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The Relationship Between Pain and Caregiver Stress
Pamela D. Wilson - Caregiver Subject Matter Expert Pamela D. Wilson - Caregiver Subject Matter Expert
For Immediate Release:
Dateline: Denver, CO
Wednesday, February 8, 2023


The Caring Generation® – Episode 160 February 8, 2023. Chronic pain can result in angry outbursts and disruptive behaviors. Learn about the relationship between pain and caregiver stress so that you can confront angry behaviors that damage relationships.

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What is the relationship between pain and caregiver stress? Caregivers take responsibility for caring for sick, aging parents, spouses, children, and other family members. Occasional sickness or ongoing health problems can result in pain that doesn’t go away. You may have heard the word chronic related to chronic health or disease.

Chronic is medical speak healthcare terminology used by doctors, nurses, and others that lasts more than three months. Chronic illnesses often result in chronic pain. If you are a caregiver of a person experiencing chronic pain and you may be on the receiving end of anger, verbal outbursts, agitation, or a loved one who is short-tempered.

This person may be experiencing chronic pain and not realize that this is the cause of their behaviors. It can be challenging to figure out what’s wrong with aging parents.

Can Pain Ruin Caregiving Relationships?

Watch More Videos About Caregiving and Aging on Pamela’s YouTube Channel

The Link Between Chronic Illness, Pain, and Anger

Research confirms the link between chronic illness, chronic pain, and anger. Learn how to:

  • Identify how pain results in angry expressions that negatively affect caregiving relationships
  • Recognize the effects of pain on interpersonal relationships
  • Initiate discussions about pain can improve the relationship between pain and caregiver stress
  • Increase awareness of how chronic illness, pain, and anger link to other aspects of life

Chronic disease can result in pain that translates to anger. If you are a caregiver, ask the person you care for about their experience of pain. Can mom or dad give you a rating of 1 to 10, 10 being unbearable?

If an aging parent is in pain, has anything been done to investigate the source or cause of the pain? Has the pain been discussed with the doctor? If yes, what was or is the treatment plan?

Initial suggestions to alleviate pain can include physical therapy, medications, or other interventions like injections. These interventions vary in effort, potential side effects, and time required.

For example, taking Tylenol is something anyone can do. On the other hand, pain medication that requires a doctor’s prescription means ongoing doctor visits.

Stronger pain medications can cause drowsiness, constipation, nausea or an upset stomach, cloudy thinking, kidney damage, a weakened immune system, depression, or falls in the elderly. These side effects may be a non-starter for individuals who want to drive a car, go to work and perform other daily activities that require a sharp mind.

Opioids, which are strong pain medications, can be highly addictive if taken for extended periods of time. So for anyone who doesn’t want to take medication or who experiences side effects from pain medications, taking medication may not be a solution to pain.

What other options exist to stop pain from ruining caregiving relationships? Depending on the source of the pain, physical therapy can be a solution. Unfortunately, physical weakness combined with activity can result in pain.

Let’s say you go outside and mow the lawn or shovel snow, and your back, shoulders, or arms ache the next day. It would be safe to say that you might have overused these muscles if mowing or shoveling are not regular activities. The pain, in this case, results from weak muscles.

The Brain-Pain-Physical Connection

A study by Tanaka, I’ll place a link in the show transcript, describes the relationship between knee osteoarthritis, limiting physical activity, increased muscle weakness, and what I call the brain-pain connection.

If aging parents have arthritis or pain and limit their activity, this research offers insights into why limiting activity worsens physical disability and increases pain. Let’s begin with a definition and description of a medical term called pain catastrophizing.

Pain catastrophizing means that a person has a tendency or a habit of focusing on pain and feeling helpless about actions to reduce the pain. As a result, disruptive behaviors, attention seeking- demanding, or verbal abuse can result.

In these situations, pain can ruin caregiving relationships. If you have had any injuries, you may be able to relate to the examples I’m about to share that highlight the relationship between pain and caregiver stress.

Focusing on pain and feeling helpless to do anything becomes a pattern in how a person thinks about pain. Another emotion—fear—also contributes to experiences or thoughts about pain.

Let me use a simple example. You, your children, or an aging parent need a vaccine. Fear of the needle that delivers the vaccine can be overstated or cause a lot of worries.

It’s easy to imagine that the needle stick will cause a lot of pain. Temporary arm soreness may also result.

