The National Chronic Pain Outreach Association, Inc. (NCPOA) is a non-profit organization established in 1980. Its purpose is to lessen the suffering of people with chronic pain by educating pain sufferers, health care professionals, and the public about chronic pain and its management. NCPOA helps people with chronic pain regain control of their lives, spreading the message, You can lead a fulfilling life despite the pain.
Chronic Pain And The Family
by Leslie F. Martel, Ph.D

We are born within a social context, we live within a social context, and we get ill within a social context. As self-evident as this might seem, our medical system, to some extent, tends to ignore this fact. Western medicine remains fascinated with technologically advanced methods to treat pain and as a result, attention to the interplay between chronic pain and the family
system is not studied with the same intensity. This is not to negate the importance of the medical advances but rather to emphasize that a truly comprehensive approach to chronic pain is necessary to maximize improvements for as many people as possible.
For the person experiencing chronic pain, the temptation to repeatedly involve oneself in medical procedures may be very seductive. Given a heightened level of distress in the patient, the physician or other health care provider may also experience this temptation. Both patient and doctor share a common goal -- to decrease suffering. Given this, it may be helpful for doctor and patient alike to better understand how pain and the family system interact.

The Search For The Golden Grail

When first approaching a persistent pain problem, it is usual to seek physiological /anatomical causes and cures. Yet, for many individuals with chronic pain, physiological/ anatomical causes provide an inadequate explanation to account for the subjective experience of suffering and for the lack of success of conventional treatments. After a comprehensive medical evaluation and an adequate trial of conventional treatment, there comes a time when both the doctor and patient must acknowledge that the continued search for the "lesion" is not a productive course of action. Knowing when to "hold on" and when to "let go" is not an easy decision in any area of one's life, and this is certainly true for the treatment of chronic pain. Once the patient and their family acknowledge that the pain will most likely not be entirely removed by medical means, the healing process can truly begin.

The Family As A System

Physicians and health care providers are accustomed to a "systems approach" to biological organisms. For example, it is clearly understood that a problem in the heart, lungs, and blood vessels has implications for the cardiovascular system as a whole. However, they are generally not accustomed to viewing social groups such as families in systems terms. Yet, it is just such a framework that is necessary to fully understand the complex nature of chronic pain.

There are five core family systems principles (adapted from Doherty & Baird, 1983) that are helpful in understanding this perspective:

1. The family is more than a collection of individuals. That is, the whole is greater than the sum of its parts. One must view the family as an entity in its own right with its own "life." Knowing all of the members individually is not enough. One must understand that change or stress affecting one member of the family affects the whole family.

2. Families have repetitive interaction patterns that regulate members' behavior. These are the implicit rules for daily living; they may be "rituals" and are often not articulated. These patterns make family life predictable and generally make life easier. On a less benign level, the patterns may "freeze" a particular way of behaving, making change difficult.
3. Individuals' symptoms may have a function within the family. For many reasons, a symptom may become incorporated into the family interaction pattern in such a way that it seems essential for the family's harmony and regularity.

4. The ability to adapt to change is the hallmark of healthy family functioning. Change is the ever-present challenge to families. In addition to normal life cycle transitions, illness may challenge a family's ability to adapt to new circumstances. With illness comes the reshuffling of roles. Perhaps the primary wage earner must now become the recipient of disability payments. The ability to handle these changes with flexibility, creativity, and determination reveals a great deal about family functioning.

5. There are no victim and victimizers in families: family members share joint responsibility for their problems. Family members are both actors and reactors, especially in maintaining chronic problems. There are no family villains. Like a dance, family members move with one another in ways that lead to healthful or hurtful consequences. Family systems theory encourages one to look at the interconnectedness of behavior and seed solutions in accordance with this viewpoint.

Implications For Individuals With Chronic Pain And Their Families

The person with chronic pain is not the only person whose life changes. Each member of the family must make adjustments which may be psychological, social, economic, and physical in nature. All involved will have thoughts and feeling about these changes and it will be essential to remove barriers in order to freely discuss these issues. Honest, straightforward, and routine communication is the key to maintaining healthy family functioning.

The founder of general systems theory, Ludwig Von Bertalanffy, noted that "system sickness is system rigidity." It is essential that the family examine the patterns that have developed as a result of one of their members being in long-standing chronic pain. Has the family become "frozen" in their roles? Is there room for change that would improve the quality of life for all concerned? When a member of the family system develops chronic pain and it becomes clear that the problem is indeed chronic, the family will usually reorganize in a way that allows it to keep functioning as a family unit. Once the reorganization of roles and the shift in power has occurred, there is a distinct tendency for this new order to he maintained. For example, Mr. X, who was responsible for working 40 hours a week, taking care of household maintenance and household bills, was relieved of these responsibilities during a long and difficult bout with chronic pain. He may be unaware that he has now adapted to a life free of these responsibilities. When he attempts to handle bills, he finds that, for some reason, he experiences more pain. His wife, who is quite caring and solicitous and solicitous of him, assures him that she can handle these tasks.

Over time, a symptom may take on a life all its own. The family needs to be aware that this can occur and make a special effort to routinely assess family roles/tasks and make changes that will facilitate continued growth of the individual and family unit. By understanding that significant change is usually accompanied by some resistance to it, difficulties may be anticipated and eventually overcome.

These two points are closely related to the three previous ones. Change is an ongoing and necessary process. The ability to adapt to changes and to acknowledge what you can change and what you cannot change may potentially lessen the feeling that one has lost control of one's life. Viable choices usually exist. Each choice has it's pros and cons but it is making choices that prevents a person or family from feeling victimized. In essence, if chronic pain affects a given individual, it becomes essential for the health care professional, the "sufferer", and the family to understand that the pain also affects the family. By understanding this, all concerned can view the problem in a broader context and address the issues accordingly. With increased stress in the family system, communication tends to break down, patterns become more rigid, and overall family functioning diminishes. Addressing the concerns of all those involved in a timely manner will go a long way toward identifying and remediating any potential problems.