The Story of Pain


Somehow everything in the past 24 hours has been about pain. As a runner, I have the honor and privilege of experiencing a myriad of physical aliments associated with running on pavement (with the wrong shoes); first bursitis in my hip and now shin splints. Last night, I couldn’t run. My shins hurt so bad they felt like they were on fire. My feet were abnormally swollen, I felt fatigued and run down. And I thought to myself “this is not fun”. So yes, I know I should get better shoes, ice my shins, stretch properly, run less, rest more and watch my sodium intake. But all I kept thinking though was “God I’m turning into my father”. Both my parents suffer from rheumatoid arthritis. I grew up listening to their pain stories. And pain is a sophisticated story teller, more so than any other physical ailment. I started thinking about how my mother’s arthritis flare up put her in a rehab at 19 for 25 days, being pumped with every steroid imaginable and feeling like a water balloon ready to pop. And all of a sudden, my shins started to hurt more, and my heart started to pound and a puddle of embarrassing tears formed silently in my eyes. God, what a bummer!

This morning at the doctor’s office I rated my pain as a 10 from 1 to 10. But then I started thinking, was it really that bad? See, the problem with pain is, it’s very subjective. With all the science advances, we have not been able to come up with a pain “meter”. We rely on the patient’s subjective account of how much it hurts. And I guarantee you, that rating feels correct. My pain felt like a 10. But what makes my experience different from any other runner who has experienced shin splints, is my parent’s story and my fear of having the same painful fate. Fear. Fear is a powerful thing. Fear can propel your pain scale to the sky. Perception of that pain can too. Our minds are powerful; they can fuel our physical pain like oxygen does fire, keeping it alive and roaring. When you are in physical pain, you are in emotional pain too.

This morning I was listening to the Diane Rehm show on NPR as I’m driving to work. It’s on prescription drug abuse, with a focus on the Oxycontin epidemic. Professionally, this is right up my ally. You can listen to it here. As usual Diane has invited an impressive panel of pain doctors, substance abuse experts and a sheriff. The debate is very interesting, informative and important. Then a heroin addict in recovery calls and makes the most important point in the whole show. He’s talking about emotional pain.

Sure, we can do research and come up with telling statistics, sure we can blame Purdue and sue them for producing such an “evil” drug, sure we can talk about prevention, education and ways to decrease abuse and diversion while still helping people who are suffering from chronic pain and NEED these “evil” drugs. But are we talking enough about emotional pain?

In my years of experience working with people addicted to opiates, emotional pain is the one, single, most important aspect of their addiction and recovery. This is simply an observation, but emotional pain is the determining factor in whether or not that temporary prescription your dentist gave you for Hydrocodone is going to be just a pill or is going to turn into your love, you lifeline and ultimately your worst nightmare.

We are a pill popping society. There is no doubt about it. The pharmaceutical companies and pill pushing doctors have perpetuated this “fast food” like culture of making your problems disappear. No one wants to talk about the underlying emotional pain. No. That’s a painful, grueling, long process. We can’t bare feeling exposed, powerless, weak, sad, lonely, fearful. We can’t sit with ourselves. Even when we think we have religion, many times we have lost our spirituality.

Many of my clients would initially talk about how their doctor didn’t warn them enough about the risks of becoming addicted and how a seemingly innocent prescription turned into something they needed to function every day. Even when they didn’t have any of the risk factors to becoming addicted such as biological/family predisposition or prior history of alcoholism or abusing illegal drugs, they became addicted. After a year or so in therapy their real stories start to come out. About how the pills did more than just kill back pain, how they liked the way it made them feel and how that was an escape from their reality. And then, slowly they start to open up about their emotional pain, which is the hardest to talk about. Somehow, physical pain is acceptable but God forbid our heart hurts and our brain feels like it’s going to explode. Somehow we are weak for experiencing that kind of pain. Somehow we should be tougher, stronger, saner. But we are not.

The scary part about this is that we are teaching this to our teenagers who are the most at risk  of developing an addiction to pain pills. Yes these pills are more available to them. Yes, people believe they are safer because they are legal and a doctor is prescribing them. Yes, they find these pills in your medicine cabinet. But what else is happening in our families that we are not talking about? Why are we so afraid to expose our demons? Why are we stubborn when it comes to change? What is the larger responsibility that our schools, communities, cultural, political and economical climates have on this epidemic?

And most importantly, why aren’t we in therapy more?

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