How Can Chronic Pain Ruin Relationships?

Chronic pain, it's there in the morning when you wake up and there in the evening when you go to bed. This constant, but unwelcome companion might take a toll on your relationship as you struggle to understand each other's perspectives on the pain. Female-centric diseases such as endometriosis, fibromyalgia, cystitis, and vulvodynia can cause chronic pain.

According to the Centers for Disease Control and Prevention (CDC), fibromyalgia affects an estimated 4 million Americans (most being women). Frequently, women are told things like the pain is "all in their head"—a message that their partners had sometimes taken to heart as well. Misunderstanding the pain your partner is enduring can lead to significant relationship problems.

Connection of Relationship Support

Chronic pain, whether it stems from fibromyalgia, back pain, arthritis, or some other condition, can have a toxic effect on relationships, especially if one partner is skeptical about the source or the severity of the pain, and the other feels that they aren't receiving the proper understanding and support.

"People who have chronic illnesses desire support from their loved ones," said Annmarie Cano, PhD, the dean of the college of arts and sciences and professor of psychology at Gonzaga University, in Spokane. "We all want to feel loved and cared for, but if the people around us are not supporting us the way we want them to, we might become resentful and feel like we are entitled to support."

Hearing about pain can dampen the mood, and if you're the one in pain, the strongest potential sources of support—your partner, spouse, or kids—may simply tune you out when you talk about it. The good news is that how you talk about pain matters. There are things you can do that can help you win—not lose—your loved ones' support.

Catastrophizing and Chronic Pain

Cano has studied the unhealthy dynamics that pain can create among couples. In a December 2009 Pain study, Cano and her colleagues followed 106 couples in which one partner had a chronic pain condition, such as arthritis or back pain (the most common condition).

The researchers found that people in pain who felt entitled to more support from their partners were more likely to have excessive or exaggerated perceptions and thoughts about the extent of their pain and the disability it caused—known as catastrophizing.

Catastrophizing isn't a healthy or successful coping strategy; in fact, it's associated with higher levels of pain, distress, and depression. It's also associated with passive ways of asking for help—a strategy that tends to backfire as well, according to Cano.

"If someone expects other people to provide support but doesn't know how to communicate directly what they would like, that person might express their frustration indirectly by sighing, moaning, or engaging in other behaviors that might seem off-putting to the other person," Cano explained.

And if the person in pain doesn't receive the help they want or expect, Cano said, they might react with anger or disappointment, even though "the other person had no idea of what was expected."

Michael E. Geisser, PhD, a professor of physical medicine and rehabilitation at the University of Michigan, in Ann Arbor, said that in such situations, the person who isn't in pain is likely to respond in kind, especially if they suspect that the other person is exaggerating or even fabricating the pain.

"If one partner doesn't believe in the diagnosis, they are more prone to respond in an angry fashion as opposed to [being] more supportive," Geisser said.

This cycle of resentment, aversion, and unmet expectations can infect every aspect of a relationship. If spouses in pain consistently feel that they deserve more special care and attention than they are receiving, said Cano, "this mismatch of attitudes can certainly cause problems in couples and can spill over into other areas of disagreement, like financial decisions and decisions about how to spend leisure time."

The potential for pain-related discord to spread into the rest of the relationship has been well documented, according to Geisser. "It has been shown that relationships in which one partner has chronic pain tend to be more strained, have more marital distress, more conflict, and a greater likelihood for divorce," Geisser said.

How To Halt the Cycle

If you sense that chronic pain is tearing your relationship apart, it's important to act before things get out of hand.

Education

The first step is education, Cano suggested. "Consider treatment as a joint effort," Cano added. "Both partners should try to learn as much as they can about the pain condition and should attend doctors' appointments together to learn about options for treatment."

It's helpful for both partners to hear a professional opinion on how much exercise and movement is healthy for the person with pain, for instance, and to what extent the partner in pain should help with housework and physical tasks. (Moderate physical activity can actually lessen the pain associated with some conditions, such as fibromyalgia and arthritis.)

Couples therapy is another option. In a March 2020 study published in Couple and Family Psychology: Research and Practice, Cano and her fellow researchers discovered that, for distress arising from pain and relationships, the participants preferred couples therapy. "It allows couples to talk openly and without defensiveness about how the pain has changed their lives," Cano said.

Communication

Communication between partners is essential to prevent pain from interfering in a relationship, said Mildred Farmer, MD, an internist, and fibromyalgia specialist formerly at Meridien Research, in St. Petersburg, Fla. And it goes both ways: People who are in pain also need to listen to their partners and make an effort to understand how they're feeling, Dr. Farmer said.

"Keep lines of communication open with your partner and understand that both partners may have issues with fairness," Dr. Farmer added. "While it doesn't seem fair to have to struggle with pain, watching a loved one struggle with pain is another kind of burden."

Communication doesn't just mean speaking, Dr. Farmer said. People in pain should realize that they might be signaling anger or distress "even when [they] think [they] are doing a good job hiding the pain," Dr. Farmer added. "Be aware that you can manifest pain purposefully by talking about your pain, or manifest pain indirectly through facial expression or body language."