Isolation and Chronic Pain – How to Beat The Downward Spiral?

Social isolation is common in people with chronic pain. This article explores the reasons behind this, and provides guidance to combat the problem.


For most people, day to day life involves interacting with others, both throughout the day at work or in the home, as well in social settings such as meeting up with loved ones. Social interaction is an important part of our lives, but when chronic pain makes an appearance, things can drastically change.

What causes social isolation with chronic pain?

  • Feeling misunderstood

For a lot of people, even if their loved ones are very supportive, the fact that they haven’t been through it themselves can make the individual with chronic pain feel alone.

Even with the best of intentions, sometimes being surrounded by people who want to help but don’t really understand what you’re going through, can feel even more lonely than being alone. It’s common for pain patients to feel that they are the only ones going through this.

  • Fear avoidance

It’s easy to feel that by resting, you are doing what is best for your body when it’s in pain, but this avoidance of activity has negative effects and contributes to the pain cycle. Patient’s often begin to fear that movement is going to worsen their symptoms, and so will avoid going out socially or engaging in activity.

  • Fatigue

Chronic pain conditions often come hand in hand with fatigue; sometimes fatigue can make the thought of just getting dressed to go out feel exhausting before you even leave the house!

  • Being unemployed

Going out to work during the day is where many people get the majority of their social interaction. A lot of jobs involve interacting with colleagues, with customers or clients, and even chatting with people on the journey to work. 

Pain of patients often find that going out to work can be too much, particularly as the vast majority are not being given the appropriate treatment and aren’t able to reduce their pain effectively. This robs them of this daily social interaction which so many people can take for granted.

  • Not having transport

If pain patients have a low level of functioning, they may not be able to drive or be financially able to run a car. They may not feel able to use public transport as these activities can often be draining which creates another obstacle to socializing.

  • Financial struggles 

Without being able to work, often pain patients are in debt or struggle financially. Finances play a part in almost every part of our lives. Without being able to afford transport a lot of social activities, it can feel really hard to engage with friends. Even for those with jobs, medical expenses can mount up and become troublesome.

  • Feeling unable to keep up

Many people with chronic pain worry that they may not be able to keep up with loved ones, that they may be a burden or hold loved ones back, so they will ‘stay out of the way’. 

  • A breakdown in relationships

Trying to maintain relationships, whether romantic or platonic, when one person has a chronic illness can be taxing and complex. Seeing a loved one in pain and not knowing how to help can result in guilt and confusion. 

Often those with chronic pain conditions have very little energy and even struggle with cognitive issues, so may be forgetful and not mindful of maintaining contact with friends. Not fully understanding an invisible illness can mean that loved ones may perceived the person with chronic pain negatively and not understand their actions.

  • Depression and anxiety

Mental health issues often come along with chronic pain and can impact people having the energy and desire to socialize.

  • Stigma

Unfortunately, people do not always understand illnesses that they cannot see and are lacking in compassion; this stigma can make people reluctant to be around other people.

  • A lack of invitations

Often people with chronic illness need to cancel plans at the last moment due to a flare in symptoms, or say no initially due to the aforementioned reasons, leading loved ones to feel that they are always going to say no, and so they stop inviting them. This can leave people with chronic illness feeling even more alone and often unwanted.

Why is social isolation so negative?

Social isolation can have negative impacts on physical health; it’s proven that those who are socially isolated are more likely to suffer from a wide array of health problems. This study explains that scientists, “have begun to identify potential behavioural, neural, hormonal, cellular, and genetic effects of isolation in humans.” The reasons for this are not yet fully understood, but many theories suggest that part of this is the support and encouragement we get to take care of our health from those around us. 

Being around other people keeps our bodies active and also engages our brains, studies such as this one have found that when people aren’t regularly engaging with others, they are more likely to develop problems with cognitive functioning.

Being socially isolated can be just as dangerous for our health as other bad habits.This study states that, “social isolation was as strong a risk factor for morbidity and mortality as smoking, obesity, sedentary lifestyle, and high blood pressure.”

Social isolation even changes the way we perceive our chronic pain; those who are able to maintain connections with people who understand what they are going through are better equipped to deal with their pain; this study concluded that, “Our study provides evidence that the impact of pain is reduced in individuals who perceive a greater sense of inclusion and engagement with others.”

Being alone also has significant impacts on mental health. Humans are designed to be social creatures and for the vast majority, we need that interaction to be happy. When people don’t have this, they begin to feel lonely; this can lead to depression, anxiety and worsen the already existing mental health issues which so often come with chronic pain. This study states that, “The collapse of one’s social world can precipitate feelings of panic, emptiness, anger, hurt, sadness, and a range of other emotions linked to depression.” Being social and having significant connections in our lives is proven to keep stress levels low. Stress causes and worsens pain, keeping patient’s stuck in the stress and pain cycle.

