Making Peace With Chronic Pain

A Whole-Life Strategy

Marlene E. Hunter

• Publisher: Routledge
• Year: 2013
• eBook ISBN:
  9781135062729
• Print ISBN:
  9781138451926
• Subtopic: Anesthesiology & Pain Management

Published in 1996, Making Peace With Chronic Pain is a valuable contribution to the field of Psychiatry/Clinical Psychology.

Chapter One

What Chronic Pain is … and What it is Not

Prelude to the Dance

Samantha is an intelligent and articulate 32-year-old with gorgeous red hair and a bright, ready smile. She is a research chemist, very respected in her field. She was referred by her family physician and I asked her how I could be of help to her.

“I have migraine headaches,” she said. “I have had them for twelve years.”

Although she had had headaches from time to time in her teens, it was in her early twenties that they began to intensify. The pain was now so excruciating that she felt she had reached the limit of her endurance. And it was seriously interfering with her work—she had had to give up on a very important project because, with the amount of medication she needed even to keep the pain barely tolerable, she couldn’t think straight.

Early last year, she was admitted to University Hospital for two or three days, because her neurologist wanted to sort out her medication and get her on a better regime.

She was there for four months.

This is a book about pain. It is a book directed particularly toward coping with a specific kind of pain—the kind that we call “chronic pain.” And, more specifically, it is a book that describes a different approach to the “management” of chronic pain (as we say in the professional jargon) through a new interpretation of what chronic pain is all about.

This is NOT a book about some magical way to get rid of chronic pain. If there were such magic, someone would have discovered it long before now. It is natural for someone suffering from intractable pain, and for those whose mission in life it is to help people find relief from that pain, to grasp for magic. How we wish we had some! Instead, we are left face-to-face with the fact that, once most (if not all) of the conventional ways to dissolve pain have been explored, and the pain is still there, we must discover new approaches that depend on the incredible capacity of humankind to transcend otherwise intolerable situations—our strengths and resources from deep within us.

We all have such strengths and resources. Even when life seems to have bludgeoned us into submission, there is that little spark that can ignite new spirit and resolve.

This book is about a new way to discover and use those little sparks.

Because this journey involves making new interpretations, we need to clarify some of our definitions. Reading about definitions, especially if you are living with pain and looking for some help, can be a little bit boring, so let’s get it out of the way right at the start.

What is “Pain”?

Pain is a response. It can sometimes be thought of as the body’s way of expressing anger. If someone has been injured, we can think of the body as being angry at the injury. If there is severe infection or inflammation, the body complains loudly. We even speak of the “red, hot, ANGRY” joint of an acute arthritis flare-up.

Emotional pain can also be traced to anger—anger at intrusion or injustice, anger because of fear or frustration. The body responds to this fear, this injury, this infection, through pain.

There are two main components of pain: the physiological component and the suffering component. Of the two, the suffering component is always the hardest to bear and the hardest to treat.

The physiological component is found in the neurological pathways that carry messages of pain. The stimulus comes from whichever part of the body is affected, along the sensory nerves and up the spinal cord to that part of the brain that interprets these sensations as ‘pain.’ These neurological pathways are present and operating even before we are born. There is evidence that even fetuses can and do respond to a painful stimulus by withdrawing from that stimulus. The smallest babies respond to pain, and so do our oldest citizens. The awareness of pain is a talent—I use that word deliberately—that is with us throughout our lives.

The suffering component reflects the interference that pain causes in our lives. Pain intrudes into one’s life. If such an intrusion is short-lived, it is usually relatively easy to bear. But when the intrusion lasts for prolonged periods, it becomes harder and harder for a person to accept with equanimity.

Think, for instance, of someone who has had a work-related injury. There is an initial period of time when pain seems appropriate to the victim, but after a while—after going to the doctor, and getting medication, and attending physiotherapy, and diligently doing all the exercises, and then maybe being sent to a specialist, and getting more medication, and doing more physiotherapy, and really behaving oneself, and doing everything that one has been told to do, and the pain is still there or even worse—the unfairness of all this begins to weigh upon the person. “Why am I not getting better?” “Why isn’t all of this wonderful medical expertise helping me?” “What’s wrong?”

Sometimes doctors and other medical people are so focused on the physiological part of the pain, and how they can offer relief to the patient, that they forget to ask about the suffering part. When I ask a patient, “Tell me how this pain intrudes into your life,” I see many eyes fill with tears as they answer, “No one has ever asked me that before.” Then they tell me: “I can’t go for walks anymore, and I used to love to walk for hours,” or “I can’t pick up my grandchildren,” or “I can’t do my gardening—it makes me cry to look at it, so neglected,” or “I can’t make love with my husband—now he doesn’t even ask anymore and in some ways that hurts even more.”

All Pain is Real

All pain is real. This may seem to be a self-evident statement, but I am still surprised that so many patients come to me and say that they have been told the pain is “all in my head.” This is, accurately, interpreted by the patient in a very negative way, as if they are being accused of making it up or imagining it.

