Living a Healthy Life with Chronic Pain (30 page)

To learn more about the topics discussed in this chapter, we suggest that you explore the following resources:

Caudill, Margaret A.
Managing Pain Before It Manages You
. New York: Guilford Press, 2009 (especially
Chapters 8
).

Feldman, William.
Take Control of Your Health: The Essential Roadmap to Making the Right Health Care Decisions
. Toronto; Key Porter Books, 2007.

Hadjistavropoulos, T., and Heather D. Hadjistavropoulos (eds).
Pain Management for Older Adults. A Self-Help Guide
. Seattle, Wash.: IASP Press, 2008 (see
Chapters 9
).

Jones, J. Alfred, Gary L. Kreps, and Gerald M. Phillips.
Communicating with Your Doctor: Getting the Most Out of Health Care
. Cresskill, N.J.: Hampton Press, 1995.

E
NJOYING A LOVING RELATIONSHIP WITH PHYSICAL INTIMACY
and sexual pleasure is a basic human need. However, many individuals and couples with chronic pain problems find it challenging to maintain this important part of their lives. Fear of causing more pain or injury, worry about being unable to perform or of rejection by a partner, or just plain disinterest can interfere with healthy sexuality. Sex, after all, is supposed to be joyful and pleasurable, not a cause of worry, discomfort, and pain.

If you have these worries or feelings, you are not alone. About one-half to two-thirds of people with chronic pain report significant reduction or loss of sexual functioning because of pain or its treatment. Of course, sex is more than the act of sexual intercourse or achieving orgasm; it is also the sharing of our physical and emotional selves. We enjoy a special intimacy when we make love. Believe it or not, having
a chronic pain problem may actually offer the opportunity to improve your sex life by encouraging you to experiment with new types of physical and emotional stimulation. This process of exploring sensuality with your partner can open communication and strengthen your relationship. Furthermore, when we are sexually active, natural “feel-good” hormones, including endorphins, are released into our bloodstream. These help us achieve a deep sense of relaxation and a feeling of well-being. They may even provide pain relief, at least temporarily, by closing the pain gate.

For many people with chronic pain, intercourse is difficult because of the physical demands. It increases heart rate and breathing and can tax someone with reduced energy due to fatigue, poor sleep, and stress. Intercourse can also be physically uncomfortable by placing strain on muscles, tissues, and joints that may already be hurting or sensitive to touch. For these reasons, it may be more satisfying to spend more time on sensuality or foreplay and less on actual intercourse. By concentrating on ways to give pleasure to your partner in a relaxed, comfortable atmosphere, your intimate time together can last longer and be very satisfying. Many people enjoy climax without intercourse; others may wish to climax with intercourse. For some, climax may not be as important as sharing pleasure and time together. There are many ways to enhance sensuality. Because our minds and bodies are linked, we can increase sexual pleasure through both physical and mental stimulation.

Emotional concerns can also be a serious factor for people with chronic pain conditions. Someone with angina may be concerned that sexual activity will bring on another attack. People with migraine headaches may worry that climax may trigger an episode. People with neck, back, or joint pain may be anxious that sex will spike their pain if they happen to move the wrong way. Their partners may fear that sexual activity might cause these problems and that they would be responsible. Some conditions such as diabetes or just normal aging can make erections difficult or cause vaginal dryness. These worries can certainly hurt the relationship.

Loss of self-esteem and a changed self-image can be subtle and devastating sexual barriers. If pain has left you physically changed, unemployed, or not able to contribute to your home life the way you used to, you may think of yourself as unattractive or undesirable to your partner. Thinking this way can damage your sense of self, which could cause you to avoid sexual or intimate situations; you “try not to think about it.” Ignoring the sexual part of your relationship or physically and emotionally distancing yourself from your partner can lead to isolation and depression, which in turn leads to lack of interest in sex and more depression—a vicious cycle. (For more on depression and how to help yourself overcome it, see
Chapters 4
. If self-management techniques are not enough, talk to your doctor or therapist.)

Even good sex can get better. Thankfully, there are ways you and your partner can explore sensuality and intimacy, as well as some ways to overcome fear during sex.

With a condition like chronic pain, you probably worry that your pain will get worse and spin out of control. Fear and anxiety can really get in the way of the activities that you want and need to do. When sex is one of those activities, you face a difficult problem. Not only are you denying yourself an important, pleasurable part of life, but you probably also feel guilty about disappointing your partner. On the other hand, your partner may feel more fearful and guilty than you do. Your partner may be afraid he or she might hurt you during sex, or feel guilty for feeling resentful due to lack of sex. This dynamic can cause serious relationship problems. The resulting stress and depression can produce even more symptoms. You don’t have to allow this to happen!

For successful sexual relationships, the most important thing is communication. The most effective way to address the fears of both partners is to talk about your concerns openly and find ways to alleviate them through good communication and problem solving. Effective communication will not only help you and your partner explore your fears and desires about sexuality, it will lead you to new ways of expressing intimacy. This is particularly important for people who worry about how their pain and other health problems may make them look physically to others. Often they find that their partner is far less concerned about their looks than they are.

