Heartache and Hurt
The connection between difficult relationships and physical pain.
Posted Feb 12, 2020
Pain is a universal experience, from paper cuts and scraped knees to surgery and childbirth. Whether a stubbed toe or a broken bone, everyone has had experiences with physical pain.
However, chronic pain—the kind of pain that lasts beyond when we’d expect it to, for months or even years—is also increasingly familiar. At last count, more than 25 million adults in the U.S. reported chronic pain. The costs of treating pain, and the productivity lost by people sidelined by pain, is estimated to be upwards of $635 billion. Faced with the opioid epidemic, scientists are now scrambling to understand how to prevent acute pain from escalating and how to better support people living with chronic pain.
While there are several avenues to the etiology and evolution of pain, some remain less explored. One pathway to pain that has received insufficient attention is our close relationships—which are also a correlate of pain that is potentially amenable to change.
While researchers have tested the effects of family and intimate partnerships on pain in a few different ways, studies tend to center on how the quality of close relationships contributes to the progression of pain. For example, recent evidence suggests that strained family relationships—those that are demanding, critical, and irritating—may increase the risk of developing new chronic pain over the course of 10 years for previously pain-free adults. Further, acute pain is more likely to become chronic over 10 years for people whose family relationships were negative.
So, how does this happen? It’s unlikely our close connections are hostile or unreliable and then—bam!—we experience arthritis. Instead, the link between distress in our social networks and physical pain appears to be our experiences of stress—the individual, emotional experience of strain and tension. The more stress we feel over time, the more likely we are to respond to that stress physiologically, and in ways that are harder for our bodies to keep in check.
Recent research has begun to support this connection, finding that negative encounters with others are associated with a worse mood, which is, in turn, associated with pain. For people who already have chronic pain, depression and anxiety symptoms also appear to explain the association between stressful family and intimate partner relationships and the intensity of pain’s interference with life.
But this dynamic also provides hope for those suffering from chronic pain: Close family relationships that are supportive, caring, and understanding are linked to a lower likelihood of acute pain becoming chronic pain. Having a romantic partner nearby when we’re in pain—even thinking about that partner—can result in lower blood pressure reactivity to pain. And holding their hand proves especially powerful, as research increasingly shows us the benefits of human touch for buffering discomfort. In lab-based research, even deciding to endure extra pain in order to reduce the pain a romantic partner may need to experience is associated with less unpleasantness related to the pain—an effect so powerful it is visible via brain imaging.
Most important is the role social support plays in protecting against stress—it helps us to understand the stress related to pain differently, and it promotes actively coping with stress in order to interrupt its metamorphosis into pain.
Recently, my young daughter experienced the pain associated with vaccination injections. Though I’d hoped to moderate her fear and discomfort with my compassionate presence, her threats of “Why are you doing this to me?” suggested I was less than effective.
But then I realized I wasn’t exactly comforting her—I had taken my cues from the environment, and instead of validating her anxiety, I was allowing our very well-meaning nurse to suggest repeatedly, “It will be OK!” (To which my daughter explicitly replied, “Everything will not be OK!”)
While my daughter may have benefited from our close relationship, overall, her pain and pain-related distress in the moment were not going to be lessened by a hands-off approach. I needed to move in, provide physical comfort, and validate her worry when she was too overwhelmed (and too young) to do it herself. Supportive close relationships are what makes the difference: Our caring has power over how we experience both mild and disabling pain.
You may be looking for an excuse to connect to loved ones or heal family rifts. Or you may be needing hope in the face of chronic migraine, a serious injury, or fibromyalgia. Either way—consider the ties between social relationships and chronic pain a good reason to focus your energy there. Simultaneously addressing the quality of your close relationships (or even regularly negative interactions with acquaintances!), your coping skills for emotional distress, as well as treatment for pain, may be the most effective method of healing.
It may also be beneficial to involve supportive ties early on in the treatment of new, acute pain—leverage the healing power that is feeling validated and cared for, and prevent the negative physical effects of bottling up emotion. In other words, healing pain in either area of your life—relational or physical—may be powerfully aided by soothing distress and maximizing support.