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Chronic pain is the leading cause of disability in the United States, affecting as many as 48 million people in this country alone. It can demoralize and depress both patient and family, especially when there is no effective pain control and no hope for relief. Improperly managed, chronic pain can lead to substance abuse (usually painkillers) and to acute psychological and emotional distress. Pain begets stress and stress begets pain in a wretched downward spiral. Silver reviews the causes and characteristics of chronic pain and explores its impact on individual family relationships and on the extended family, covering such issues as employment, parenting, childbearing and inheritance, and emotional health. Silver treats aspects of chronic pain not covered in a typical office visit: how men and women differ in their experience of chronic pain, the effect of chronic pain on a toddler's behavior or an older child's performance in school, the risks of dependence on and addiction to pain medications, and practical ways for relatives beyond the immediate family circle to offer help and support to the person in pain. (20040906)
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the harvard university press family health guides This book is meant to educate, but it should not be used as a substitute for personal medical advice. Readers should consult their physicians for specific information concerning their individual medical conditions. The author has done her best to ensure that the information presented here is accurate up to the time of publication. However, as research and development are ongoing, it is possible that new findings may supersede some of the data presented here. This book contains references to actual cases the author has encountered. However, names and other identifying characteristics have been changed to protect the privacy of those involved. Many of the designations used by manufacturers and sellers to distinguish their products are claimed as trademarks. Where those designations appear in this book and Harvard University Press was aware of a trademark claim, then the designations have been printed in initial capital letters (for example, Valium). Chronic Pain and the Family a new guide Julie K. Silver, M.D. harvard university press Cambridge, Massachusetts London, England 2004 Copyright 2004 by Julie K. Silver All rights reserved Printed in the United States of America Library of Congress Cataloging-in-Publication Data Silver, J. K. (Julie K.), 1965– Chronic pain and the family : a new guide / Julie K. Silver. p. cm. — (The Harvard University Press family health guides) Includes bibliographical references and index. ISBN 0-674-01505-3 (alk. paper; cloth) — ISBN 0-674-01666-1 (paper) 1. Chronic pain—Patients—Family relationships—Popular works. I. Title. II. Series. RB127.S499 2004 616′.0472—dc22 2004047527 This book is dedicated to my mentors, an eclectic group of very special people who have guided and inspired me both personally and professionally. I am blessed by and grateful for their presence in my life: Dorothy Arnold Diana Barrett Walter Frontera Lauro Halstead Marc Shell Contents 1 What Is Chronic Pain? 2 Effect on the Couple 1 20 3 4 5 Intimacy and Sexual Activity Work Issues Childbearing and Inheritance 35 45 57 6 7 Growing Up with a Parent in Pain Chronic Pain in Children 64 75 8 9 10 The Extended Family Emotional Changes and Depression Medication Dependence and Addiction 11 Diagnosing Chronic Pain Conditions 12 Traditional Treatment Options 13 Complementary and Alternative Medicine 86 95 104 118 124 139 Afterword 148 Appendix: Resources 151 Suggested Reading 155 Notes Acknowledgments Index 159 161 1