Chronic pain changes everything in life, most entirely invisible to outsiders. Many people do not seem to understand chronic pain or just how extensive its effects are, how exhausting always being in pain is, how displacing and uncertain, nor how hard that pain makes it to concentrate and think.

They cannot see that sufferers have attempted numerous treatments, approaches and alternative therapies to heal and manage that pain, and know what therapies have worked or not worked for them. While the depth of loss and longing for our lives before it began becomes as constant as the pain is.

Life with chronic illness and pain is so vastly different to that of healthy people. Every single act must be weighed against the pain, rest, recovery, and pacing is a constant evaluation too. There are so many considerations healthy people do not have, alongside symptoms themselves, the attitude of others, as well as our own complex inner feelings.

The chronic pain patient wants those around them to empathize with their situation rather than be sympathetic, to have understanding, not pity, though sadly, understanding can be extremely rare. Not that there aren’t compassionate souls who support us but because the ‘pain experience’ is hard to grasp.

In the spirit of informing those who wish to understand, here are some things that can enable you to do just that to help people who suffer from, often debilitating, chronic pain:

For those living with chronic pain, one of the greatest challenges is in dealing with attitudes, from our own attitude towards the pain and our personal situation to those from family, friends and sometimes even complete strangers. Our attitude is important as it deeply influences the efficiency of the coping strategies which evolve and determine our ability to function well in spite of pain.

Yet for almost everyone whose lives have been so drastically altered by chronic pain, the attitudes of others can be an ongoing challenge. Most people have experienced pain at some time in their lives and that pain would have likely been caused by an obvious event or condition, but even if it was intense pain, would have abated and eventually settled.

This experience will determine their attitude towards pain but unless the pain was prolonged for at least a few months or more they will have an inadequate idea or appreciation of what it is to live with chronic pain, and no matter how empathic, will not truly grasp the full, unimaginable nature of the situation, much less what it is to never know if the pain will ever end.

Worse still, people with the regular aches and pains of ageing assume that they know what it is like but unless the pain is severe enough to completely dismantle the person’s life, it is far from the same experience, physiologically or emotionally

Chronic Pain Sufferers Talk Differently from Those Not in Pain

Chronic pain sufferers often talk differently from those free of constant pain, many people forget that after many years of pain, we just want to appear normal — so we modify our behavior, and avoid letting people see just how much pain we are really in.

A numeric pain scale is used as a quantitative measure to identify pain intensity for medical professionals, with description of pain being on a scale from 1 to 10 (1 being “no pain at all” and 10, the “worst pain ever felt”).

After many years of chronic pain and despite it often worsening, this scale may change and shift, instead being more reflective of individual tolerance to ongoing pain, especially in progressive conditions; what was once an “8” is now a “6” for instance — people can only measure pain against the most pain they have experienced.

Yet as for most this was acute pain, a different physiological process, and even if severe, still brief when compared to constant pain of CRPS for example or that of central sensitisation, which occurs in many complex pain conditions including Fibromyalgia, making such subjective understanding by those without chronic pain all the more difficult.

Never assume the chronic pain patient is not experiencing pain when they say that they are fine.

Hiding the pain due to lack of understanding in others, protecting others (from feeling uneasy or helpless, after all, no one likes seeing someone they care for in pain), or just to fit in is a natural response to ongoing pain. Accept that words are often inadequate to articulate how the chronic pain sufferer is feeling.

Recall a time when you were in pain, then multiply the intensity and try to imagine that pain is present twenty-four hours a day, every day, without any relief in sight. It’s hard to find the words for that kind of pain or experience.

Respect the Chronic Pain Sufferer’s Physical Limitations

With chronic pain and invisible illness the uncertain nature of our fluctuating symptoms is as confusing to us as patients as it is those around us. Our mobility, pain levels and ability to cope with movement can be erratic, unpredictable, and frustrating for all involved.

Every pain patient does not know, from day-to-day, how they are going to feel when they wake up and each day has to be taken as it comes. In many cases, they don’t know from minute to minute. This is one of the hardest and most frustrating components of chronic pain. Using pacing for pain management is paramount but even with the most meticulous planning, sometimes the pain flares or is just too fervent.

