This means that individuals must go about functioning by switching their attention from the pain that they are experiencing to the task at hand, their emotions, or their thoughts. This is an extremely difficult skill as pain is meant to be interruptive and distracting. When your body is constantly screaming that it is in pain, it is difficult to ignore those screams and carry on as normal. When the pain is more severe, it can become almost impossible to think or remember. Without going through years of severe chronic pain, it is difficult to understand how bad it can truly get. It’s almost as if the pain destroys your mind and ability to function, even to think.
Painsomnia
Painsomnia is the inability to sleep, insomnia, but due to the body being in pain. As pain remains persistent through all hours of the night, sleep becomes an impractical escape from the pain.
Effects:
Difficulty falling/staying asleep, fatigue
Diminished concentration, memory, attention, alertness, reasoning, problem-solving ability, and learning
Depression, anxiety, confusion, frustration, irritability
Change in appetite and digestion
Increased risk for medical conditions
Shortened life expectancy
Issues with relationships, lower performance at work/school, increased errors or accidents
What it means: I’m sure most can relate to the feeling that the hours in the middle of the night can be the most lonesome. When you are forced awake during these hours from intense pain, it can become a pretty dark place. You are forced to acknowledge the pain of your illness, are often alone, feel desperate and sad, and are left to lay wishing for relief. Some people may use a form of distraction, such as TV or music, to occupy their mind and to cover up the negative thoughts. Unfortunately, the pain often becomes so severe that it prevents you from being able to use any form of distraction while staying awake. When the pain is at its worst, you curl up in bed, eyes closed, tears shedding, and don’t even get a second of sleep. No matter how tired you feel, the pain doesn’t stop, and you feel as though you are being tortured. This is very frustrating to experience, especially considering that sleep, at least for some, is the only thing that can reset their pain back to its baseline. As you lay there awake through all hours of the night, the lack of sleep further exacerbates pain and worsens mood. People who experience chronic pain can take 30 minutes of sleep and be appreciative of the fact that they were able to sleep at all that night. They become used to functioning on very little sleep and listen as others complain that they are tired.
Fight-or-Flight
As the body interprets pain as a danger, the sympathetic nervous system initiates a physiological reaction to prepare the body to fight-or-flight. As a chronic pain sufferer’s body is constantly in pain, the body continually perceives itself to be in danger and thus is constantly in fight mode.
Effects:
Rapid heart rate, increased blood pressure, rapid breathing, dilated pupils, sweating, and heightened senses
Pale or flushed skin
Increased adrenaline, decreased ability to feel pain, increased strength
Feeling jittery, anxious, irritable, or sensitive
Difficulty sleeping
What it means: To live constantly in fight mode is more exhausting than it seems- your body is endlessly working overtime to do the simplest of things and survive through the day. Unfortunately, no matter how exhausted you are, the extra adrenaline keeps your body awake into all hours of the night. When the pain is at its worst, sleep isn’t an option. Even when you are able to fall asleep, you won’t wake up feeling rested; the increase in adrenaline makes entering deep sleep more difficult and increases the number of times your sleep is disrupted. Getting poor sleep can make you feel irritable and tired, triggering more adrenaline, which then makes it more difficult to sleep later that night. Additionally, getting an inadequate amount of sleep can further exacerbate pain, interfere with the ability to think and function, and can make you feel emotional. Furthermore, chronic pain affects almost every endocrine system in the body, impacting the regulation of hormones and causing either an excess or deficiency. The hormonal abnormalities lead to additional complications and symptoms, as well as immune suppression, and many hormones have not yet been studied in relation to chronic pain, so their impact is unknown.
Anxiety
Anxiety often accompanies chronic pain as pain is one of the greatest stresses your body can experience. It is also influenced from pain signaling a fight-or-flight response and impacting hormone production.
Effects:
Lack of concentration, racing/unwanted thoughts, excessive worrying
Worries surrounding chronic pain - fear of undiagnosed symptoms, reinjury, increasing severity, or that others won’t believe your condition; stress regarding lifestyle impact (school, work, completing daily tasks, relationships); and economic stress (medical bills, being unable to work)
Rapid heart rate, palpitations, chest pain, increase in blood pressure, breathing problems, headaches, dizziness
Insomnia, fatigue
Nausea, sweating, upset stomach, muscle aches and pains
Depression, hypervigilance, irritability, restlessness
Weakened immune system
Lack-of-control perspective
Avoidance and withdrawal behaviors, social isolation
What it means: As the body is already on-edge from being in fight mode, the lingering pain continuously reminds individuals that they have so many unanswered questions regarding their health and lack control over their conditions. The lack-of-control perspective is established as individuals have little indications to predict pain severity, no treatments to relieve pain, and find that the inconsistency makes their bodies untrustworthy. As bodies perceive uncertainty as a threat, anxiety levels increase, which then worsens pain severity and even influences other medical complications. As chronic pain patients undergo stressful circumstances and medical concerns, worrying thoughts haunt their minds and anxiety is often developed.
Depression
Unfortunately, chronic pain and clinical depression are multidimensional syndromes with the capability to influence each other. The combination of pain and depression can lead to a vicious cycle in which pain exacerbates the symptoms of depression, which then worsens the pain.
