Social isolation and chronic pain

I have been thinking a great deal about the impact of social isolation on my life. Past and present. And how it impacts my health and mood.

The social isolation and consequences of chronic pain are important as the physical and psychological consequences.

In the areas of

• taking care of children, spouse or parents
• relationships with friends
• relationship with significant other’
• relationship with family and relatives
• employment
• taking part in family events and activities
• participating in social/recreational activities

All of which rank as high in our typical pain consequences, such as emotional wellbeing, lack of sleep, and fatigue, poor concentration.

This makes logical sense when we think about it. That is because all these things are participating in Life and Functioning. These are the things that are limited and reduced significantly. It is clear all of these have a significant impact on us all.

Although improved social outcomes are a critical goal of pain management for patients, the social outcomes of pain management are rarely evaluated. Failing to adequately address the social functioning of patients with chronic pain may hamper the longterm effectiveness of interventions, and may be a missed opportunity to mitigate the risk of intergenerational transmission of pain within families. –Beyond pain, distress, and disability: the importance of social outcomes in pain management research and practice

Anger and depression

In fact, the decrease in our social satisfaction predicts our level of distress, anger and depression in chronic pain because of the massive disruption to our social relationships. And maybe this isn’t that surprising since there is a lot of research into how loneliness has such severe consequences. Humans are social animals. Even I, an introvert, am aware of this. I love my alone time. I need it being an introvert. But I am a human being and as such, I need other human beings. I suffer without social interaction. Although I do not need an abundance of it, I do need it.

Part of my treatment for depression, back in the day, was increasing my social time with friends and family. One therapist never mentioned it much at all. To treat my significant depression due to my unmanaged and untreated pain, all she recommended was walks outside. She worried I was not leaving the house enough. Not the isolation itself. Not the complete social isolation. It was much later my pain psychologist pointed out that yeah, even introverts, with introverted hobbies, need to socialize sometimes. And he was right about that. I used to make a point of just that. And then, again, the social isolation has caught up with me.

We have a difficult time with this. For many reasons. One basic reason is actually maintaining friendships. The other is having the capacity to socialize. Weight the cost and the benefits of it. Doing social activities we actually can for durations we can handle. With people that have the capacity to understand, that means we cannot do other activities that we simply can’t do and for durations that are impossible. Or locations that do not work. Or many other factors we have to turn down. Or bad days. A lot of people do not get that, so that means very few friends indeed.

The cycle

When social satisfaction tanks, our anger and depression increase. So it is our pain intensity that impacts our functionality and often mobility. This then affects our ability to do the social roles I mentioned, leading to much lower social satisfaction. Because of lower social satisfaction, we get depressed or angry, or both.

I tend to get depressed. And that makes me less motivated to even try to socialize. I get into hermit mode. And why even try? People just… disappear.

This makes sense to me because the more disconnected we become from all aspects of our lives in society, the more frustrated (leading to anger) and lonely/isolated (leading to depression) we become.

Socializing can be compromised by:

• Our inability to relate to others
• Physical symptoms such as fatigue
• Mental illness such as depression and/or anxiety, which can be increased or magnified by the social isolation itself
• Felling unable to keep up with our peers
• Dwindling invitations

Impacting relationships

It impacts all social relationships, mind you. But I think often about:

Our friends:

It has a strong negative effect on our friend relationships. We have fewer friends and a lower level of social support. It is difficult to maintain friendships with chronic pain. Empathy is not something that is an endless supply. If a person doesn’t recover or heal, then empathy wains. We become tiresome. We are too negative. We talk about our illness ‘too much’. We never ‘come out’ or ‘do things’. Certainly, we do not get the support someone with an acute illness would. Hell, I wouldn’t even expect that. I sort of find a way of trying not to mention my chronic pain much while at the same time ensuring I do not exceed my limits by doing things I cannot just to keep friends.

Our colleagues/employer:

This is a category I think we all know there is a huge negative impact. Man, the impact on my life was horrific. Absenteeism causes co-worker conflicts. We can face suspicion, mistrust, and job insecurity. We are perceived as lazy and unreliable. Expressions of pain are often perceived as disability… no matter the actual level of functionality. We are literally perceived differently based on our expressions of pain or pain behaviours.

Then we add in the loss of work altogether and we have a social interaction void that we do not replace of co-workers and peers. People we saw and interacted with on a daily basis in social situations. And in some jobs, customers as well. All of which goes away with the onset of long term disability.

So we can say for social consequences of pain

Isolation takes a massive toll on us at times. It certainly can for me. With extensive gaps where I do not socialize at all. I have to say that can lead to the complete loss of friends. Perhaps simply by the inconsistency of my capacity to function in the world. It can and does affect us mentally, physically and emotionally. However, it can be a difficult puzzle to resolve.

Some recommended suggestions

• Inviting people to your home– This can reduce fatigue. It can decrease the cost associated with chronic pain. It can help with issues such as location and travel time. When I was in university this was a viable solution. I didn’t always go out with my peers. At times, we stayed in or they came over and we played cards.
• Planning according to our good days– However, this recommended tip seems to suggest a level of both pacing and spontaneity of both you and your friends. But I have in the past quite suddenly decided to go to planned occasions based on good days.
• Choose activities based on your level of functioning– again, with playing a good game of cards/games vs. going out to party when I was younger actually represented this quite accurately.
• Choosing things that fit our budget– We can be on disability or reduced incomes. So choosing things that literally fit our budget can help us get out.
• Reminders– In the case of brain fog and just mental fatigue setting reminders to actual events and then also reminders to connect with family, friends and loved ones can help keep us connected.
• Just support groups– I thought of joining a pain support group myself locally at the pain clinic. And it is an extremely good idea. Just to get out and about but also to have time with people you can relate to.
• Joining hobby groups– book clubs, art clubs, writing clubs and so on that support hobbies that you enjoy can also really be useful. I joined a local art community center when I lived in a smaller location than I do now and it was great.
• Online support and community– Not only do we utilize online support groups to socialize when we cannot get out but we use them for hobbies and other things as well.
• Maintain a sense of purpose, meaning and goals– Outside of your peer group or within it. Something to get you up in the morning. Something to establish that sense of purpose.
• Get out and about– Someone once said just being around people helps. So I do things like go out of coffee by myself. Run an errand. Things like that. Just to get out of the house. Even that go for a walk is a good idea. Gets me out of my mindset.

How I will attempt to get out of this particular hermit mode onset I am not sure of. Aside from taking my own advice bit by bit and see what works. A small bit can help increase our life satisfaction.

Effects of social isolation