Being able to stand up for three minutes doesn’t necessarily mean we can stand up for twenty minutes, or an hour, or give you a repeat performance.

Just because we managed to sit up for an hour yesterday, does not mean we are able to do the same today.

Understand the Difference Between Happy & Healthy

When you have a nasty bug or an injury that suddenly hampers your life, you may feel frustrated and miserable. Chronic pain patients have experienced pain from 6 months to many years, even decades, without a break. That changes you. It changes how you respond to the pain, as well as how much and how well you hide it.

Pain has caused us to adopt coping strategies that do not necessarily reflect the real level of pain we are feeling. When we see our loved ones, we are happy. Happy is not the same as healthy but we choose to hide our pain and suffering, for others as well as ourselves. Sadly we are often misjudged for it, especially when they rarely see how excruciating and debilitating the consequences are afterwards.

Many struggle to believe you can be in severe pain if you are happy, laughing or simply not voicing the pain in the same way someone without chronic pain would expect, but voicing it does nothing for the pain, in fact focusing on it can make it worse, and only serves to make others feel uncomfortable. Laughter is also one of the most enjoyable ways to manage it and cope. Chronic pain and illness has already taken away so much, stripping our lives to their barest bones. Respect that the person who is in pain is trying their best. Associating illness with exclusively feeling unhappy or thinking it impossible to be in pain and still find joy is a great source of misunderstanding. When someone living with chronic pain says they are in pain—they are in pain. They are merely coping, sounding happy and trying to look normal.

Be Patient

If you’re impatient or want someone with pain to “just get on with it” you risk laying a guilt trip on a person who is already suffering with pain, undermining their determination to cope.

They likely have the will to go out or engage in another activity but have neither the strength nor the coping capacity as a result of severe pain. A chronic pain patient may need to cancel a commitment at the last minute—please do not take it personally.

Instead, always remember how blessed you are to be physically able to walk, sit, stand, run, dance and do all the things that you can do and how sad the patient is at having to cancel [again] due to severe pain, illness and disability.

It’s important to remember that the pain is in charge, not your loved-one or associate. While you could get annoyed, it shows a complete lack of understanding of chronic pain and all they endure on a moment to moment basis.

Always be understanding if the chronic pain sufferer says they have to sit down, lie down, stay in bed, or take medication RIGHT NOW. It means that they do have no choice but to do it right now. Chronic pain does not forgive or wait for anyone. We’re already hiding immense pain, when it flares up, it becomes unimaginable.

Chronic Pain Changes How the Body Processes Pain

Be Helpful

Much as holding onto our independence is so dear to us, frequently we need support in more obvious ways. Living with chronic pain means we depend on healthy people to assist us or visit when we’re too pained-up and sick to leave our home.

Without some degree of support, so much is left undone, and often is, for much like our pain and symptoms, this support can fluctuate. If you care about someone living with pain, want to help but are unsure how, be specific.

A general “let me know if you need anything” is obviously compassionate and deeply appreciated but tends to result in our not accepting it, being too proud or even feeling shame for needing this help. But a specific question, like: “I’m going to the supermarket, can I pick something up for you?” is essentially the same offer but one we’re more likely to accept.

It also doesn’t leave us feeling indebted in ways we cannot repay. We may need help with shopping, cooking, cleaning, getting to the doctor or collecting medication. Some may need help with their children. Changing bed sheets for instance is an immense or impossible task in pain but one so deeply appreciated.

You can also crucially help loved ones so isolated by chronic illness and pain stay tethered the aspects of life that they miss and desperately want to be a part of again. You can be an immensely healing link to the normalcy of life and support them.

Being able to talk about the pain openly with others is important — it’s such an all-encompassing part of our lives — though equally not talking about it or defining us exclusively by it is too and it helps us feel less isolated or distanced by the pain, offering a little taste of normal, which is after all what so many living with chronic pain and complex illness truly long for.

* This post by Jo Malby, aka “The Princess in the Tower” was originally published at her website, ThePrincessInTheTower.org. For more information on life with chronic pain, consider visiting Jo on Facebook or Twitter.