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Inspiration: Episode #: Episode 19 | Partners in Pain (Part I) – The Invisible Burden of the Mind Your Body podcast with Dr. Nevo.

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TL;DR

Chronic pain doesn’t just live in one body. It reshapes two nervous systems, two identities, and the entire relational space between them. Partners of people in chronic pain carry real suffering too, and most of them are doing it without the right language, the right model, or anyone acknowledging they’re in it.

• The person in pain is often carrying seven distinct layers of suffering, only one of which is physical.

• Partners who appear indifferent are frequently running on nervous system depletion, not lack of care.

• Two nervous systems in the same household actively amplify or calm each other, which affects pain outcomes directly.

• Sympathy and pity, even when well-meaning, create hierarchy and erode dignity. Empathy means climbing down into the experience, not observing it from above.

• Empathy is a learnable skill set, available to any partner at any stage of a relationship.

Every time I sit across from a patient in chronic pain, there’s a third presence in the room. I can feel it in the way she holds her shoulders, in the pause before she answers a simple question, in the smile she offers me because she’s been offering it to everyone for years. Somewhere else, in a waiting room or at home or in a car circling the block, there’s another person carrying a version of the same weight. Her partner.

The appointment is for the person in pain. But two people walked into this life. Both are exhausted. Both are quietly wondering if they are doing this right. In my experience, almost nobody is talking to them about that.

This is the first of two conversations I want to have with you about partners in pain. Today I want to name what is actually happening between two people when one of them lives with a body that hurts. The human version. The one Sarah, a mother of three I have had the privilege of working with, gave me in one sentence that has stayed with me since.

“I just pretend I’m okay.”

She masks so well that even her partner, the person who sleeps next to her every night, cannot always tell when she is in a flare. That’s not a failure of his attention. That is the level of performance chronic pain demands from the person carrying it. Underneath that performance, there is a stack of suffering most people never see.

The Seven Layers of Suffering

When we talk about chronic pain, the conversation usually stops at the sensation itself. The hurt. The location. The intensity on a scale of one to ten. That framing is useful in a clinical room for about ninety seconds, and then it collapses, because pain in a real life is never just pain.

For Sarah, and for so many people I sit with, the physical sensation is only the first layer. Underneath it, there are six more.

There is the shame of a body that will not cooperate. The sense that you are somehow broken in a way you were not supposed to be.

There is the guilt of what your pain costs the people you love. Missed birthdays. Cancelled plans. The children’s questions you do not know how to answer.

There is the fear of pity. Because pity, as we will talk about in a moment, does something to your dignity that is very hard to recover from.

There is the exhaustion of masking. The full-time job of pretending to be fine so that the room does not shift around you every time you walk into it.

There is the isolation that grows when nobody understands, and when you have stopped trying to explain.

And there is the resentment. Sometimes at the people around you. Sometimes at your own body. Sometimes at a medical system that has passed you from one specialist to the next without ever seeing you whole.

Physical pain, shame, guilt, fear of pity, the exhaustion of masking, isolation, and resentment. Seven layers. Every one of them real. And the person you love is often only aware of the first. Research confirms that pain-related shame correlates strongly with depression and social isolation [2], while guilt in chronic pain is linked with worse physical functioning, social functioning, and psychological adjustment [3].

Key Point: Chronic pain carries at least seven distinct layers of experience. Addressing only the physical layer leaves six others unacknowledged, and those layers are where the relational fractures begin.

When Helplessness Looks Like Indifference

Now let me turn the camera the other way, because there is a second person in this story, and their suffering is real too.

When someone you love is in pain and you cannot fix it, your nervous system activates. Your body reads their pain as a threat, because on some deep level, it is. The urge is to protect, to solve, to make it stop. And when none of that works, the helplessness has to go somewhere. A survey by the U.S. Pain Foundation found that 96% of caregivers of people with chronic pain reported feeling helpless, and 80% reported feeling overwhelmed [4].

That helplessness has to go somewhere. For some partners it surfaces as anxiety, for others as over-functioning: taking on everything and burning out quietly. For others still it looks like flatness. A withdrawal. A stepping back that reads, from the outside, as indifference.

It almost never is. What looks like a partner who does not care is very often a partner whose threat response has been running so long that they have gone numb to protect themselves. Their sympathetic nervous system has been on for months, or years, and the body has one honest response to that. It shuts something down.

Here is the piece almost nobody tells you. Two nervous systems in the same room are always talking to each other. When your partner is anxious and helpless around your pain, your body registers their activation as another threat on top of the one you are already carrying. Their distress amplifies yours. Your pain gets worse. Which makes them more helpless. Which makes you more activated. Research on couples living with chronic pain shows strong dyadic effects on central nervous system processing, with a partner’s solicitous response measurably increasing the pain person’s reported pain [5]. Chronic relational stress rewires both people’s brains, and what it reinforces, over and over, is threat, disconnection, and suffering.

