The Impact of Chronic Pain on Family

By David Hanscom, MD, PNN Columnist

I have long asked the spouses and partners of my chronic pain patients to participate in the “Direct Your Own Care” project — my step-by-step method that allows patients to take control of their treatment plan.

One reason is that partners of chronic pain patients also experience suffering. They have their own broken dreams, disappointments and often just feel bad -- because their partner is feeling bad. This is not primarily psychological. The human brain has “mirror neurons” that are stimulated by others’ behavior. If one partner is having a bad day, there is a good chance that the other’s day is not going to be great, either.

So, when the patient’s partner is snippy, critical or hostile, the patient tends to feel worse, too. The region of the brain that elicits a bad mood is stimulated. Conversely, if one partner is in a great mood, the other tends to be happier.

That is why— indirectly for my patients’ sake and directly for that of their partners — I believe it is vital that both partners learn tools such as expressive writing and adding more play into their lives to restore a joyful life.

Unfortunately, it is often remarkably difficult to convince other members of the household to engage in these tools. If you care for your family member, why would you not try to do as much as possible to help him or her heal?

I ran across a study in the journal Pain that partially explains why. Researchers had 105 patients with chronic back pain and their spouses keep an electronic diary for two weeks on their interaction with each other. Spouses were asked to observe and record the patient’s pain behavior (such as complaining or grimacing), while patients were asked about any criticism or hostility they received from their spouse.   

The following observations were made:

• Patient’s pain increased for over three hours when they felt hostility or were criticized

• Patient’s pain behavior consistently created a negative reaction from their partner

• These interactions were consistent. The conclusion was that long-term negative interactions not only cause more pain, they erode relationships and quality of life

This finding is similar to what has been found in depression research. Depressed patients act in ways that cause rejection from others, which in turn exacerbates the depression.

There is no question that chronic pain is a family issue. The couples’ study doesn’t even take into account the damage an angry person in chronic pain can inflict on his close relationships. The family unit can become a living hell and seem like a hopeless situation.

Fortunately, like the patient’s condition, the family dynamic can get better with the right tools. It did with me.

Anger and Relationships

In addition to stimulating the nervous systems of those close to you through the mirror neuron effect, there are additional problems created by chronic pain in the household. Most of them stem from the understandable problem that when someone is trapped by pain, he or she is chronically angry and upset. Members of the family become targets in many ways. 

First, there is often a lot of complaining about the pain, medical care and the frequent mistreatment that patients in pain experience. We have found that many, if not most patients in pain, discuss their problems daily. Family members become worn-down by this, but the patient usually doesn’t understand the depth of their despair. Although the family is concerned and upset that their loved one is suffering, they are frustrated by their inability to help. In medicine, the term we use for this is “compassion fatigue.”

Secondly, peace, love and joy are crushed and replaced with an angry energy. Family members are often targets of sharp orders and criticism. The patient may demand that their physical needs be met by the family. At the same time, the person in pain may emotionally withdraw and become isolated even while being in the middle of a lot of bustling activity. Family life just isn’t as much fun.

Third, the essence of successful relationships is being aware of the needs of those around you. This is true in any arena, but especially critical in the family. Lack of awareness is the essence of abuse and anger is the ultimate manifestation of it. You can’t see the needs of others because you are blinded by your own angry energy.

So, instead of the home being a place of safety, it can become dangerous. When a family member is triggered by an angry patient and becomes hostile or critical, then the patient becomes more upset and it all becomes like a giant ping-pong game. This the opposite of what you would want, where a happy person creates the opposite contagious reaction. And where is the end point?

Since anxiety and anger are unconscious survival reactions that are much stronger than the conscious brain, they aren’t subject to rational control. How many of us have ever solved a disagreement in the middle of an argument? It never happens.

Healing Energy

We have discovered that family dynamics are such a powerful force in keeping people in pain, that medical interventions may have a limited effect. Conversely, we have also found out that the family can be a remarkably healing energy for everyone involved – and it happens quickly.

The path to this healing energy is the topic for another article. But the starting point goes like this:

The first thing I ask is that every adult family member living at home immerse themselves in the healing process. That means actively engaging in the exercises that calm down the nervous system. You can see them outlined on my website.

Second, I tell patients never to discuss their pain – ever -- except with their medical team. Talking about pain reinforces the pain circuits and is frustrating to those who care about you, but can’t help. I also tell patients that they can’t complain about anything.

Third, I want the family to reminisce about the most enjoyable times in their relationships. What were the fun times? Discuss them in detail and stick with the conversation. Try to feel it.

The final and most challenging step is not bringing the pain home with you. I tell patients, “When you walk through the door, you’ll make a commitment to never bring pain back into the house.”

The intention is not to ignore pain or pretend it doesn’t exist, but to create a safe haven in your living space. I want patients to take the positive energy generated by the conversation about the best times in their relationship into the home and keep it there.

If you have to argue or fight – take it outside. Every person in the household has the right to relax and feel safe in the confines of their home.

Dr. David Hanscom is a spinal surgeon who has helped hundreds of back pain sufferers by teaching them how to calm their central nervous systems without the use of drugs or surgery.

