Chapter One
Understanding Chronic Pain
Jim was forty-six when he had the accident at work. He and Marla had been married for twenty-two years at that point—they weren't madly in love but were comfortable friends, had an active sex life, respected each other, and had deep, abiding love for their two kids, Mandi, age twenty-four, and Ross, age sixteen. Jim worked as a psychologist in private practice, doing consulting for a large hospital. The accident happened when Jim was in front of the hospital. A disgruntled family member got into an altercation with an employee and Jim tried to intercede. He was thrown to the floor, fracturing his back and rupturing two discs, they would come to learn. 'Why hadn't he just minded his own darn business?' Marla would find herself asking late at night when she was unable to sleep. She would become enraged that their life had been irrevocably damaged that day, all because her gallant husband felt the need to be a hero!
Sylvia and Larry had been together for four years. Things had started off idyllically—they clicked immediately and had similar goals of success, romance, and eventually marriage and kids. Now, after her diagnosis of fibromyalgia, there was only a shell of their relationship. They didn't go out, have fun, or even relate to one another. They couldn't talk without fighting, it seemed. Sylvia felt that deep in Larry's heart, he didn't believe she really hurt like she did. He just didn't get it. Neither did her mom, her boss, or most of her friends. Larry felt powerless to help her and frustrated he was stuck with a sick person who didn't seem to want to help herself. In the last nine months—since the prescriptions took hold—she was downright stoned a good part of the time. He'd be damned if he'd put up with a drug addict in his life.
These two families are confronting chronic pain, and in this book, they will help us to illustrate the challenges of living with this widespread but under-recognized phenomenon. It is estimated that more than 70 million Americans are afflicted with chronic pain. Each individual's and families' journey is different, but some common themes run through them all. As with Jim and Sylvia, when a person develops chronic pain, everyone that person lives with or has a close relationship with is likely to suffer. A range of difficult and stressful emotions often accompany the pain problem, such as fear, helplessness, frustration, anxiety, depression, grief, and anger. Lifestyle changes and prolonged stress brought on by Jim's condition are taking a heavy physical, mental, emotional, and spiritual toll on Marla, Mandi and Ross, and causing communication to break down. But there are many things a family can do to better cope with the unbalancing effects of chronic pain. A good starting point is to learn as much as you can about chronic pain and your PWP's specific condition.
A Pain Primer
Pain is an intriguing phenomenon, the source of consternation, irritation, and suffering for millions since the beginning of time. It alerts us that something is wrong—that there is damage or threat of damage to our tissues. Pain is usually produced at the site of an injury and is processed in our complex, computer-like nervous system, causing a vast array of physical and emotional responses. The simplest response is to withdraw from the source of pain and then to protect the area that hurts.
Pain occurs in the body as a result of the interaction of nerve cells, the spinal cord, and the brain (together known as the nervous system). Interactions of a multitude of chemicals, including endorphins, prostaglandins, and neurotransmitters, with electrical impulses coming from the nerve cells create the pain experience, and also pain relief. The brain is exquisitely complex. The part of the brain that processes pain impulses, mainly the thalamus, interacts with other areas of the brain that govern memory, emotions, alertness, movement, blood pressure, hormone levels, and hundreds of other functions. The net effect, in a split second—a composite result of many inputs and outputs—is the experience of pain. Needless to say, this system is efficient beyond that of the most sophisticated computer; however, in the case of chronic pain, the system has gone awry.
There are two types of pain, acute and chronic. In acute pain, the computer functions properly, as it was meant to. With chronic pain, on the other hand, it is as if the computer has been affected by a nasty virus, turning previously healthy and needed mechanisms into overactive and inefficient impulses that disrupt normal function.
Acute pain is time-limited—usually gone within a few hours to days. It may last weeks to a few months, but it eventually goes away. Acute pain can be associated with fractured bones, sore teeth, bruises, cuts, surgeries and their aftermath, infections, and a variety of other injuries and conditions. It exists when there has been damage, and as the damage heals, the pain subsides and eventually resolves, and life returns to the way it was before. Acute pain is part of the body's 'response-to-injury' system, which causes us to try to put an end to the offending, pain-causing experience. We also learn from painful experiences and are less likely to do something that causes pain (although later as we explain addiction, you will see that this is not true in all cases).
Chronic pain continues beyond three to six months and has outlived any useful function. It should have gone away, but persists. It is the exaggerated response of the nervous system to damage, as in Jim's case, but also to other conditions and situations that occur in the brain, as Sylvia experiences. It is often pain out of proportion to the prior injury or damage. Sometimes a condition will develop for no apparent reason, and there is not even a clear physical basis for the protracted pain. This is not to say that the pain is in any way unreal or imagined, which was the crux of the problem for Larry, who just didn't buy that Sylvia's pain was real. In actuality, Sylvia's body simply responded differently over time to certain conditions, damage, or injury. The result is pain that won't quit.
Pain, as we experience it, is the net effect of tissue disturbance, transmission to and from the brain, and extensive processing and modifying of the pain signal. With chronic pain, the signal and its transmission are often distorted. So, despite the fact that Jim's broken back had healed and the 'need' for pain (protection, withdrawal, avoiding further injury) had passed, he still was hurting.
Chronic pain is usually neuropathic, meaning associated with disturbances of the nervous system. Often the character of chronic pain differs from that of acute pain (called nociceptive pain), which is usually sharp, aching, or throbbing, and comes from sprains, fractures, burns, bruises, or other forms of tissue damage. Jim experienced a burning sensation and troublesome numbness, especially travelling into his right leg. Neuropathic pain can have a lightning-bolt sensation or an electrical quality. With neuropathic pain, people may experience allodynia, which is pain from something that normally doesn't cause pain, such as light touch or a breeze across the skin. Also associated with neuropathic pain is hyperalgesia, meaning more pain than would normally be caused by a stimulus. This kind of pain may be difficult to localize, and the source of the pain may be widespread or changing. Sylvia had excruciating tenderness at certain trigger points, a hallmark of fibromyalgia.
Sylvia's pain, as with many others who experience chronic pain, was a part of a phenomenon called central pain. This is the result of poorly understood changes in the nervous system's perception of pain. With central pain, the 'volume knob' for the perception of pain is turned up higher than normal. It is the increased 'volume' that causes a normally light-touch sensation to be an awful sensation for Sylvia.
Chronic pain is pain that continues beyond three to six months, has outlived any useful function, and may or may not have a clear physical basis. |
The worst news about chronic pain is—though it may wax and wane, in most cases it doesn't go away. Chronic pain is one of the major reasons people go to doctors and is said to be the most costly health care problem in America. Countless others such as Larry, Marla, Mandi, and Ross are affected by living in a household with or caring for someone with chronic pain. Obviously, if you are reading this book, your life has been affected significantly by chronic pain. |
