Family Dynamics and Chronic Pain
Chronic pain is a condition that occurs jointly with other co-morbidities to form the chronic pain syndrome. Each co-morbidity (pain, insomnia, fatigue, sexual dysfunction, depression and anxiety) works against functioning in the chronic pain patient. In particular, chronic pain leads to depression and, conversely, depression increases the incidence of pain.
The effects of chronic pain syndrome are not independent to the pain patient, but also outreaches to the family of the sufferer. Pain, depression and anxiety alter the daily functioning of the patient. Prior to the onset of chronic pain, the patient lived, interacted, and contributed to his or her social environment. The active participation may have been in a breadwinner role, spousal role, parent/child relationship or other significant relationship (i.e. friend or coworker). In each role/relationship, the pain sufferer made contributions to the relationship and fulfilled certain expectations. The impact of chronic pain changes the pain patients ability to contribute in the same way to each role and, in the process, strains each relationship and changes the way the patient and family perceive themselves. The effects of pain, depression and anxiety vary depending on sex and age.
Treatment of depression and anxiety for the patient experiencing chronic pain syndrome must involve a multidisciplinary approach. Referrals to psychotherapy (both family and individual), occupational therapy, and physical therapy are desirable and necessary. In situations where a pain specialist is referred, it is important that the pain specialist remains in communication with the family physician and ensures that all of the co-morbidities of pain are addressed.
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