When it comes to acute trauma, the damage is obvious. The broken leg is at a bad angle, the blood is pouring out of somewhere, or multi-coloured bruises radiate from where the damage was done. Hospitals are equipped to handle it. Doctors are trained to manage it. People comprehend it. There are cures and solutions for acute pain with a clear end point.
Chronic pain, on the other hand, isn’t well understood. Doctors can’t fix it. Surgeries often make it worse. Society either doesn’t understand it or puts their own baggage on top of it as though it were a trolley. Chronic pain doesn’t have a cure, the solutions are often worse than the problem itself and the best possible outcome involves accepting your new normal, not trying to change it.
It’s been more than ten years since I reached for my toothbrush one morning and realized that my left index finger was numb, as though I had slept on it but nothing else on my hand. I went with the folk cure of leaving it alone and hoping it gets better, but my doctor didn’t seem too worried. Four months later, I woke up with shooting pain down my arm so bad that I couldn’t sit up. Any part my left arm could bend radiated pain.
When you have pain, the doctor is trained to use the pain scale. Zero being no pain at all, ten being the worst pain imaginable. There’s no litmus paper or formula that comes up with that number; it’s self-reported. For acute pain, it makes a lot of sense in an emergency situation, but for chronic pain, it’s next to useless. Obviously everyone’s ten is subjective, but I spent my active youth crashing from one accident to the next. I’ve crashed into the ditch trying to make an S turn with an open throttle on a bike. I’ve had a horse pile drive me into the dirt at a dead gallop. I’ve fallen down a mountainside with a ski that didn’t pop off the way it should have, almost ripping off my foot as I fell. I had a man bash my face in with his fists to the point that one eye completely swelled shut and the other only open a sliver.
Compared to that pain, what I experience on the day-to-day is a three or four at best. But that’s for acute pain, not pain that goes on and on and on. And on and on and on. I’d keep going, but this article has a word limit. Chronic pain is the squeal of a brake pad telling you it needs to be fixed but in a world where there is no replacement parts. It leaves you gutted and gasping for air on the pier of life. Instead of a simple line scale, a three-dimensional chess board is needed.
Finding a doctor willing to help can be a major struggle. I found life got easier once I had a diagnosis, but the eighteen months that passed between me waking up in agony and some technician looking at my results and saying I had the MRI of someone sixty years my senior was miserable. My doctor was a very nice lady, but she spoke out of both sides of her mouth. She would say that she believed me and would do all that she could to help and then tell me that I was much too young to have that much pain. Worse, while the pain manifested itself in my arm, the damage was done in my neck. So for the first year they were looking at the arm from the shoulder down. Since there was nothing wrong with my arm, all the ultrasounds, Xrays and conduction tests came back negative.
Some doctors will try to believe you. Others won’t give you the benefit of the doubt. Scheduling the MRI took six months and before I could have one done, our family doctor moved away. One of the interim doctors told me I had tennis elbow. When I asked why it was that my shoulder hurt if it was in my elbow, he templed his fingers and said, “Ooooh, so it’s your shoulder that hurts now?” in an obvious “gotcha” tone. A week later the MRI results came in and the damage to my neck was obvious, but I’ll never forget how helpless I felt in that moment.
I’m in a much better place now and I’ll get to how I got there in a moment, but you can’t talk about chronic pain without talking about the medications involved in treating it. They’re currently working on a painkiller derived from a particular spider’s venom. It’s completely non-addictive or euphoric and if it’s strong enough to allow a spider to liquefy your insides and suck them up through their fangs without kicking up much of a fuss, it should manage chronic conditions, but that’s years away.
For right now we have opiates and opioids. Conventional wisdom used to say that pain patients using their medications correctly only have a 2% chance of addiction. Recent studies have brought that number up to 35%. More people die of prescription medication abuse than they do from any other form of opiate. Purdue, the company that makes OxyContin, lied to the doctors about not only the addiction rate but also the length of time the pills were effective. After selling medical grade heroin for so long, they then switched the formula so that they couldn’t be tampered with and while on paper that sounds like a good thing, it’s the reason why you now know what fentanyl is and how high its butcher’s bill costs.
So finding a pain specialist who cares about finding the dose that allows you function day-to-day with a clear head is vitally important to both your health and your well-being. The solution to managing pain is not going to be found in a prescription bottle with endless refills, but proper pain management will greatly improve your quality of life. Pain levels and your emotional state go hand in hand, so if an anti-depressant helps with that, give it a chance.
Back in elementary school the teachers used to hand out those morbid life or severe injury insurance pamphlets for us to take home. We poured over them, trying to figure out exactly what we could lose that would impact our lives the least but pay out the most money. Losing your thumb, for example, earned you ten grand while losing an index finger was slightly less and losing your pinky was barely worth breaking out the hacksaw. The naïve idea that there was anything more valuable than health was beyond us.
It’s easy to fall into the trap that allows the pain to define you. Chronic pain can challenge the most optimistic outlook on life. It can test the best relationship and alter your path from where you thought you were going to be to where you end up. The surgery that might be able to fix the constricted nerve channel and shave off the bone spurs has a one percent mortality chance, and another one percent chance of either being a paraplegic or a quadriplegic. Both specialists I’ve seen have assured me that the risk/reward is just too high. I’ve also talked a lot of people who went the surgery route, and not one of them would happily go back to the amount of pain they were in before the surgery. One person had five corrective surgeries to correct the first one, and her pain level was exponentially increased. With so many nerves and blood vessels located at C3 and C4, the best the specialists could say was take the pills, try not to get too addicted, and come back in a decade to see if there were any advances on the procedure.
But the drugs are just one of the tools I’ve used to greatly enhance my quality of life. Studies of children in hospitals have shown that being creative is as effective for dealing with the pain as some opiates. Being a writer, I can attest to this. When the pain is out of control, simply being in a far off land in my head works better than handfuls of medication. Meditation, yoga, hobbies, anything that takes your mind off the pain can raise your pain threshold. I pace myself using the Spoon Theory, https://en.wikipedia.org/wiki/Spoon_theory, a brilliant way to visualize your new normal. While I have the objectively have greatest partner in the world, being your own self-advocate and speaking up for yourself is vital. Assembling the right Team You makes all the difference in the world. From your doctors to the pharmacist to your friends or your therapist should all be on your side. You don’t have room in your life for people who aren’t there to make the world a better place.
At the start of this journey, I wanted to take enough pills that I could close my eyes and wake up when the pain’s gone. I lost three years of my life to pharmaceutical zombification. Life will continue, and the sooner I accepted that this was my new normal, the happier I’ve been. Chronic pain does what it says on the tin, but in the long list of things that make up who you are and what you’re going to be, it is not your main ingredient.