Such feelings exacerbate the helplessness that begins to develop in the patient with long-standing pain. I know how easy it is for a doctor or nurse or physiotherapist to become frustrated or even exasperated and “try” to educate the patient into understanding that the origins of his or her particular pain are not, or are no longer, traceable to some specific organic cause, and therefore the patient must begin to reorganize his or her thinking about that pain and find ways to cope with it more comfortably. But implying that the pain is imaginary does not achieve that purpose; it only enrages the patient. Because patients usually cannot afford to be enraged at their medical support people, they swallow their anger, pushing it far beneath the surface where it bubbles and erodes their self-esteem.

This is not helpful.

In fact, because—as we have said—one way of describing pain is that it is the body’s way of expressing anger, such suppressed fury may make the pain much worse—and this is entirely beyond the patient’s awareness. Patients only know that they feel worse than ever and that their suffering has become even more intense.

Pain is a Dissociative Experience

Jargon again.

A dissociative experience is simply one in which one part of the mind is distracted from what is going on around it, and goes off on its own little tangent. Daydreaming is a very common, very mild dissociative experience: we know where we are, but for the time being, we don’t care.

A motor vehicle accident might create a more serious dissociative experience. Often people have a real amnesia for the experience, which may last for quite a period of time. On the other hand, we can be very preoccupied with some situation or problem, but nevertheless still carry on and do our jobs—that is also a very typical dissociative experience.

Generally, such experiences are quite benign, and often they are really very pleasurable.

However, just ask people who have been ill for an extended period of time and they will tell you that it is as if the illness has taken over their minds and bodies. There seems to be a separation—some part of themselves is linked to the illness or pain and the other parts are not.

Pain can be thought of as just such a dissociative experience. We can ask, “What part of us¹ perceives and takes care of the pain? How does that part of us do that?”

When that part of us takes over instead of taking care of us, then we have entered the arena of chronic pain and chronic pain syndromes.

Acute pain, although it may be anything from mildly to excruciatingly uncomfortable, nevertheless can be thought of as a positive pain—that is, it sends a clear message to us that something is acutely wrong, and that it needs immediate attention. Such pain can be caused by injury, inflammation, infection, or one of the degenerative diseases. The baby with red, inflamed ears, the young adult with a terrible pain in the lower right part of the abdomen, the victim of a motor vehicle accident, the skier with a dislocated hip—all these people are experiencing acute pain.

If the pain is not satisfactorily taken care of (that awful pain in the belly abates when the inflamed appendix is removed), it may go on to produce secondary characteristics. These could be due, for example, to scarring, nerve involvement, or phantom pain (after amputations), or they could be due to psychogenic factors brought on by stress and anxiety and a host of other things which we will talk about later. Often there are components from several of these roots.

This is the predicament of the person who has had a work-related injury. Despite good medical care and a cooperative and intelligent patient, the pain has not only not gone away, it has worsened. And everybody begins to get a little tense.

Samantha didn’t understand why she was still in the hospital and why the new drugs weren’t working. She could tell that her neurologist was puzzled too. She began to get a bit uptight and she knew that would probably make things worse. She also thought that she detected some negative vibes from the nurses—almost as if she were deliberately not getting better. Before she had become this neurologist’s patient, many doctors and other medical people had told her that she was going to have to change her attitude—as if the headaches were all her fault. This made her even more depressed. Sometimes she found herself thinking, “What’s the use?”

She was taking an awful lot of medication. That seemed to get everybody lathered up too—but it wasn’t her idea. It was the neurologist’s, and she was grateful to him because at least for short periods of time she was free from pain. But what was she going to do when she got out of the hospital?

The weeks wore on.

Pain Relief Techniques

Pain relief techniques may be directed either toward conscious processes or toward the subconscious part of our minds. We need both approaches to relieve pain effectively.

Those techniques, which are directed more toward the conscious part of our minds generally relieve the physiological part of the pain. These include medication, physical relief obtained from ice, heat, or support, information about how to move (and how and when not to), or surgical intervention. They are usually very effective and the pain is short-lived. Often they, in themselves, cure or heal the problem, or buy a little time for the body to heal itself. These are the pain relief techniques that we doctors are taught about in medical school.

Those techniques, which are aimed more towards the subconscious are more likely to relieve the suffering component of pain. These include ways to release muscle tension, dissociation and distraction, biofeedback, or hypnotic techniques.

We’ll be talking much more about some of these approaches later in the book. They, in themselves, are not usually thought of as “cures” but...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Dedication
• Contents
• Preface
• Acknowledgments
• About the Author
• Chapter One: What Chronic Pain is … and What it is Not
• Chapter Two: Types of Pain and Pain Relief
• Chapter Three: The Role of Pain in Your Life
• Chapter Four: Identifying Your Pain Triggers
• Chapter Five: Naming Your Pain Players
• Chapter Six: Your Personal Path to Well-Being
• Chapter Seven: Enduring Relief
• Chapter Eight: Harmony and Healing at Last!
• Chapter Nine: Research and Literature Review and Commentaries
• Bibliography
• Index