This is not anybody’s fault. It is what happens when two people are trying to love each other through something neither of them was trained for.

Key Point: A partner who looks checked out is often a partner whose nervous system has been in overdrive for so long it defaulted to shutdown. The two are neurologically connected, which means one person’s dysregulation amplifies the other’s pain.

Sympathy, Pity, and the Empathy Miss

I want to bring in Brené Brown here, because her work in Atlas of the Heart named something I had felt for years in the clinic but had not yet had words for [1].

She draws a clear line between sympathy and empathy, and it’s a distinction that changes how you read every interaction once you see it. Brown defines empathy as connecting with the emotions of another without judgment or problem-solving, while pity creates distance and hierarchy [1]. Sympathy, she argues, is the near enemy of empathy: it looks like care but creates separation.

The image she uses has stayed with me. Imagine the person in pain is at the bottom of a hole. Empathy climbs down into the hole and says, “I’m here. You are not alone.” Sympathy stands at the top of the hole and looks down. Pity, which is sympathy’s harder edge, stands at the top of the hole and feels quietly grateful not to be in it.

The difference is not semantic. Pity creates a hierarchy. It positions the suffering person as somehow lesser, and the observer as fortunate. It strips dignity, even when the person offering it means well. It is one of the reasons Sarah pretends she is okay. She would rather carry seven layers of suffering alone than be looked at from the top of the hole one more time.

When we misread this, we default to sympathy and we call it care. And the person we love feels it, every time. They feel the space between the top of the hole and the bottom. And they stop climbing out to meet us there.

Key Point: Sympathy and pity are not the same as care, even when they feel that way from the inside. The person in pain registers the difference every time, because it shows up in the quality of presence, not the words chosen.

The Five Ways Well-Intentioned Partners Disconnect

In the work Brown has done on empathy, she names specific patterns she calls “empathy misses” — responses that look like connection and are actually its opposite [1]. I see all five of these in the clinic every week, from partners who love their person deeply and are trying their hardest.

The sympathizer, or pitier. The partner who responds to pain with, “Oh, you poor thing.” The words sound kind. The nervous system underneath them is standing at the top of the hole. What the person in pain receives is not comfort. It is confirmation that they are now an object of sadness.

The minimizer, or silver-liner. The partner who reaches for the bright side. “At least it is not worse. At least you can still walk. At least you have the kids.” Every “at least” is a small door closing on the reality of what the person is actually feeling.

The fixer. The partner who leaps to unsolicited advice. New doctors. New supplements. New protocols they read about online. The intention is love. The message received is, “I cannot sit with you in this, so I am going to try to make it go away.”

The comparer, or hijacker. The partner who responds to pain with their own version of pain. “I know exactly what you mean. My back has been killing me too.” The story shifts. The person who was speaking is now the listener. The hole is now shared, and not in a good way.

The avoider. The partner who changes the subject. Who stays busy. Who is loving in a hundred other ways but cannot be present when the pain shows up. The message received, whether it is meant or not, is that this part of me is too much.

None of these partners are villains. All of them are trying. The shared root is the same across all five responses: the suffering was too uncomfortable to sit with, so the response reached for an exit. Empathy is what becomes possible when you stop looking for the exit.

Climbing Down Into the Hole

Sarah said something to me that I think about often. It is the closest thing to a thesis on this entire subject I have heard from anyone, patient or clinician.

“People just want to feel like they’re not going through it alone. They don’t need you to fix them.”

Sit with that. She’s not asking for a diagnosis, a plan, or for her partner to shoulder the weight. She’s asking not to be alone in it. That’s the whole ask.

Climbing down into the hole means being willing to stay present without needing to change anything. No fixing, no reframing, no silver lining. It requires tolerating your own helplessness long enough to remain with someone in theirs, rather than reaching for sympathy, advice, or distance to manage your own discomfort.

When that happens, something shifts in the room. Two nervous systems that were amplifying each other’s threat start to settle. The pain does not disappear. But the loneliness around it does. And in my clinical experience, the loneliness around pain is often heavier than the pain itself.

Key Point: Co-regulation is a real neurobiological process. When one person stays grounded and present, the other person’s nervous system responds. You don’t need to fix the pain. Presence alone changes the physiology of the room.

What Comes Next

In the next conversation, I want to give you the tools. Brené Brown outlines four specific attributes of empathy, and I’ve come to think of them as a learnable skill set. A set of practices any partner can build, at any point in a relationship, no matter how long the disconnection has been running.

We will walk through each of the four together, with language you can actually use, so that the next time your person is at the bottom of the hole, you know how to climb down.

Key Point: Empathy is not a personality trait some people are born with. It’s a set of four learnable practices, and the next conversation will walk through each one with language you can use immediately.

Until then, I want to leave you with this. If you are the person in pain, your suffering is real and it is layered. The fact that you’re still here, still trying, still showing up for the people you love, carries real weight. If you are the partner, your exhaustion is real too. Your helplessness is not indifference. Your urge to fix is love looking for the right language, and that language can be learned.

