How to Manage Social Isolation, Loneliness, and Chronic Pain during COVID-19

By Dr. James Fricton

This article can help you prevent further spread of infection which in turn triggers more isolation. Our tips on managing isolation and loneliness are critical at this time when COVID-19 means we all spend more time alone.

Last month, the Center for Disease Control estimated that over 12 million people (3.6%) have tested positive for the Covid-19 virus and that 0.2%, or over 260,000 people in the U.S. have died from it.1 The current projections are for it may spread to the entire population if we do not participate in social distancing and masking.

Unfortunately, the fear of being infected by Covid-19, spreading the virus to others, social distancing, and quarantining has also lead to the unintended consequence of social isolation and loneliness. This particularly impacts individuals with a chronic illness such as chronic pain. This article explores the impact that social isolation and loneliness can have on our health and, specifically those with chronic pain conditions and suggest strategies to stay connected to others while still maintaining safety and social distancing.

How is COVID-19 Affecting People Experiencing Pain and Isolation?

Social relationships are central to human well-being and are critically involved in the maintenance of health.2-5 Social isolation reflects a lack of regular connection with other people that leads to loneliness and a dissatisfaction with the frequency and closeness of the social relationships that want to have. Studies have found that socially isolated individuals are at increased risk for the development of chronic illnesses including chronic pain, cardiovascular disease, infectious illness, cognitive decline, stress induced TMJ, and more.

Is it possible that loneliness and isolation could eventually kill someone?

In extreme cases of extended and severe times of loneliness, mortality through heightened inflammatory and metabolic responses to stress may result in death.6-14 It is far more common to trigger depression and exhaustion that may trigger a person slumping in poor posture who experiences neck pain or other physical symptoms.

How does a lack of one-on-one connections affect chronic pain?

Researchers have found that loneliness disrupts the fight-or-fight response. This leads to a decrease in protecting white blood cells, lower antiviral responses and increased inflammation, and are at greater risk for chronic pain, chronic illness and infection.

A study of 3,012 adults who were 45 years of age and older conducted by AARP found that 55 percent of the respondents who reported being in poor health were lonely, compared to 25 percent of respondents who reported being in very good to excellent health.11

The Jul 18, 2019 Pubmed Depression and activity-limiting fall worry among older adults: longitudinal reciprocal relationships article is co-authored by Namkee G. Choi, Ph.D.. It also reports that “13% of lonely respondents felt they have fewer deep connections now that they keep in touch with people using the Internet, compared to 6% of non-lonely respondents. Loneliness was a significant predictor of poor health, as measured by self-report and total number of diagnosed medical conditions”.

Seasons of Isolation and Loneliness Can Limit Life and Normal Activities

Data from the 2019 National Health Interview Survey found that “20.4% of adults had chronic pain and 7.4% of adults had chronic pain that frequently limited life or work activities (referred to as high impact chronic pain) in the past 3 months”. The November 2020 Chronic Pain and High-impact Chronic Pain Among U.S. Adults, 2019 article also reports that “126 million or 55.7% of all adults experienced a pain condition in the past year with 20.1% having daily pain and 31.8% experiencing severe pain”.

It’s co-authored by Jacqueline Wilson Lucas who summarized that: “Overall, the prevalence of chronic pain was 20.4%, and the prevalence of high-impact chronic pain was 7.4% (or 36.4% of adults who had chronic pain). Chronic pain was highest among women (21.7%), non-Hispanic white adults (23.6%), and those aged 65 and over (30.8%). High impact chronic pain was highest among women (8.5%) and those aged 65 and over (11.8%).

This creates a tremendous need for help with pain relief and is why our pain specialists offer diagnosis and healing pain solutions.

What does Loneliness and Isolation Trigger in our Physical Bodies?

People suffering with chronic pain such as fibromyalgia, myofascial pain, migraine, and neuropathic pain have an invisible illness that by its self can be isolating. When faced with the added loneliness and isolation from social distancing, chronic pain can increase. This lack of normal routines and daily human connection triggers an increased risk of stress, depression, and anxiety.

These stressors make pain worse because stress affects the peripheral nervous system by causing more muscle tensing and pain. It also makes the central nervous system more reactive and more anxious and tense, leading to more pain.

