Consequences of chronic pain

Sleeping problems

Approximately 50-80 % of people with chronic pain have ongoing sleeping problems. When trying to fall asleep we eliminate all distractions (e.g. light, sounds etc.) so that we can relax, but this can be problematic because all that's left to focus on is the pain, which increases our pain perception. Worrying about the pain and not being able to fall asleep often makes it even harder to relax, which creates a negative circle.

Another common problem is that the quality of sleep tends to be lower among those with chronic pain. It may be difficult to find a comfortable sleeping position, and lying still for too long may cause aches and stiffness. People with chronic pain often experience less deep sleep, wake up more frequently during the night, and don't feel as refreshed when they wake up in the morning.

Sleeping problems often lead to fatigue, irritability and mood swings, stress our nervous system, and affect our cognitive functions, e.g. thinking, reasoning and decision making. All of this makes it a lot more difficult for us to manage and cope with the pain. Not only does this lead to more pain - it can also lead to feelings of sadness, worry, hopelessness, anxiety, or even depression. Inevitably, this will affect our sleep even more, thus creating a negative circle that can be difficult to break.

If you experience sleep disturbances, the first step is to change your sleep habits. Here is a list of suggestions, but feel free to come up with others that work for you.

Try to calm down/relax for at least an hour before going to bed (this eases the transition to sleep), e.g. no screen time, a warm bath, read a good book, dim the lighting, a warm cup of tea...
Create bedtime routines - with time, your body will associate them with sleep.
Stretch, relax, or take a warm bath before bedtime.
Drink warm milk or herbal tea an hour before going to bed.
Exercise early in the day, but not within 4-6 hours of bedtime.
If you're worried/anxious or have thoughts that you can't let go of, write them down so that you can deal with them the next morning instead.
Try to go to bed and wake up at the same time every day.
Do breathing exercises to activate your parasympathic nervous system.
Try relaxation exercises, guided meditation, or visualizing something peaceful.
Make a playlist with relaxing songs or sounds (you can set the timer on your cell phone so the music stops playing after you've fallen asleep).
Listen to soothing sounds, eg ocean waves or raindrops (I love the app "Relax melodies")
Turn your bedroom into a place where you WANT to relax, e.g. lots of pillows, a fluffy duvet, fresh linens, aroma oils.
Buy a high quality mattress.
Use body or neck pillows to provide support.
Lower the room temperature.
Avoid caffeine (especially in the afternoon/at night) and don't eat heavy meals too close to bedtime.
Quit smoking (!!)
Try using a heavy blanket.

If nothing seems to help, contact your doctor. Severe sleep problems can be treated with medication and/or cognitive behavioral therapy.

Depression and mental illness

There is a strong link between chronic pain and depression. Studies show that people with chronic pain are 3 times more likely to develop psychiatric symptoms, and that approximately 60-85 % may suffer from severe depression. In many cases, depression and anxiety are a result of the pain and its consequences, e.g. not being able to work or do meaningful activities, fatigue, the lack of a social life, sleeping problems, stress, feelings of hopelessness, and worrying about the future. However, people with clinical depression also have 3 times the average risk of developing chronic pain.

Having both chronic pain and mental illness unfortunately leads to worse treatment outcomes and a poorer long-term prognosis. Depression and anxiety often increase and intensify the pain and affect a person's ability to manage it. The increased pain then aggravates the severity of the depression, leading to a vicious cycle that can be very hard to break.

There also seem to exist physiological associations between chronic pain and depression. Several studies have shown that there are many similarities in how the two disorders affect the nervous system. In other words, the changes in the nervous system that are caused by the chronic pain may also worsen the depression, and vice versa.

It is not always easy to differentiate between depression and chronic pain since many of the symptoms are the same, for example sleeping problems, loss of appetite, fatigue, and feelings of hopelessness and helplessness. In order to make a good assessment of the situation, it is crucial that your physician knows about your chronic pain.

There are many ways to treat depression, the most commonly used ones being counselling and medications. Most drugs that are used to treat psychiatric symptoms (e.g. antidepressants and anticonvulsants) can also serve as pain medication. In pain rehabilitation centers, depression and chronic pain are usually treated together.

For more information, check out these two links:

https://www.health.harvard.edu/mind-and-mood/depression-and-pain

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494581/

Dyspareunia (pain during sex)

Pain during sex (dyspareunia) is very common in women with endometriosis. Penetration (especially deep penetration) can pull or stretch endometrial growths and/or adhesions around the uterus and behind the vagina. The pain often gets worse with increased intensity and duration of the intercourse. The pain isn't always continuous but can depend on the sexual position, the phase of the menstrual cycle, how aroused the woman is, etc. A lot of women experience pain for several hours or even days after sex. Vaginal dryness, which is a common side-effect of hormone treatments, can also cause pain during sex.

Dyspareunia often affects a person's sexuality and can cause tension in a relationship. It tends to lessen your desire to have sex or to be intimate with your partner. The pain (as well as the strain on the relationship) can cause anxiety and feelings of shame or guilt, all of which can increase the pain.

How do you improve your sexual life when you experience pain during sex?

Talk to your partner and explain what dyspareunia is so they understand your situation better. This will help you relax a little, and you can discuss how to avoid or minimize the pain.
Don't skip the foreplay! It increases lubrication and your sexual arousal and helps you relax, all of which decreases the pain.
Use lubrication if you experience vaginal dryness.
Try different positions and see what works best for you. Positions where penetration is shallow or where you have control over the depth often hurt less.
Think about the timing, eg. if the pain usually gets worse around your period, you might want to avoid sex during that time.
Experiment with other kinds of sex instead of just penetration.
Don't be afraid to tell your partner if you experience pain. If you continue doing something that hurts (especially for a long time), you are more likely to experience pain that lasts several hours or days.