When you and your partner are comfortable with talking about sex, you can go about finding solutions to your concerns. Start by sharing
what kinds of physical stimulation you prefer and which positions you find most comfortable. Then you can share the fantasies you find most arousing. It’s difficult to dwell on fears and worries when your mind is occupied with a fantasy.

Get started by reviewing the communication skills in
Chapters 10
and the problem-solving techniques in
Chapters 2
. It takes really good communication and problem-solving skills to discuss sexuality openly and sort out your different needs. Remember, if these techniques are new, give them time and practice. As with any new skill, it takes patience to learn to do them well.

In our society sexual attraction has become almost solely dependent on the visual experience. This leads to an emphasis on our physical image. Sight, however, is only one of our five senses. Therefore, when we think about being sensual, we must also consider the seductive qualities of our partner’s voice, scent, taste, and touch. Sensual sex is about connecting with our partner through all the senses, making love not only with the eyes but with our ears, nose, mouth, and hands as well.

Sensual touch is particularly important because the largest sensual organ of our bodies is the skin. The right touch on almost any area of our skin can be very erotic. Fortunately, sexual stimulation through touch can be done in just about any position and can be enhanced with the use of oils, flavored lotions, scents, feathers, fur gloves—whatever the imagination desires. Just about any part of the body is an erogenous zone. The most popular are the mouth, ear lobes, neck, breasts and nipples (for both genders), navel area, hands (fingertips if you are giving pleasure, palms if you are receiving pleasure), wrists, small of the back, buttocks, toes, and insides of the thighs and arms. Experiment with different types of touch—some people find a light touch arousing; others prefer a firm touch. Many people also become very aroused when they are touched with the nose, lips, and tongue. Even sex toys can play a part.

Some chronic pain conditions can cause hypersensitivity to even light touch. It is especially important that you determine what type of touch is pleasurable for you and what is not. Then talk to your partner about this. By working together you should be able to find ways to increase sensual pleasure and decrease your fear and anxiety about being touched in the wrong places or in the wrong ways.

If you decide that you wish to abstain from sexual activity because it is not an important part of your life, that’s okay—but it is important that you discuss this decision with your partner. Good communication skills are essential in this situation, and you may even benefit from discussing it with a professional therapist present. Someone trained to deal with important interpersonal situations can help facilitate the discussion.

Sometimes people are unable to find a sexual position that is completely comfortable. Other times, pain, fatigue, stress, or even negative thoughts (self-talk) during sex are so distracting that they interfere with your enjoyment of sex or your ability to have an orgasm. This can pose some special problems. If you are unable to climax, you may feel resentful of your partner. If he or she is unable to climax, you may feel guilty about it. If you avoid sex because you are frustrated, your partner may become resentful and you may feel guilty. Your self-esteem may suffer. Your relationship with your partner may suffer. Everything suffers.

One thing you can do to help deal with this situation is to review your medications. It may be important to take a pain medication for example so it is at peak effectiveness when you are ready to have sex. Of course, this involves planning ahead. The type of medication may be important too. Such medications as narcotic-type pain relievers and some antidepressants can reduce interest in sex or inhibit sexual functioning. Your doctor may be able to reduce the dosages of these drugs or prescribe other medications that are effective for treating pain and other symptoms but have less effect on sexuality. Drugs such as muscle relaxants may also muddle your thinking, making it more difficult to focus. Alcohol and marijuana (cannabis), which are used by some people to reduce pain, can also impact sexual functioning. Some medications can make it difficult for a man to achieve an erection; others can help with an erection. Likewise, there are water-based lubricants that can help with vaginal dryness. Ask your doctor, nurse practitioner, or pharmacist about timing of your medications, and alternative medications,
as well as medications to help with other concerns such as erection or dryness.

Another way to deal with uncomfortable symptoms is to become an expert at fantasy. To be really good at something, you have to train for it, and this is no exception. The idea here is to develop one or more sexual fantasies that you can indulge in when needed, making it vivid in your mind. Then, during sex, you can call up your fantasy and concentrate on it. By concentrating on the fantasy or picturing you and your partner making love while you actually are, you are keeping your mind consumed with erotic thoughts rather than your symptoms or negative thoughts.

If you have not had experience with visualization and imagery techniques, you will need to practice several times a week to learn them well. All of this practice does not need to be devoted to your chosen sexual fantasy, however. You can start with any guided imagery tape or script such as the ones in
Chapters 5
, working to make it more vivid each time you practice.

Start with just picturing the images. When you get good at that, add and dwell on colors. Then listen to the sounds around you. Then concentrate on the smells and tastes in the image, and feel your skin being touched by a breeze or mist. Finally, feel yourself touch things in the image. Work on one of the senses at a time. Become good at one scene before going on to another. Once you are proficient at imagery, you can invent your own sexual fantasy and picture it, hear it, smell it, and feel it. You can even begin your fantasy by picturing yourself setting your symptoms aside. The possibilities are limited only by your imagination.

Learning to call on this level of concentration can also help you focus on the moment. Really focusing on your physical and emotional sensations during sex can be powerfully erotic. If your mind wanders (which is normal), gently bring it back to the here and now.