The American Inquisition: Chronic
By Dan Schweitzer
With review and input from Dr. Stevens of Bend, OR.
Note: This column is not intended to replace the expertise of a physician, but to supplement and inform that expertise, as well as to inform patients, potential patients, and those who live or interact with chronic pain patients.
There are uncounted millions in the US alone who are in
pain every moment of every day, without end or relief. They are routinely
told to "Learn to live with it", which is physiologically impossible; that
can't possibly be in pain because nothing shows on x-rays. They're told that because they don't look like they're in pain, they must be lying. They are called "drug seekers", which is the new word for addicts.
They're called malingerers, fakers - liars. They're accused of trying for "secondary gains" such as not having to work for a living - as though any disability pays enough to live on. They're accused of looking
for secondary gains like getting sympathy from friends and relatives - which ignores what really happens. As long as the patient DOES look and act like he's in pain, people get tired of it. Friends and relatives
feel helpless, unable to do anything useful, uncomfortable, unsure what to say, and they stop coming around. The term "secondary gains" is a fantasy. None of these gains is worth losing a mate, a home, a decent income, usefulness - a life.
What really happens is loss of the ability to work, inability to do the things you love, the things by which you've learned to define your self. Ask someone who he or she is, and most often you'll get a recitation of what they do for a living, of what they own, of who they know. When suddenly someone is in unending pain, all of this is lost, a little at a time.
No one has really done a definitive study, and I hesitate
to present statistics. As Mark Twain once said, "There are lies, there
are damned lies, and there are statistics". Still, to offer an idea of
the scope of
this problem, estimates run from 9,000 to 16,000 people every year who die by their own hands in the US alone because of untreated pain. This gives the lie to another favorite statement by doctors: "No one dies
As for not looking like they're in pain, to begin with, no one can scream and writhe for years, much less for decades. If it sounds unlikely that someone could go so long in this society without being treated, sorry - you're wrong. I went for more than 10 years. I know others who have gone for twenty and more. After a while, we get lonely. We learn that if we moan and groan, complain, cry, or even move like we're in pain too much, people avoid us. We get tired of hearing ourselves, so it's easy enough to understand the avoidance of others. We learn to move carefully, and only when we must. We learn to school our faces to blandness, our voices to silence. Also, the loss of dignity is so great that we come to treasure any relationships we have, and to take a little pride in at least being able to control most of our outward reactions when we're around others. We lose so many of our reasons for any pride at all.
It is also one cause of our downfall. This control isn't something we can just turn off. It's something we must maintain every waking moment. When we're seeing a doctor, we'd have to resort to acting in order to fit his idea of what we should look and sound like. Not that it would help in most cases - doctors are used to dealing with acute pain, not chronic pain. Acute pain is when you slam your hand in a door. You hurt a lot right now, and you can reasonably expect the pain to go away sometime soon. Chronic pain doesn't go away.
This is the first of what I hope will become a regular column. I've been lucky: my pain is, after almost fifteen years, pretty much under control. Most people in my position are not so fortunate. Part of the reason is that, while doctors are taught pharmacology, they are NOT taught pain management; they get an average of one afternoon of it in medical school. Also, the information they get in that afternoon is out of date, and is riddled with propaganda and incorrect assumptions.
In future articles, I'll show how pain works, why people on narcotics do not automatically become addicts, that different parts of the nervous system are used in transmitting chronic pain and acute pain and therefore need different treatment, and that different treatments are needed for different types of pain and even for the same type of pain in different people. The next article will begin with myths and other misunderstandings about pain and it's treatment.
There is finally a new treatment paradigm for pain. People with chronic pain do not have to remain untreated, they do not have to be a burden on their families or society.
There is an answer!
by Dan Schweitzer