In his book Back in Control, Hanscom shares the latest developments in neuroscience research and his own personal history with pain.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Why I’m Leaving My Spine Surgery Practice

By David Hanscom, MD, PNN Columnist

From the day I entered medical school, I wanted to be an orthopedic surgeon. I was planning on practicing internal medicine, but on a whim I applied for an orthopedic residency and, much to my surprise, was accepted.

I came out of my residency and fellowship in 1985 on fire, ready to solve the world’s spine problems with my surgical skills.

About six months ago, something shifted deep within me. In the three decades I’ve practiced spine surgery in the Seattle area, I’ve tried to address the whole patient. But I didn’t yet have a clear idea about all the factors that affect a person’s physical and mental health.

In fact, for the first eight years of my practice, I was part of Seattle’s movement to surgically solve low back pain with lumbar fusions. A new device had been introduced that ensured a much higher chance of a successful fusion. Our fusion rate for low back pain was nine times that of New England’s. I felt badly if I couldn’t find a reason to perform a fusion.

Then a paper came out in 1993 documenting that the success rate for fusion in the Washington Workers Compensation population was only between 15 to 25 percent. I had been under the impression that it was over 90 percent. A lumbar fusion is a major intervention with a significant short and long-term complication rate. I immediately stopped performing them.  

I also plunged into a deep abyss of chronic pain that many would call a burnout. I had no idea what happened or why. I had become a top-level surgeon by embracing stress with a “bring it on” attitude. I was fearless and didn’t know what anxiety was.

What I didn’t realize was that my drive for success was fueled by my need to escape an abusive and anxiety-ridden childhood. I was a supreme master of suppressing anxiety until 1990, when I experienced a severe panic attack while driving on a bridge over Lake Washington late one night.

Although I was skilled at consciously suppressing my anxiety, my body wasn’t going to let me get away with it. Anxiety and anger create a flood of stress hormones in your body. Sustained levels of these hormones translate into over 30 possible physical symptoms. I descended into a 13-year tailspin that almost resulted in my suicide.  

DAVID HANSCOM, MD

I can’t express in words how dark my world became. I experienced migraines, tension headaches, migratory skin rashes, severe anxiety in the form of an obsessive-compulsive disorder, burning feet, PTSD, tinnitus, pain in my neck, back and chest, insomnia, stomach issues, and intermittent itching over my scalp.

In 2002, I accidentally began my journey out of that dark hole by picking up a book that recommended writing down thoughts in a structured way.  For the first time I felt a shift and a slight decrease in my anxiety. I learned some additional treatments and six months later, I was free of pain. All of my other symptoms disappeared.

I began to share what I learned with my patients and watched many of them improve. Addressing sleep was the first step. Slowly I expanded it to add medication management, education about pain, stress management skills, physical conditioning, and an improved life outlook.

I still didn’t know what happened to me or why. Then in 2009, I heard a lecture by Dr. Howard Schubiner, who had trained with Dr. John Sarno, a physiatrist who championed the idea that emotional pain translates into physical symptoms.

Within five minutes of the beginning of Dr. Shubiner’s lecture, the pieces of my puzzle snapped into place. I realized that sustained levels of stress hormones can and will create physical symptoms. I also learned how the nervous system works by linking current circumstances with past events. If a given situation reminds you of past emotional trauma, you may experience similar symptoms that occurred around the prior event.

I felt like I had been let out of jail. I’ll never forget that moment of awareness.

What’s puzzling is that these concepts are what we learned in high school science class. When you’re threatened for any reason, your body secretes stress chemicals such as adrenaline and cortisol. You’ll then experience a flight, fight or freeze response, with an increased heart rate, rapid breathing, sweating, muscle tension and anxiety. When this chemical surge is sustained, you become ill. It’s been well documented that stress shortens your life span and is a precursor of chronic diseases.

Modern medicine is ignoring this. We are not only failing to treat chronic pain, but creating it.

Spine surgeons are throwing random treatments at symptoms without taking the time to know a patient’s whole story.  It takes just five minutes for a doctor to ask a simple question, “What’s going on in your life over the last year?” Answers may include the loss of a job, loved one, divorce, or random accident. The severity of their suffering is sometimes beyond words. But once we help them past this trauma, their physical symptoms usually resolve.

What has become more disturbing is that I see patients every week who have major spine surgery done or recommended for their normal spines. It often occurs on the first visit. Patients tell me they often feel pressured to get placed on the surgical schedule quickly. At the same time, I am watching dozens of patients with severe structural surgical problems cancel their surgery because their pain disappears using the simple measures I’ve learned.

I love my work. I enjoy my partners as we help and challenge each other. My surgical skills are the best they’ve been in 30 years. My clinic staff is superb in listening and helping patients heal. I’m also walking away from it.

I can’t keep watching patients being harmed at such a staggering pace. I have loved seeing medicine evolve over the last 40 years, but now I feel like I am attempting to pull it out of a deep hole. I never thought it would end this way. Wish me luck.

Dr. David Hanscom has helped hundreds of back pain sufferers by teaching them how to calm their central nervous systems without the use of drugs or surgery. In his book Back in Control, Hanscom shares the latest developments in neuroscience research and his own personal history with pain.

More information can be found on his website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.