“Patients with chronic pain tend can feel as if they lost their sense of direction to life and empathy from others. They can be stuck in a pain cycle with significant stress, loneliness, and depression.” – Alfred Clavel MD, Pain specialist for Minnesota Head and Neck Pain Clinic and HealthPartners

What Social Distancing Factors Affect a Person’s Well-being?

Request help when social isolation and loneliness become too intense.

Social distancing escalates a person’s experiencing fear and worry about their own health and the health of loved ones in a state of being alone. Then in turn, when pain becomes chronic it is very difficult to share with others without it sounding like an exaggeration. The lack of normal social connections can directly influence a person’s overall sense of well- being.

With chronic pain, there is often a feeling of shame, guilt, and being not worthy of love and attention due to the pain. A person may experience rejection by others who do not want a relationship with someone who has the functional limitations, social burden and health care intensity of chronic pain.

“Pain is often the most debilitating component of many diseases. People can find a way to live with the other challenges of painful conditions like arthritis, cancer, even paralysis but if you actually ask the patient, their number-one concern, the one thing that they want us to cure, is the pain.” – Yves De Koninck, professor of neuroscience at Université Laval, Canada

What are the Symptoms of Painful Chronic Loneliness?

The symptoms of isolation’s negative impact on chronic pain are:

• It is more difficult to do daily activity such as exercise; further disability may result.
• An attitude of pessimism, self-blame and catastrophizing that life is over because of the misery of pain.
• A person’s diet and sleep patterns worsen.
• An increase in alcohol and drug misuse to compensate for fatigue.

One or more of the above symptoms may results in feeling tired and fatigued with low energy. Even the thought of getting dressed may feel exhausting before you even seeing others. The challenge of coping with the ups and downs of this pandemic creates even more stress and more pain. The pain cycle can continue for years.

The graphic above illustrates the pain cycle that may be fueled by isolation and loneliness from Covid-19. Fear and anxiety can lead to depression, anger, and, even, suicidal ideation. These negative emotions turn the volume up on pain leading to an increase in central and peripheral sensitization, muscle tensing, postural strain, and sensitivity to touch and movement.

What are Consequences of Forced Quarantine for Persons with Chronic Pain?

The social consequences of social isolation stress in those with chronic pain and illness include:

• Feeling misunderstood and miscommunication with others. Even if loved ones are supportive of those with chronic pain, feeling FRAIL is common. Even with the best of intentions, sometimes being surrounded by people who want to help but don’t understand what you’re going through, can feel even more alone.
• Fear avoidance of movement. It’s easy to feel that by resting, you are doing what is best for your body when it’s in pain, but this avoidance of activity has negative effects and contributes to the pain cycle. Patient’s often begin to fear that movement is going to worsen their symptoms, and so will avoid going out socially or engaging in activity. They may not be able to keep up with daily activities and expectations of those around you.
• Conflict and breakdowns in relationships. Maintaining relationships, whether romantic or platonic, when in chronic pain is challenging and complex. Seeing a loved one in pain and not knowing how to help can result in guilt and confusion. Not fully understanding an invisible illness can mean that loved ones may perceived the person with chronic pain negatively and not understand their actions.
• Unintentional avoidance of social connection. Often people with chronic pain cancel plans at the last moment due to a flare in symptoms, or say no initially due to other reasons, leading loved ones to feel that they are always going to say no, and so they stop inviting them. This can leave people with chronic illness feeling even more alone and often unwanted.
• Loss of employment. Work each day is often the glue of their social interaction. A lot of jobs involve interacting with colleagues, with customers or clients, and even chatting with people on the work journey. Pain of patients often find that going out to work can be too much, particularly as the vast majority are not being given the appropriate treatment and aren’t able to reduce their pain effectively. This robs them of this daily social interaction which so many people can take for granted.
• Financial struggles. Without being able to work, often pain patients are in debt or struggle financially. Finances play a part in almost every part of our lives. Without being able to afford transport a lot of social activities, it can feel really hard to engage with friends. Even for those with jobs, medical expenses can mount up and become troublesome.

Avoid becoming FRAIL: Feeling Rejected Alone Isolated and Lonely

COVID-19 and the forced quarantine can leave us FRAIL– Feeling Rejected Alone Isolated and Lonely. This may lead to more pain and fatigue. The lack of social stimuli may be the root of why some people blame negative thoughts and emotions to pain. They often overlook the experience of FRAIL as a major contributor, especially during the COVID pandemic.

