By Jim Brown, PhD

The unintended effects on a spouse or partner are familiar. Concern, support, and love are challenged by fatigue, frustration, and a sense of being overwhelmed.

Alcoholism? Substance abuse? Eating disorder? No, the problem is chronic pain — the kind that can last months or years. The kind that can threaten a marriage or a relationship, and the kind that is all too familiar to people who deal with dependency.

Studies show that those who suffer chronic pain often suffer anxiety and depression as well. Many sufferers turn to alcohol for relief, and some may be unaware that they are using alcohol as a pain medication. Unintended addiction to pain killers has made the headlines as well-known sufferers fall victim. The actor Jeff Conaway, who died this year, blamed his cocaine use and pain pill abuse in part on lingering pain from back surgery.

Although originally triggered by conditions such as arthritis, cancer, fibromyalgia, damaged spinal discs, osteoporosis, or shingles, chronic pain becomes a disease itself. Pain signals continue to pummel the brain regardless of treatment, and sometimes the exact cause is not even known.

The number of Americans suffering from chronic pain reveals the scope of the problem. More than 75 million adults — one in every six Americans — have reported long-term chronic pain, even though the condition is under-reported and under-treated. The number is higher among those 65 and over, and higher yet among cancer patients. And for every chronic pain patient, there is at least one person giving care whose life is also being changed dramatically. Chronic pain introduces tension to a marriage and increases the likelihood of divorce.

Reduce the stress. You and your spouse can reduce pain-related stress and protect your marriage. The first step is to be as well informed as possible. Support groups such as the American Chronic Pain Association and the American Pain Foundation (APF) are good resources. A monthly electronic newsletter titled Pain Monitor is free and full of practical information. (www.painfoundation.org/learn/publications/pain-monitor-electronic.html). Help is also available from family counselors, psychologists, and pain management physicians.

The caregiver has to acknowledge that chronic pain is real, it’s hard to manage, and it’s individual in nature. Wide variations exist in pain tolerance and how people respond to treatment. There will be good and bad days, so both partners should take advantage of the good ones.

Understand. The patient has to understand 1) that the symptoms can often be controlled by complying with a doctor’s recommendation (for example, losing weight or exercising regularly), 2) that the condition places stress on both spouses, and 3) that there are limits to how much help one person can give.

Take a break
The caregiver should take breaks — emotionally and physically — and the patient should encourage the spouse to take those breaks without feeling guilty. Scheduled breaks seem to work better than waiting for the right time. Help is often available from family members, friends, or support groups. If someone volunteers to assist, have specific things in mind that person may be able to do (sit with the patient, run an errand, take the person to physical therapy or to a non-emergency doctor’s appointment).

Support without enabling
The last suggestion might be the most difficult to implement, and you’ve heard it regarding dependency. If you are taking care of a person with chronic pain, help but don’t enable. It sounds harsh, but there are incentives for some patients not to get healthy. It might be to get more attention. It might satisfy their perceived need for more or stronger drugs. Pain, or exaggerated perception of pain, enables some patients to avoid household or family responsibilities.

Educating yourself and your spouse about the nature of chronic pain, complying with medical advice, scheduling breaks, and supporting without enabling may not only save a marriage, they might even make it stronger.

Jim Brown, PhD, Executive Editor at the Steadman Philippon Research Institute, is the author of Pain Management: Advances in Diagnosis and Treatment.