Chronic pain is seldom life-threatening, but is marked by its lengthy duration (at least six months to qualify for the designation “chronic”) or frequent recurrence over a long period. There may be a slow progression of severity, persisting over time, with no easily definable beginning, middle or end. Chronic pain has the potential to negatively affect a person’s family relationships, emotional well-being, friendships, occupation and leisure time – as well as having a direct financial impact. The solitary experience of chronic pain can diminish a person’s role within the family physically, emotionally and psychologically, and often results in a reduced sense of self-worth as sufferers reduce their activities to focus on their physical state, experiencing multiple vague symptoms.3
The idea of “family resilience” (or hardiness), as a means of managing chronic pain, highlights the potential for family, relationship or social support in this process. Although the application of this model of care may involve professionals – such as nurses or health visitors – it is not difficult to see how its basic principles can be adapted to self-application.4 The key feature is identifying and building on perceived relationship strengths (see list opposite), rather than focusing on deficits, encouraging greater resourcefulness in facing immediate and long-term challenges.
The successful ability of a family (or couple or social group) not just to cope with, but to weather crises together and emerge stronger and more resourceful, is the basis of family resilience. This approach focuses on the influence of positive relationships between people.
Research indicates that all families have strengths, and that by building on these the adverse effects of chronic pain can be reduced. This approach supports the re-establishment, or reinforcement, of communication between family members (or couples) and, by placing an emphasis on strengths, helps to shift the focus away from the problem of pain. A family resilience model of chronic pain management does not suggest that people will always “bounce back”, untouched by their experiences; rather it proposes focusing on what works, instead of just looking at their problems.5
IDEAL FAMILY RESILIENCE CHARACTERISTICS
Your task is to identify which of the main family resilience (hardiness) attributes and resources you can draw on, and to encourage and work with these. Aim to develop those that aren’t present, perhaps using some of the varied exercises and suggestions outlined later in this book.
• A positive outlook: sense of humour, confidence, optimism. Spirituality: values that are shared with others that may offer meaning to the situation, the stressors and the pain.
• Accord: avoidance of conflict; a sense of cohesion.
• Flexibility: the ability to adjust and modify family or relationship roles depending on circumstances.
• Communication: the ability to express feelings and emotions openly; collaborative problem solving – “you are not alone”.
• Financial considerations: maintaining family warmth, despite possible economic pressures.
• Mutual family/relationship time
• Shared recreation
• Routines and rituals: the personal, private, internal activities of couples and families that can be encouraged in order to promote closer relationships.
• External support: networks of condition-specific contacts, shared resources, internet chatrooms, social networking websites.