Isolation and loneliness can cause a person to feel like their emotional and physical health are affected. Take action steps to stay healthy.

Being FRAIL turns the volume up on pain and delays recovery and leads to persistent chronic pain. FRAIL leads to feeling a lack of love and belonging to a social group, so you often feel as an outsider and are left alone. It makes one feel that there is little love, attention, and social support to help you through life. Chronic pain increases with more stressors, muscle tension, and the perceived sensitivity to pain.

Conversely, being a part of social activities with its shared love, empathy, and a feeling of belonging within social circles is an essential part of coping with pain.

Combating Negative Effects of Loneliness during Social Isolation

How to fare well during periods of time without human interaction?

Social connections and support are one of the most important and essential experiences in our lives to help us feel healthier, happier, more satisfied in life and recover from illness such as chronic pain. Like physical, cognitive, and mental health, we need to work on social health too.

Ways to Improve Relationships and Social Support during Isolation

How to keep loneliness from impacting a person’s positive outlook?

Ways to keep a positive outlook even during seasons of isolation:

• Love and be loved. Compassion, understanding, and love for others begin with self-compassion. This positive energy will be naturally extended to others and garner social support. Ensure that the relationship you have with yourself is a positive one. Work on recognizing your strengths and uniqueness and forgive yourself for your weaknesses, faults, and mistakes.
• Be kind and receive kindness. Simple acts of kindness can go a long way in developing good relationships. This may include saying “Good morning”, say “I love you” to someone you love, give away something you don’t need, stop for a pedestrian crossing the road, let drivers merge, bringing a treat to work, compliment someone on their clothing, send flower, write a kind letter, smile, and many others.
• Express gratitude. Be polite, courteous and appreciative when someone assists you in anyway.
• Trust and be trusted. The foundation of relationships is based on trusting that the relationship will not be hurtful. Without trust, most relationships wither and die. Trust is based on both self-honesty, honesty with others, and caring about the other person to not be purposeful hurtful.
• Have time for others. In turn they will have time for you. In our over-scheduled lives, the gift of time with people we care about is precious. Spend face-to-face time with the people you enjoy whether it is in person or on-line. Choose friends, neighbors, colleagues, and family members who are upbeat, positive, and interested in you and spend time with them. Go for a walk, meet for coffee, and visit a museum together. Be present in the time you give to people.
• Communicate and be understood. Communication occurs when someone understands you, not just when you speak. We assume that another person understands the message we are trying to get across but this is not always the case. Poor communication and being misunderstood can lead to a culture of conflict, blame, confusion, and stress. When having a conversation, listen and be heard and ask if the listener understands.
• Listen and be heard. A key to developing supportive relationships is to be a good listener who listens without a pre-existing agenda. A good listener listens to the feelings behind the words and does not interrupt, judge, or criticize. Active or reflective listening is the single most useful and important listening skill. Active listening suggests that we are genuinely interested in understanding what the other person is saying, thinking, feeling, wanting, and the message behind it. Respond with our own new message by restating or paraphrasing an understanding of the message for verification. Keep comfortable eye contact (where culturally appropriate), let the other person speak without interruption, keep an open, non-defensive relaxed posture, avoid distracting gestures, such as fidgeting with a pen, glancing at papers, tapping feet or fingers. Mutes phones and other communication devices to ensure that we are sincerely interested.
• Give and take feedback. Feedback is the fuel for progress and it usually good for us in the long term. It can help us to tap into our personal potential and develop mutually beneficial honest relationships. Feedback is free information that we can choose pay attention to, react to or ignore. It can help us see a blind spot and get a different perspective. Learn to give and receive positive and negative feedback. But, the ability to provide constructive feedback to others is an art form. In providing feedback, be gentle not brutal. Truth can be presented in a positive or negative manner.
• Be helpful and be helped. When we do something that helps others, this will also have a beneficial effect on how you feel about yourself. The meaning and purpose in helping others can provide positive energy and expand your own life. There is no limit to the opportunities available to help in schools, churches, nonprofits, charitable organizations, and with families and friends.
• Respect uniqueness and be unique. Everyone is unique. When we build relationships, there often is a desire or expectation that people will think like we do and, if so, it seems easier to create a rapport. We feel more comfortable when we feel that people understand us and can see our point of view. If we were all the same, life would be dull. While we may find it initially easier, the novelty of sameness soon wears off. Allow people to be different and appreciate their differences. Accept and celebrate our uniqueness.
• Learn to show and receive empathy. People may forget what you said, and forget what you did, but will never forget how you made them feel. Empathy and understanding of another person’s feelings will build the relationship. Empathy is the state of perceiving and relating to another person’s feelings and needs without blaming, giving advice, or trying to fix the situation unless they ask. Empathy also means “reading” another person’s inner state and interpreting it in a way that will help the other person and offer support and develop mutual trust.
• Recognize and respect comfort zones. Everyone has comfort zones that when encroached, can disrupt a relationship. Be aware of how close people stand next to you and how comfortable they are with physical contact. This is all the more important during a social distancing mandate. Look at the person who is talking for sincere eyes, facial expressions, and smiles. Study body positions to pick up on postures, gestures, and cues that suggest a person is comfortable or not. When person sits or stands comfortably with open arms, welcoming gestures and good eye contact, they are happy to be with you.
• Recognize and respect personal boundaries. Everyone has boundaries such as how much of a person’s personal life they reveal or mistakes they have made. Boundaries need to be respected and not pushed until a person is ready. This often depends on the trust level already established in the relationship.
• Deal with conflicts. Most conflicts with other people are a normal part of everyday life. Conflicts can offer an opportunity to not only learn about yourself and others, but when resolved, can enhance the relationship. Resolving conflict in a win-win situation is best for all parties in the conflict. Listen to the other person and confirm your understanding of the issue. Express your feelings about the situation and offer positive ways to move forward. If you cannot resolve the conflict on your own, ask a friend, family member, or colleague to help with it. If the conflict is simply a difference of opinion, accept it and move on. However, if the conflict involves verbal, physical, or sexual abuse, you need seek care with appropriate professional help.
• Nurture close relationships. When building positive relationships, it is important to act in a respectful manner. Be respectful to your co-workers by listening to their positions and responding in a professional manner. Respect yourself by staying in control of your emotions and using your best judgment when working towards conflict resolution with co-workers. For example: If you are having a disagreement with a co-worker, take a few deep breaths before responding or agree to discuss the issue at a later time so that you can walk away from the situation and come up with an appropriate, professional response.