Some people get worked up emotionally when scheduled to receive an injection, see the dentist for a filling or go to the doctor. Then when the procedure is done, the thought may be, “well, that wasn’t as bad as I imagined it to be.”

Mental Management of Pain

A nurse, doctor, or dentist can prepare a patient by saying, “this will hurt for a few seconds or a minute,” so the patient isn’t surprised. Managing beliefs about pain or perceptions about how painful something will be is vital in managing thoughts and emotions around pain.

People avoid activities that they perceive to be painful. For example, I know I need a filling, but the injection is painful, so I don’t want to go to the dentist. Or maybe I don’t have the money, so this is the excuse I use not to receive dental care.

Focusing on feeling pain can lead to avoiding short-term actions that may be painful but that reduce the pain in the long term. If you have a cavity and don’t get treated, you could lose the tooth or several teeth or have infected gums.

pain and caregiver stressAnother example is an elderly parent with knee pain. The physical therapist showed a parent exercises, which mom and dad did, but they caused more pain, so now mom or dad refused to exercise.

These thinking patterns can result in avoiding activities that might reduce pain. If elderly parents have knee pain and don’t participate in therapy, they may eventually be unable to stand or walk. Not being able to stand or walk have far-reaching implications not considered today.

Increasing Activity Can Reduce Pain

Specific to an arthritic knee, pain that leads to exercise avoidance will lead to increased muscle weakness and more pain. Pain and weak muscles increase physical dependence on others for assistance to perform daily activities like showering and dressing.

Elderly parents may eventually be unable to leave home for doctor appointments or grocery shopping. A wheelchair may become the only option to move around.

So when anyone says they are in pain or experiencing hurt, it’s essential to investigate the cause, research potential solutions and then implement a plan. Functional changes in the human body’s ability result in fast-forwarding the effects of aging.

A body that does not move or walk will eventually lose muscle strength and be unable to move or walk. Persons with dementia are more susceptible to losing the ability to perform physical tasks if there is any break in routine patterns. Persons with memory loss forget how to walk and perform daily activities.

Active People Recover Faster from Illness

Athletes and persons who exercise regularly gain muscle memory. Muscle memory is the ability of muscles to take a break from exercise or movement and regain the lost strength in a short period of time.

More exercise equates to greater muscle memory. This is why active and healthy people recover faster from illnesses than people who may be already sick or have weakened immune systems.

While weak muscles in the body may be a source of pain, with regular exercise and strengthening muscles, the pain lessens or goes away altogether. The critical consideration is to begin a treatment activity and stick with it.

Pain Catastrophizing and Psychogenic Pain

Pain catastrophizing links the relationship between emotional and physical pain. The body’s neurological system processes emotional and physical pain differently between the right and left brain. Sometimes the mind doesn’t know the difference between physical and emotional pain.

For example, think of the pain of being rejected by someone you love or not getting the job of your dreams. Emotional pain can feel as great as physical pain.

Psychogenic pain relates to physical pain caused by emotional stress—it’s real. We’ll talk about this type of pain briefly.

If you’re interested in learning more, search for the Caring Generation episode 68 called Caring for an Elderly Parent, You Don’t Like. On this program, I interview John Leach about the psychology of human survival, where he describes psychogenic reactions to stressful situations.

Psychogenic or emotional pain can result from experiencing pain, stress, or anxiety. The mind creates physical symptoms in the body that can result in death.

Fear of survival or worries about the ability to manage day-to-day can result in physical aches and pain. So as you can see, pain is complicated. Pain can cause anger that is disruptive to caregiving relationships. Emotions and thoughts can result in physical pain that seems just as real.

The Relationship Between Pain and Caregiver Stress

To advance the conversation about the relationship between pain and caregiver stress, let’s look at the effect of emotional expressions of pain on caregivers. A loved one experiencing pain can make caregivers feel powerless, hopeless to find a solution, anxious and uncomfortable.

Expressions of pain can place stress on caregiver relationships when verbal outbursts, hitting or throwing items become routine. Physical or verbal expressions of pain can help a person release their anger, but at what cost?

Unfortunately, many caregivers on the receiving end of these outbursts are afraid to say anything for fear of making the reaction worse. People in pain can become verbally abusive—their voice and the words they say become their weapons to attack others.

