According to a paper by Allen and colleagues, published in the November issue of the Journal of Psychiatric Research, loneliness increases the likelihood of experiencing both acute pain and chronic pain. This is the first investigation examining the association between loneliness, social exclusion, and pain in the general population (of half a million people).
Before going further, it is important to understand the difference between loneliness and social exclusion because loneliness and social exclusion (or social isolation) can be defined in a number of ways. In the paper that will be reviewed today, loneliness is defined as “a subjective, negative feeling of disconnectedness or isolation.”
Loneliness can be detrimental to health. Previous research suggests loneliness is associated with various medical and psychological conditions, like anxiety, depression, obesity, insomnia, heart disease, stroke, lung disease, and pain.
Social exclusion is different from loneliness and refers to “the inability of certain groups or individuals to participate fully in society due to personal and societal factors.” Social exclusion incorporates a variety of factors, like social isolation, economic deprivation, lower socioeconomic status, lack of access to services, and disability.
With this information in mind, let us review the present study, which examines the link between loneliness, social exclusion, and pain.
The data came from UK Biobank, a large population-based investigation that aims to enhance diagnosis, treatment, and prevention of serious diseases. It collects biological and mental health information from a sample of over a half-million participants (age 40 to 69) recruited between 2006 and 2010. The sample in the current investigation consisted of 502,528 individuals—limited to participants who had completed the baseline assessment and had answered questions related to sleep, social support, loneliness, and pain. The average age was 57 years (46% male; 95% White).
Loneliness was measured simply with the question, “Do you feel lonely?” Social exclusion was assessed using the Social Exclusion Index for Health Surveys. This measure consists of four factors: inadequate social participation, material deprivation (e.g., low income), lack of access to social rights (i.e. inability to exercise one’s rights), and lack of normative integration (i.e. not complying with core societal values).
The outcome variables consisted of sleep, acute pain, and chronic pain.
The results showed that lonely individuals and those suffering from acute pain and chronic pain, when compared to non-affected people, scored significantly higher on measures of social exclusion. In addition, acute pain, chronic pain, and loneliness were associated with increased sleep problems.
More importantly, loneliness predicted acute pain and chronic pain. Loneliness was “significantly associated with an almost two-fold increased prevalence of both acute pain and chronic pain.” After adjusting for sleep, there was a small reduction in the odds of acute pain (from 1.9 to 1.5) and chronic pain (from 1.8 to 1.5).
In addition, the results showed that social exclusion was a significant predictor of both acute and chronic pain. Odds ratios were 2.1 for acute pain and 2.3 for chronic pain. This relationship may have been partly mediated by sleep, though this was a small effect (a reduction of the odds ratio of about 0.3).
Chronic pain is prevalent. And more than half of chronic pain patients struggle with insomnia, anxiety, depression, or other mental health problems.
Pain is influenced by many factors, including isolation and loneliness. The investigation reviewed here found that social exclusion and loneliness were associated with an increased prevalence of pain (acute and chronic).
Of course, this relationship may be bidirectional. In other words, greater pain might also result in a higher prevalence of loneliness and social exclusion, at least in part because pain makes it more difficult for a person to socialize or work.
The relationship between pain and loneliness is complicated, even from a biological perspective, since physical pain and psychological pain (e.g., pain caused by rejection) share some of the same brain circuits. Perhaps that is why rejection can hurt physically.
The findings on pain and social isolation discussed here have important implications for the treatment of pain and the prevention or management of disability. Specifically, while painkillers and therapy can be helpful for pain conditions, social factors need to be considered as well: Referrals to community support, helping people improve their quality of life, and removing environmental and societal barriers (e.g., discrimination, bullying) to full participation in society may also reduce pain.