Often the results of this are not taken seriously enough by medical professionals, who may treat the depression presented but do not offer appropriate treatment for the root cause, the chronic pain. This study found that social withdrawal lead to fatal results, stating that , “the level of social withdrawal had implications beyond PI (pain interference) and PF (physical function) status and was predictive of suicidal ideation for people with chronic pain”

Without the right treatment chronic conditions can destroy someone’s life, robbing of them of meaningful relationships among so much more. The way that medical professionals treat chronic pain must change, they must be educated in a more apt and in depth way on chronic illness; treatments are out there which can improve patient’s lives and we all deserve to have access to them. This study states this clearly, “Here, surely, is an unambiguous warrant for an early, robust, and compassionate intervention, one aimed at relieving symptoms and restoring engagement, before irreparable damage has been done.”

How can you combat social isolation?

  • Invite friends to your home

Being social doesn’t mean that you must go out and about. Invite loved ones to your home so that you can see them. You could arrange all sorts of inventive activities to keep things interesting, from a movie night, a games night or even starting a book club.

  • Plan social activities on your good days

Utilizing your good days without worsening symptoms can be tricky, but it’s a balance well worth learning. On days when symptoms are more manageable, often socializing is put on the back burner to focus on more pressing matters; make being social a priority. It’s important for your health and you might find you’re having more fun than you imagined!

  • Arrange activities which suit your level of functioning

If you are worried that the activities your loved ones are doing are too much for you, take the lead and arrange something that suits your level of functioning.

  • Suggest ideas that are budget friendly

Not all social activities need to cost a lot of money. Arrange to go for a walk, meet at a free museum or even visit your loved one’s house rather than go out.

  • Set reminders for loved one’s significant life events

If like me you have fibro fog or problems with your memory, you might find it tough to keep up with your loved one’s birthdays and important life events. Writing these down or setting a reminder on your phone can be useful so that you can send them a celebration message, present or card.

  • Use reminders to prompt yourself to reach out to loved ones

Using reminders can also be useful to encourage yourself to engage regularly. You could set a time each day that you are going to reach out to one friend or family member with a phone call or even an email or text if you don’t feel like talking.

  • Use video calling

We are in an age of amazing technology which means that even we can’t literally be in the room with someone, we can still be face to face. Speaking to a loved one over video call is so much more intimate than over the phone and fosters deeper social connections.

  • Be open with loved ones

If you feel that your loved ones don’t grasp what you are going through, be open with them about your condition. If you don’t feel able to explain it yourself, consider sign-posting them to resources where they can educate themselves, sending them articles that you feel are applicable to your situation or even writing it down yourself to share with them. 

Be clear about setting boundaries but also try to explain why you might not feel like engaging or why you might need space sometimes, so that they can understand it’s not because you don’t love them or want to spend time with them.

  • Join support groups

Your doctor can pinpoint you to support groups in your local area or you may be able to find a list online. Joining a group not only gets you out of the house once a week on a regular basis, it also allows you to be around people who share the same experience and who can be there for you.

  • Take up a hobby

Doing something you really enjoy that can also help you to get out of the house can be motivating. If you feel that the activity is worth the effort because it brings you happiness, then you are far more likely to keep engaging in it. 

Try and find hobbies and groups that suit you, from walking groups, craft groups, art groups; there really is something out there for everyone, and if there isn’t one that suits your interests, why not start a group yourself?

  • Engage with like minded people online

There are whole communities of chronically ill people online who really understand what it’s like to live with chronic pain. I have found a community of friends on social media who mean the world to me.

  • Adopt a pet

If you have the financial resources then adopting a pet can be wonderful. Having that connection with another living being can be so comforting, it means that you are never alone and is scientifically proven to increase happiness and have health benefits as explained here. It also gives you a routine; dogs are wonderful pets as they need to be walked which gets you out of the house even when you don’t feel like it, and they’re great conversation starters.

  • Find ways to get appropriate treatment for your symptoms

Many people who experience chronic pain are not aware that their symptoms can be reduced and even cured. Finding the right treatment can deal with the root cause of this isolation and remove these obstacles from your life. 

Do your research on various therapies and find what you feel could help you; there are options such as Cognitive behavioural therapy (CBT), Acceptance and commitment therapy (ACT), mindfulness techniques, Graded Motor Imagery and so much more. You can access these therapies through your doctor by advocating for yourself, find a private therapist and even find these therapies online or through an app like Pathways Pain Relief.

  • Practice self-care to reduce symptoms

Doing all you can to manage your symptoms and improve your overall health is going to allow you to feel physically more able to engage socially. Being proactive socially is an act of self-care.

While social isolation is common and certainly understandable with chronic conditions, it’s in our best interests to overcome these obstacles and be socially active. We all deserve those connections in our lives and there are ways that you can build a social life that works for you. 

References

  • Annals of Behavioural Medicine, Volume 53, Issue 1, Nicholas V Karayannis, MPT, PhD, OCS, FAAOMPT, Isabel Baumann, PhD, John A Sturgeon, PhD, Markus Melloh, MD, PhD, Sean C Mackey, MD, PhD, (2019), “The Impact of Social Isolation on Pain Interference: A Longitudinal Study”
  • Journal of Pain Research, Rebecca Arden Harris, (2014), “Chronic pain, social withdrawal and depression”
  • John T. Cacioppo, Louise C. Hawkley, Greg J. Norman, Gary G. Berntson, (2011), “Social isolation”
  • Barrie Gunter, (2019), “Pets and people: The psychology of pet ownership.”

Please note: This article is made available for educational purposes only, not to provide personal medical  advice.

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