So instead, the caregiver says nothing or walks away because they don’t know how to respond. This non-response can be perceived as an agreement that the angry expression is okay when the opposite—the caregiver feels threatened and powerless.

Pain Damages Caregiving Relationships

An elderly parent or spouse who expresses pain through anger damages caregiving relationships. The path forward is to confront the pain, not the person.

Identifying the source of the pain, developing solutions, and implementing an action plan can reduce feelings of helplessness. Admittedly, this can be a long or frustrating process if healthcare providers struggle to identify the source of the pain, if suggested treatments don’t work as expected, or if battles with insurance companies become routine.

Caregivers may have to go through several doctors to find someone with the right skills who will listen and problem-solve. Identifying the root cause of the pain can be an elusive journey.

Taking time off work to attend medical and other appointments can be difficult. So there are many hurdles to overcome to solve the pain.

Let’s talk about pain and its effect on interpersonal relationships. Because the person in pain may be so consumed thinking about themselves and the pain, the caregiver must be brave enough to begin these conversations.

Conversation Starters for Angry Behaviors

Healthy caregivers may be unable to understand or empathize with the effects of pain on the body or mind unless. It can take research and education to learn about pain bo become empathetic.

Even still, empathy does not remove feeling threatened by an angry loved one. Here are several conversation starters:

  • I can’t imagine the pain you feel from X.
  • What I notice is that the pain makes you angry because you yell, throw things, and accuse me of not being a good caregiver
  • These behaviors make me uncomfortable, so we both have feelings about this.
  • You may not see our feelings as equally important because you believe your pain is worse. But I have feelings.
  • When your pain makes me feel this way, I don’t want to be around or care for you.

After saying one or more f these, be ready for the explosion. The person you care for may feel attacked, so their first inclination is to strike back.

They may cite the caregiver as being inconsiderate or make a long list of other accusations. My recommendation is to hold your reaction and consider that the foundation of anger is pain.

Conflict is an Opportunity for Personal Growth

relationship between caregiving and painPeople who respond emotionally in any situation have not learned to cope with pain or problems constructively or positively.

Responding appropriately to stress is a skill that can be learned and practiced to preserve relationships with others in the workplace, at home, and in social settings.

Likewise, dealing with conflict is a learned skill. Conflict and disagreements of opinion occur in every relationship because people are different.

When we look at conflict as an opportunity for growth, understanding, and improving communication skills, we can reframe the anxiety about the experience in a more positive light. To identify the relationship between pain and caregiver stress, we must examine the effects of anger and address the concern directly.

How we respond in high-conflict situations can escalate or raise emotions or have a calming effect.

Separate the Person from the Problem

Separating the person from the problem can help make the discussion more manageable. Look at pain and anger as contributors to emotions.

When you depersonalize the issue—the pain—it becomes easier to discuss. Remove blame and own feelings and actions. Eliminate excuses for why something—like improving pain—can’t happen.

When exploring the relationship between pain and caregiver stress being right is not the objective. The future of the relationship—if this relationship is important to you—is all that matters.

Compromise, collaboration, and having more patience than you feel you can extend are necessary. Being flexible to move past what each person wants to find common interests, like mutual respect and the ability to feel comfortable talking about difficult situations, is a starting point.

Emotional and Physical Connections to Anger

Another aspect that has gained more attention due to the isolation that occurred during COVID is loneliness. According to research by Powell at the University of Michigan in an article titled Unwelcome Companions, loneliness strongly predicts the development of pain, fatigue, and depression among older adults.

Feeling lonely can impact the relationship between pain and caregiver stress when you think about the mind-body connection. Family caregivers who devote their lives to care for a spouse or aging parent trade parts of their lives to provide care.

Caregivers experience isolation and loneliness. As a result, caregivers diagnosed with multiple chronic illnesses can feel angry. So until we look at the big picture of health, how health problems worsen, and the effects on the individual and the caregiver, we may face continual issues we don’t know how to solve.

So looking at the lives of caregivers and care receivers and thinking about the links between chronic disease and pain and loneliness, it’s important to emphasize that while caregivers feel that they have to take on all of the responsibility, this is not good for the caregiver nor is it for the care receiver.

Life Reflects Priorities

In care situations and other relationships, individuals can become isolated unless efforts to remain outer-focused continue. Relationships can become limited to the caregiver and care receiver.

