Chronic and Acute Pain - There's Nothing Cute About It

"Sorry, not today, Joe. I really over did it yesterday. You guys go on and enjoy the game. I'll amuse myself at home today."

Sound familiar? We all say things that are variations on this particular theme when we live with chronic pain. We tend to respond to the world the same way someone suffering with rheumatoid arthritis does - it's called "avoidance behavior." And it makes perfect sense - when our feet are screaming at us, who in their right mind would just jump up and join the fun? We need to recuperate. Some can recuperate quickly, some of us take quite a while longer to get the same relief. Some of us use medication, some refuse to. Some resort to additional surgeries, often with dubious results, while others will no longer even trust a doctor to trim our toenails. So while we have many different approaches to dealing with our pain, we all have one thing in common - pain.

Chronic pain differs from acute pain only in duration. Chronic pain does not have to be present every minute in order to be chronic - it just has to display some type of regularity. Acute pain (stub your toe - that's the ideal demonstration) arises quickly, and eventually resolves. Chronic pain usually resists resolution through the normal approaches to pain resolution, or at least, requires ongoing, and often debilitating, regular application. This often leads to addiction issues, just one more thing you just love to deal with. (Irony alert.) The medical establishment has struggled for decades on the issue of chronic pain, and because they have still not found real solutions that work in most cases, there is sometimes a tendency to "blame the patient." It's "in our heads," we need psychological counseling, etc. Gee, that's the answer I was looking for! (Sorry.) Well, there is some truth to this assertion: pain is, literally, in our heads. All those nerve endings getting crushed between bones and compressed by chronic inflammation is being sent to, and processed within, our brains. But as for psychological issues? Look, Doc! You walk every day in pain, subject yourself to multiple surgeries, get told you are now "normal" when you know its a lie, try to fit into your community without being seen as a freak, and then tell me its in MY head. Hell, sure it is, but its also in my feet, and my ankles, and my knees, and my back! I mean, stop treating us clubbies like were ignorant fools, and that you have all the answers. because so far? Your answers haven't done much good.  (Sorry, again. Just went off, there, didn't I?)

Let me give you an illustration, something that just happened to me yesterday, that might illuminate what will follow. I am currently undergoing prolotherapy to attempt healing my torn meniscus and other parts of my knee without resorting to surgery (getting tired of people cutting me open.) Now, prolotherapy consist of many small injections of lidocaine and dextrose - -sugar, really - into the area in question. These injections are done over many months, in a series. They can be very painful, even with the lidocaine injections first, because they can be fairly deep, and because the fluid instantly puts pressure on the local nerves. (I know this sounds like a real sales job, doesn't it? But given all I've learned about prolotherapy, I feel it will be worth it. I'll keep you informed on my progress.) So, who wants instant screaming-I'm-gonna-tear-the-roof-off-this-building-with-my-bare-teeth kind of pain? Not me, nosiree. So, I opted for the meds.

Now, I took 3 2-mg hydromorhonne - dilaudid - which did in fact reduce the screaming. But (you knew there was a but in there, didn't you?) some of the deeper injections still hit their marks, and I was not too happy. Finally, my good Doctor Mike pulled off his ear protectors and made a little, well, suggestion. You could call it a guided image for me to focus on. He suggested I let the drugs "do their job." He said, don't focus on the pain, just watch it when it happens, like its somewhere in the distance, and just watch it while it does what it does. "Ride on the drugs like they are a cloud," he suggested. So, I did. And I was soon able to feel the needle while simply observing what it was doing. I seemed to see the pain like it was on it's own little island, and I was simply a distant observer. And it worked. I still felt a couple at a deeper level than I wanted to, but overall, it made a real difference, and we got through the session fairly quickly. When we were done, I simply got up, with only a little dizziness, which passed quickly, and off I went. Its a bit sore today, but that was expected, and is mostly tolerable.

So, how does this apply to chronic pain? After all, it was acute pain I was dealing with, right? Yes, this represented acute pain, no question. But think about this: if I was able to use that type of mental imaging with acute pain, how might I be able to use that same concept with chronic pain, where I have even more time to excersize those mental muscles?

When I feel pain, I am not merely experiencing the pain where the hurt arises. I am also extending that pain by my systemic reactions to that pain. I "splint" against the localized sensation, by tightening muscles around the area in an effort to stabilize the region. This tensioning of the surrounding musculature tends to spread - first its my foot and ankle, then I may limp, which is simply another type of compensatory function in the face of painful feet. While this limping may take some immediate pressure off the affected foot (or feet - yes, there is bi-lateral limping,) it has the longer-term effect of tensioning other sets of muscles and ligaments further up the body. The pain is no longer truly localized. The ultimate effect of this is to make me focus on how the pain makes ME feel, not on simply observing the pain where it arises, and allow it to occur in only that locality. I have now made the pain, ME. And the more, and the longer, the pain is ME, the harder it is to relate to anything else other than as a response to the pain I am feeling. This is why using meds to "stop" chronic pain seldom works -first, they wear off, and therefore the pain is still, ME. Then, the meds don't merely affect the pain itself - they also affect the way I feel in general - foggy, sleepy, forgetful, on and on. I either become addicted, or I eschew meds altogether, and become, well, surly, cranky, depressed, you get the picture.

So, how to get to that place where the pain is no longer YOU, but is merely pain occurring in one locale, and capable of being observed, rather than being obsessive? There are many relaxation and centering techniques out there. You may have to try a few before finding the one that works right for you. For example, biofeedback has a long and proven history with helping people control pain, as does meditation, visualizations, yoga, even certain martial arts, like tai chi. The main thing is to find a way to isolate the pain in your mind - surround it with a certain color, or an enclosure. Allow it to be there, but not be IT. yeah, sounds all New Age-y, but there is a growing body of research to support this approach to dealing with chronic pain. And until some pharmaceutical company develops the perfect drug, with zero side effects, and non-addictive, well, we may be on our own. And medical marijuana is not legal in all states, so what can we do?

We can take control of our own bodies, and the pain that arises in them, instead of surrendering that control to things that either don't work, or that turn us into something we no longer want to hang around with.

How do YOU handle your pain?