The connection we make with other people is the essential touchstone of our existence. Positive human relations improve chronic pain levels and protect us from negative feelings that escalate chronic illnesses. As Maya Angelou stated; “People may forget what you said but they will never forget how you made them feel.”

Do you make the people around you feel good about being with you? When we devote time, energy, and effort in developing and building supportive relationships, we keep loneliness from weakening our positive outlook. Instead, we learn the most valuable skill in our life is building positive relationships.

Ease Chronic Pain with Self-care during COVID-19 Isolation

What are the most important action steps to take during isolation?

Each person with chronic pain needs an Action Plan to follow each day to reduce the social risk factors that drive chronic pain and becoming FRAIL. You need to evaluate your social groups and relationships, and then cultivate togetherness and harmony with family, friends, and colleague. Both show and receive love and caring for yourself and others.

Action Steps to Combat Loneliness and Chronic Pain during Covid-19

Social activities do not need to cost a lot of money or involve crowds. Arrange to go for a walk, meet at a free museum or even visit your loved one’s house rather than go out.

Conclusion

Chronic pain can leave us FRAIL with Feeling Rejected Alone Isolated and Lonely. Social connections are one of the most important and essential experience in our lives to help us feel healthier, happier, and more satisfied in life. When elective, in-person patient visits or meetings have to be suspended, our telemedicine services are ideal.

Check MN Head & Neck Pain Clinic’s COVID-19 Policy; you’ll feel confident that we are doing our best to keep you safe while seeking help for chronic pain.

Call (763) 577-2484 or Schedule a Clinic Visit

About the Author

James Fricton DDS, MS, co-founder of the MN Head and Neck Pain Clinic, takes great joy in helping patients with simple to complex head, neck, orofacial, and TMJ pain conditions as well as obstructive sleep disorders. He also founded and runs pactforpain.com.

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