Do you remember hanging around with friends? Eventually, you meet a boy or a girl, a man or woman with whom you want to spend time. But unless you commit and plan to see your friends, these friendships slowly disappear.

Life reflects priorities. How do you spend most of your time, and with whom? When you add anger and conflict to caregiving situations, these emotions can translate into co-occurring anger and frustration.

Life reflects focus and intentions. If being angry at another person or finding a way to hurt another person for the way they treated you is your priority, then your days will be self-destructive.

Individuals can become critical by blaming themselves for poor health or their caregivers for not doing enough. Feeling lonely can lead to depression, fatigue and pain.

Digging Out from Pain and Anger

Where is the motivation to become more active or exercise, which can be a solution to reduce pain? Motivation has to come from within. While it’s possible to motivate loved ones to take action, no one can force anyone to do anything.

Even though caregivers who try to do it all could benefit from support, the issue is similar. No one can force a caregiver to seek help, resources, or support, so if you are a caregiver before you pressure a loved one to take action, look at your situation and what you can do to help yourself first.

So these components – chronic pain, anger, loneliness, isolation, a lack of motivation, depression—all together become an endless spiral of poor health. A relationship with a spouse or aging parent who needs care can be like quicksand that pulls the caregiver down with them.

The relationship between pain and caregiver stress has a long-term effect on the health and well-being of the caregiver. Knowing this makes it imperative for caregivers to take the initiative to discuss health and expressions of anger or drown in their own pool of quicksand.

If you are a caregiver or care receiver who has been in this situation for a long time, you may be hesitant to take action to change the situation. Yet, your health and well-being depend on taking action.

Chronic Pain Affects the Relationship Between Pain and Caregiver Stress

Chronic health and pain are serious concerns connected to many aspects of life. People who work through pain research alternative means of treatment that include exercise, meditation, listening to music, cold packs, hot packs, pain patches or creams, stretching, TENS unit, cognitive therapy, or massage.

Being attentive to the body-mind connection is essential. As we discussed, it’s possible to work oneself up into a frenzy of worry and then be in more pain or become emotionally distraught and experience headaches or an upset stomach.

How many don’t sleep at night because of stress or worry? Pain interferes with sleep which is vital to manage depression, anger, and anxiety.

Sleep deprivation links to frustration, irritability, sadness, and anger. Sleep is the time for the mind and the body to rest.

Deep sleep helps the brain process emotions, memories, thoughts, and problems. As a caregiver, if you don’t get a good night’s rest, you may be more forgetful the next day.

Think of sleep as being similar to having a quiet day to yourself. When you have time for yourself, your brain and body recharge. As a result, you may respond calmly instead of becoming irritated when something goes wrong.

As you can see, the relationship between chronic pain and anger involves much more than meets the eye. Health is affected by so many aspects of life that may not seem related.

You love your job. You hate your job. You’re stressed about paying the bills, not having a reliable car to get to work, or taking a parent to the doctor. All of these outside effects affect the mind and the physical body.

family caregiver support programsWorry and anxiety can become a heavy weight that prevents problem-solving, investigating, and taking action to solve problems. Instead, people become stuck in negative, repetitive, or unproductive situations and don’t know how to initiate change.

We’ll discuss why making changes or problem-solving can be tricky on an upcoming show.

But for now, I hope considering the relationship between pain and caregiver stress gives you a starting point. Consider approaches to identify pain, anger and improve relationships that may be lopsided.

Looking For Help Caring for Elderly Parents? Find the Information, Including Step-by-Step Processes, in Pamela’s Online Program.

©2023 Pamela D. Wilson All Rights Reserved

About Pamela Wilson

PAMELA D. WILSON, MS, BS/BA, NCG, CSA helps caregivers and aging adults solve caregiving problems and manage caregiving needs through online programs, live support groups, and an extensive caregiving library that includes articles, podcasts, videos, and webinars.

   Check Out Podcast Replays of The Caring Generation® Radio Program for Caregivers and Aging Adults HERE

Pamela D. Wilson, MS, BS/BA, CG, CSA is an international caregiver subject matter expert, advocate, and speaker. More than 20 years of experience as a direct service provider in the roles of a court-appointed guardian, power of attorney, and care manager provides one-of-a-kind support for family caregivers and aging adults interested in taking steps to be proactive about health, well-being, and caregiving. Pamela may be reached at +1 303-810-1816 or through her website.


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