Pain Recovery for Families. Robert Hunter

exhausted, or just annoyed. This became a source of great friction for them.

       THE COMPASSIONATE BRAIN

      We also know that our brains are wired to react empathetically when someone else is in pain. A study was conducted where people were shown videos of a person experiencing pain. Brain scans revealed that the same areas of the brain “light up” in the person who is watching someone in pain as in the person who is experiencing the pain. Literally, we feel another’s pain. And this empathetic reaction is much stronger when the person in pain is a family member. So it is only natural to develop enabling behaviors when a loved one is in pain. It is our innate response to feel another’s pain and to want to do something to help, but it is just those solicitous or enabling behaviors that make the pain worse.

       Reinforcing pain causes more pain; reinforcing function enhances function.

      When Amy cried with her pain, it would break Chris’s heart. He didn’t think he could stand it. He often gave her medication before it was due (he had confiscated her medications in an attempt to control her drug use), even though she appeared to be “loaded.” He simply couldn’t tolerate the feelings that came up when he witnessed her suffering. What would happen if he didn’t give her the meds? He didn’t want to find out.

       {exercise} 2.4

       Enabling Responses ___________________________________________

      You may be unknowingly responding to _____________’s pain in ways that make the pain worse. This exercise will help you identify ways in which this may be occurring.

      Please complete the following sentences with the first response that comes to mind.

      1. I can tell when _______________ is in more pain because

      2. When I know his or her pain is getting worse, I usually

      3. When it’s time for _______________ to take more pain medication, I usually

      4. If _______________ tells me he or she is hurting more, I tell him or her

      5. If I want to go out to dinner or some other activity and _______________ says he or she is in too much pain to go, I usually

       Secondary Gain: A Hidden Obstacle to Recovery

      Secondary gain is a psychiatric term that means any hidden reason that is motivating a person to hold onto an undesirable condition or problematic behavior. Here it can refer to any perceived benefit _______________ receives from having pain, or it can refer to any perceived benefit you receive from _______________’s pain. If not identified, secondary gain can cause you to unconsciously hold onto unhealthy behaviors. This does not mean _______________ is pretending to hurt for these benefits, or that you want him or her to remain in pain, just that the benefits are making the pain rewarding in some ways and thus more complicated to treat.

      Some examples of secondary gain that might result from having chronic pain are listed below. Check those that apply to _______________.

      _____ Receiving more attention.

      _____ Not having to work.

      _____ Being excused from responsibilities.

      _____ Being on disability—essentially, being paid to be in pain.

      _____ Getting out of activities.

      _____ Having an excuse to take pills.

      Some examples of secondary gain that might result from caring for someone with chronic pain are listed below. Check those that apply to you.

      _____ Giving you a sense of purpose and meaning in life.

      _____ Being the hero/caregiver/helper/rescuer (having someone who rewards your need to be needed).

      _____ Being able to “people please.”

      _____ Being in more control or having more power in the household.

      _____ Getting you out of the house, since you have to work to support family.

      _____ Being the major breadwinner.

      _____ Receiving disability benefits that help support the family.

      _____ Expecting a large financial windfall from a lawsuit due to injuries.

      _____ Reinforcing your sense of being a martyr/victim, fulfilling a need from early childhood.

      When you become aware of them, you may view secondary gain as deserved compensation for the challenges you are experiencing. These thought processes may be conscious but are usually totally unconscious. Either way, if these beliefs remain unexamined, they will interfere with your ability to improve your situation. Taking inventory of secondary gain you and _______________ may be experiencing, and examining your attitudes about this, is an important step in moving toward balance.

       {exercise} 2.5

       Identifying Secondary Gain ____________________________________

      List all the real and perceived benefits you have ever received from _______________ having chronic pain. Be sure to include the things you get, as well as things you were or are able to avoid. One example of each is provided for thought.

      PHYSICAL {example: I do not have to be involved in activities I never really liked because _______________ can’t do them now.}

      MENTAL {example: Since _______________ is out of it most of the time, I can speak my mind more freely.}

      PEMOTIONAL {example: I can avoid emotional intimacy.}

      FAMILIAL (Include emotional as well as specific household or practical responsibilities.) {example: I am in charge of what happens around here.}

      SOCIAL/WORK LIFE {example: Just like I always wanted, I have to go to work. What a relief!}

      SEXUAL {example: He’s in too much pain for physical intimacy, so I don’t have to do that anymore.}

      It’s important to look closely at secondary gain, as the perceived benefits might not be as attractive as you believe. Most of the time secondary gain is not gain at all, but loss. Chronic pain sufferers and their families often inadvertently buy into the concept of secondary gain without looking at primary loss.

       {exercise} 2.6

       Examining Secondary Gain ____________________________________

      Go over the list of examples of secondary gain you identified and take a minute to look at what is actually going on. Write about your observations.

      Most people find they are just stuck and afraid to move forward. Once you walk through this fear, you will find you gain much more by a return to normalcy in your life.

      Looking back, Chris couldn’t say