Effects:
Persistent sadness, loss of interest/ lack of enjoyment, feelings of isolation, low self-worth, angry outbursts, irritability or frustration, anxiety, personality changes, decreased quality of life
Inability to concentrate, trouble thinking, memory issues, difficulty making decisions
Slowed thinking, speaking, or body movements
Sleep disturbances, fatigue
Increased pain sensitivity, headaches, chronic body aches, and pain that does not respond to medication
Appetite changes, weight fluctuations, stomach pain, constipation
Constricted blood vessels, increased risk of cardiovascular disease
Weakened immune system
Social isolation, relationship difficulty, avoidance and withdrawal behaviors
Inability to function, self-harming or suicidal thoughts
What it means: The loss of freedom and isolation that occurs as a result of chronic pain makes it unsurprising that pain and depression hold such a tight link. Since individuals with chronic pain often lack adequate medical support, patients often are made to feel responsible for their pain. Additionally, the recognition of the barrier separating the healthy from the unhealthy can make patients feel as though they are in their battle alone. Even when trying to explain their conditions to others, people listen, but rarely understand. The disregard from others, along with the loss of faith in the medical system as treatments expected to alleviate pain are ineffective, leaves patients feeling hopeless about ever finding relief. Individuals may feel incapable of tolerating the immense amount of pain, and as the difficult search for relief often results in disappointment, some may contemplate suicide as their only form of escape. Individuals with chronic pain have twice the rate of suicide than people without pain. This is alarming, but what’s even more upsetting is if the medical system and society responded differently, it could save a portion of these lives.
Avoidance and Withdrawal Behaviors
An individual with depression may avoid socialization as they have little energy, feel like a burden, and fear getting hurt or worsening pain intensity
A person with anxiety may avoid social settings, unknown environments, or activities due to the added stress or worry about their conditions impact
A chronic pain sufferer may avoid certain activities as they perceive that the activities will exacerbate their pain
What it means: As individuals think they are avoiding forms of pain, they are losing the opportunity of potentially rewarding events and distracting activities. In turn, individuals remain focused on their pain and act in a way that intensifies a depressed mood. This puts people in a difficult position; it is evident that avoidance and withdrawal behaviors can worsen circumstances but engaging in activities has an even greater potential to worsen pain severity. When you are feeling your worst, depressed, alone, and in pain, the last thing you want to do is socialize or engage in an activity. But it is important to consider the potential each activity has to offer and to recognize the possibility of its distraction. You have to find an adequate balance of emotional and physical pain, even if that means engaging in an activity that you know will cause you immense pain, just for one moment of happiness.
In association with chronic pain, individuals face countless emotional, cognitive, physical, and internal impacts that haven’t been mentioned, and haven’t been researched yet. If you think about the sole purpose of pain, to alert the body, it’s not surprising that the constant alert impacts the body’s ability to function properly. The constant disruption holds life-altering impacts in ways that are impossible to describe without experiencing it yourself and realizing that there is never a break from the pain. You are forced to accept it as your normal, realize you’re unique, and make the best of the situation. Hopefully, as research develops, ways to reverse the effects of chronic pain are discovered to help improve the health and quality of life of individuals, even if the pain never stops.
Batten, D., Schummer, P., & Selden H. (Eds). (2017). Pain. Human Diseases and Conditions (3rd Ed., Vol. 3, pp. 1517-1521).
Cafasso, J. (2018, November 1). Adrenaline Rush: Everything You Should Know. Retrieved from https://www.healthline.com/health/adrenaline-rush
Cheatle, M. D. (2014, June). Assessing suicide risk in patients with chronic pain and depression. Retrieved from https://pdfs.semanticscholar.org/15bb/b8fe4ed40b9d1860d7c17f9b268feb1161d5.pdf
D'Arcy, Y.M. (2007) Chronic Pain Management. Evidence-Based Tools and Techniques for Nursing Professionals (pp. 99-111).
Green, C. R., & McPhail-Pruitt, M. (2004). Chronic Pain Management. Encyclopedia of Health and Behavior (Vol. 1, pp. 187-194).
Kukla, E. (2018). In My Chronic Illness, I Found a Deeper Meaning. The New York Times.
McLean, P., & Taylor, S. (1998). Pain, Depression, and Suicide. Suicide in Canada (pp. 125-135).
O'Connell, K. (2018, August 22). Insomnia: Health Effects, Factors, and Diagnosis. Retrieved from https://www.healthline.com/health/insomnia-concerns
Pocinki, A. G. (2010). Joint Hypermobility and Joint Hypermobility Syndrome. Retrieved from https://www.dynainc.org/docs/hypermobility.pdf
Schaaff, S. V. (2017). The Strange Pain That Can Overcome Kids, Especially High-Achieving Teenage Girls. The Washington Post.
Smith, A., & Ayres, P. (2014). The Impact of Persistent Pain on Working Memory and Learning. Educational Psychology Review, (Vol. 26, No. 2, pp. 245-264).
The Psychological Impact of Chronic Pain. (2020, February 21). Retrieved from https://www.floridamedicalclinic.com/blog/psychological-impact-chronic-pain/
Turk, D. C., & Wilson, H. D. (2010). Chronic Pain, Psychological Factors in. The Corsini Encyclopedia of Psychology.
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