People suffering from chronic pain are often angry. They are trapped not only by an unpleasant sensation, but also by their limited treatment options. The experience can lead to feeling not only like there is no end in sight, but also as through there is no hope. So strong are the associated emotions that I often call this state of mind “the abyss.”
All too often, when that frustration becomes too much, it can begin to leak out, turning itself outward onto others, particularly loved ones. Ongoing criticism of anyone is a problem — and a big one. Yet in these cases, the perpetrator often does not realize that they might be inflicting so much trauma on someone they profess to love.
I am an orthopedic spine surgeon. Why am I writing about a mental health topic? I was raised by a mother who was physically and emotionally abusive. I could never figure out why she often told us how much she loved us and then fly off into anther rage that could last for days. After interviewing my physician father a couple of years ago, I realized that she suffered from chronic pain that began shortly after she finished nursing school.
Growing up, I lived in a hypervigilant state of mind. I was always anxious about when my mother would snap and begin screaming. I did not know what would set her off or calm her down. I felt powerless, and would spend endless hours trying to make sure that she was happy. The situation persisted for so long that it became normal; I did not realized the extent to which my anxiety was affecting me until I was a first year resident and forced to deal with my own stress management.
Today, as a physician treating so many conditions inextricably tied to pain, I often see disturbingly familiar behavior in the office. Certain patients will snap or yell their spouse or children right in front of me. They can be abusive to my staff. If they are demonstrating this behavior in my office, what must it be like at home?
In our chosen medical fields, we have trained and practice under a lot of stress. (The burnout rate is over 50 percent in every survey I have read.) We are continually judged, and being criticized — and critical — can be the norm for many of us. This means it isn’t always intuitive to think about the effects of patient pain on families.
Yet when asked, spouses will frequently tear up when I begin to discuss what effect the chronic pain might be having on their family. Often, the loved ones recall a pleasant environment prior to the entrance of pain and now they are in a very dark world. Even if the anger is not focused directly on the family, its tenor and after-effects can set a tense, stressful, and defeatist state of mind for everyone in the household.
From the patient perspective, it’s important to remember that they are victims too. Patients in chronic pain are suffering badly and often become socially isolated. They need their families for emotional support; they need friends to keep them interacting with the world. However, some are so used to being perpetually in pain and angry that they don’t recognize it as destructive. When I ask them to go home and ask their family and friends what it’s like to live under this shadow, the responses they usually receive are intense and sobering.
Our profession puts us in a unique position to help patients and families take the early steps toward addressing this spiral and breaking these patterns. For this, there are countless effective strategies. Many can be transformative. Learn and practice these tools yourself, and foster a positive, non-critical tone in your office, among your staff, and with your patients. When you see a problem, present these tools to your patients and direct them to the right resources. Be the change that you want to create. With over 100 million people in the US experiencing chronic pain, this is a high stakes game.
David Hanscom is an orthopedic surgeon and can be reached at Back in Control. He is the author of Back in Control: A Spine Surgeon’s Roadmap out of Chronic Pain. He blogs at The Doctor Blog.
