The course of a marriage after injury is a difficult one. The most obvious, of course, is financial. They may have significant debt going into injury and begin to spiral downward after injury.
However, an equally complex area is that of physical intimacy. After injury, the patient is often disinterested in physical contact. This may occur because of pain, but it also can occur as a result of side effects of medication. Decreased libido is also a symptom of depression as we have discussed.
The most interesting and important aspect is that whether the injured worker is male or female, they are convinced that their partner will not remain with them if they continue to have a low drive level:
The female patients believe that their husbands will not tolerate it.
The male patients believe that their masculinity is now impugned.
In the marriage of an injured worker, regardless of which partner has been injured, this becomes a source of fear, anxiety and combined with financial concerns, marital discord (which may have already been present) escalates.
Importantly, the patients rarely tell their primary treating physician of this concern. Perhaps this is because of brief office visits, but more likely, it is because the patient perceives that pain is the sole reason for the visit.
The concerns for physical intimacy complicates, and at times, full obstructs the recovery process, leads to further retreat to pain medications to _feel better_ and increases depressive symptoms.