Your partner’s experience is as valid as yours. Both of you deserve acknowledgement. Both of you are carrying something real. And with practice, with the right framework, both of you can put some of it down together.

Frequently Asked Questions

Why does my partner seem to pull away when I’m in the most pain?

Withdrawal is often a nervous system response, not an emotional one. When a partner feels chronically helpless, the sympathetic nervous system can default to shutdown as a form of self-protection. It reads as indifference because it looks like indifference, but the underlying state is usually closer to depletion. Research by the U.S. Pain Foundation found 96% of caregivers in this situation reported helplessness as a primary experience [4].

What is the difference between empathy, sympathy, and pity in the context of chronic pain?

Empathy requires entering the other person’s experience without judgment. Sympathy observes it from a distance. Pity adds a hierarchy: the observer feels fortunate not to be in the position of the sufferer. Brené Brown’s Atlas of the Heart [1] names pity and sympathy as near enemies of empathy because they look like care while actually creating separation.

Can the way a partner responds actually affect the pain itself?

Yes, measurably. Research published in the journal PAIN found that a solicitous partner response, one focused on anxious caretaking, directly increased the pain person’s reported pain levels through central nervous system amplification [5]. The nervous systems of two people in close proximity actively influence each other.

What does the “seven layers of suffering” model mean for partners?

It means that when someone you love is in a flare, you are likely only seeing one of seven things happening. The visible layer is the physical sensation. Underneath it sit shame, guilt, fear of pity, the exhaustion of constant masking, social isolation, and resentment. A partner who understands this model can stop trying to address only the surface layer.

Is an empathy miss the same as being a bad partner?

No. Empathy misses are predictable responses to unbearable helplessness. The fixer, the minimizer, the sympathizer, the comparer, and the avoider are all doing something recognizable: managing their own discomfort. Recognizing the response is the first step to choosing a different one.

What does “climbing down into the hole” actually look like in practice?

It means staying present without an agenda to change anything. No advice, no reframing, no silver lining. It’s sitting with the person in their reality and saying, in words or in presence, that you’re there. That the discomfort they’re in doesn’t drive you away.

Is empathy something you either have or you don’t?

No. Brené Brown’s framework treats empathy as a skill set with four distinct, learnable attributes. These will be covered in full in Part II of this series, with specific language and practices any partner can apply regardless of their natural emotional style.

Why does masking pain make the relationship harder?

Because it requires the person in pain to perform wellness full-time, which adds an invisible layer of exhaustion on top of everything else. The partner who doesn’t see the flare is not failing. They are being protected by a performance that the person in pain maintains at significant personal cost.

Key Takeaways

• Chronic pain is a relational experience. Two people are living inside it, and both of them deserve acknowledgement.

• The person in pain is often carrying seven distinct layers of suffering simultaneously, only one of which is physical.

• Partner withdrawal is usually a nervous system response to sustained helplessness, not emotional indifference.

• Two nervous systems in close proximity regulate each other. A partner’s anxiety measurably amplifies pain; a partner’s calm presence measurably reduces it.

• Sympathy and pity create distance and hierarchy, even when they are well-meaning. Empathy requires entering the experience rather than observing it.

• The five empathy misses (sympathizing, minimizing, fixing, comparing, and avoiding) are all forms of reaching for an exit when the pain is too uncomfortable to sit with.

• Empathy is a learnable practice. The tools exist, and they can be built by any partner, at any point.

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About the Author:
Dr. Zev Nevo is a double board-certified physiatrist, chronic pain survivor, and founder of the Body & Mind Pain Center. He helps people with persistent pain rebuild capacity and confidence using an evidence-based, trauma-informed mind-body rehabilitation approach.

Listen: Mind Your Body Podcast
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Medical Disclaimer:
The information in this article is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. New or changing pain symptoms should always be properly evaluated by a medical professional.

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References

1. [1] Brown, B. (2021). Atlas of the Heart: Mapping Meaningful Connection and the Language of Human Experience. Random House. brenebrown.com

2. [2] Coady, A., Godard, R., & Holtzman, S. (2024). Understanding the link between pain invalidation and depressive symptoms: The role of shame and social support in people with chronic pain. Journal of Health Psychology. PMC10757395

3. [3] Serbic, D., Evangeli, M., Probyn, K., et al. (2022). Health-related guilt in chronic primary pain: A systematic review of evidence. British Journal of Health Psychology, 27(1), 67–95. doi.org/10.1177/13591053231191919

4. [4] U.S. Pain Foundation. (2022). Caregiver Burnout: A Side Effect of Chronic Pain That Can’t Be Ignored. uspainfoundation.org

5. [5] Goudman, L., et al. (2021). When shared pain is not half the pain: Enhanced central nervous system processing and verbal reports of pain in the presence of a solicitous spouse. PAIN, 162(7). doi.org/10.1097/j.pain.0000000000002559