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and function within a predictable time frame. In some cases, however, the tissue does not progress normally through the stages of healing and enters a recurrent inflammatory process that leads to the prolonged experience of pain. Chronic pain can also be a persistent symptom of a medical condition such as cancer, fibromyalgia, lupus, or rheumatoid arthritis. QUALITY OF LIFE Chronic pain impacts people physically, psychologically, socially, and economically. Each person's experience with chronic pain is different. Some clients have mild pain that does not significantly limit their daily activities, but still impacts their quality of life. The important thing is to honor each person's experience with pain and not compare it to another's. Following are some of the impacts chronic pain can have on a person's quality of life. Loss of Mobility. People suffering from chronic pain often lose the ability to comfortably move around and perform tasks that are usually taken for granted. For example, daily tasks like hair brushing, showering, getting dressed, driving, grocery shopping, laundry, and housework may be difficult or impossible. Other family members may be forced to assume responsibilities for the person living with chronic pain, and this can lead to feelings of lost self-worth. Pain Avoidance. People living with chronic pain may begin to focus on pain to the extent that they avoid any activity that might increase pain. This leads to pronounced inactivity and higher levels of disability as the body's condition gradually deteriorates. Over time, the intense focus on pain causes sensations that would normally not be unpleasant to be perceived as painful. Medication Issues. Medications may decrease the amount of pain a person feels but can also produce side effects like gastrointestinal problems, drowsiness, fogginess, or aggressive behavior. Over time, the drug may lose its effectiveness and breakthrough pain might occur, or a person could develop a physical or psychological addiction to the drug. Drugs may cause other physical problems such as liver toxicity when they are used for extended periods of time. Sleep Disturbances. Persistent pain makes normal sleep difficult, and people living with chronic pain usually experience pronounced sleep disturbances that leave them feeling inattentive, foggy, lethargic, and moody. Loss of Relationships. Chronic pain places a huge strain on relationships. Activities that once promoted bonding and connection with friends and family may be impossible for a person in pain: it may be impossible to enjoy normal sexual relations; lift and care for babies and young children; sit through a movie, sports event, or lunch date; go for a walk with a loved one; or many other social activities. As time passes, friends and family stop asking people living with chronic pain to participate in activities, and so they become more and more isolated. Loss of Income. A person living with chronic pain may be forced to quit a job or cut back significantly on working hours. If the injury happened on the job, failure to heal from the injury may lead to a conflict with an employer or with a disability manager. The loss of income or a conflict over an injury settlement can lead to increased stress, which may exacerbate the pain. Loss of Credibility. Friends and family members sometimes doubt the validity of the pain levels reported by the person in pain. At first, friends and family are supportive, but when the person in pain fails to improve, frustration and feelings of helplessness set in. These feelings may eventually transform into doubt that their loved one is really in pain. The person in pain loses his or her sense of credibility and retreats further into isolation. Anxiety, Depression, and Stress. It is easy to understand why people living with chronic pain experience high levels of anxiety and stress. They may feel they are no longer the person they once were, or want to be, and are no longer able to participate in activities that give life meaning. They may feel that they are a burden on their family and friends. As they become more and more isolated from people they love and from activities that hold value, they may slip into depression. In fact, research suggests that people living with chronic pain are four times more likely to attempt suicide than people without pain. 5 Research demonstrates that when people are encouraged to talk about their pain and set goals for pain reduction with health-care providers, the quality of pain management improves and they find greater relief. 6 As a massage therapist, you can discuss pain with clients and ask them questions that will help you choose effective techniques and methods, while providing a baseline from which to The important thing is to honor each person's experience of pain and not compare it to another's.