Caught Up in the Problem
There is no doubt, from a practical and from a medical standpoint that families get caught up in chronic pain problems. For family members, the obvious distress and suffering of a loved one in pain generates an initial emotional response of sympathy, uncertainty and worry, and an eagerness to offer assistance. When the pain problem persists over months, years, or even decades, family members may develop frustration, anger and resentment, and emotional exhaustion. These negative reactions often are heightened because people in pain become so inwardly focused on themselves, their pain and misfortune. In effect, a person in pain withdraws emotionally from the spouse or partner and other family members. A family member's negative reaction to this withdrawal is a natural response.

A person in chronic pain usually has a reduced ability to function in activities of everyday living. Homemaking and child-rearing tasks get reassigned. Employment and income may be affected. Leisure activities are abandoned. These changes in function place burdens on family members. At the beginning of a chronic pain problem, family members usually are eager to accept these burdens in a willingness to help out. This often is not the case months or years later as family members' fatigue and frustration set in and as savings dwindle.

The reactions of family members and friends in turn have an effect on the person in pain. In the beginning, the emotional support and practical assistance are welcome and helpful. But later, as the pain problem persists and reactions change, the effect may not be favorable. The person in pain may come to feel like a burden on family, and his or her sense of being a valued family member is lost. Self-esteem may suffer. Without the expectation and reward of functioning as a breadmaker or a breadwinner, the dysfunction is compounded. Scientific research supports the idea that overly solicitous or helpful responses by a spouse can actually lead to higher levels of pain and disability. In effect, a person's experience of pain itself can be influenced by his or her spouse's behavior.

What to Do
There are many things that family members and friends can do to facilitate improved adaptation to chronic pain in the affected person. A helpful approach begins with learning about the pain problem and behaviorally based rehabilitative principles. There are many sources for reliable information from books and on the Internet. In addition, you can:

• Participate actively in the health care of your loved one.
• Attend visits with the treating physician so that you can hear first hand about the pain problem and treatment.
• Prepare questions in advance, and ask about ways to improve function.

In the home setting, be patient and supportive, but shift the focus of attention away from pain and suffering onto other topics. Shifting this focus can be accomplished through:

• Encouraging the person in pain to gradually increase his or her level of functioning in spite of the pain.
• Becoming involved again in activities together, such as child care, homemaking tasks, and in social/leisure pursuits.
• Promoting a return to a more independent level of functioning.

Help your family member adopt a knowledgeable, thoughtful, consistent approach to the use of medical services and medications. Together review and implement principles for healthy living, with attention to diet, exercise, smoking cessation, and moderation in the consumption of alcohol. Strive to rekindle the rewards of your relationship and the joys of life together . . . in spite of chronic pain.