When Jonathan first came to my office two years ago, I could see his problem before he said anything. He walked gingerly, shoulders hunched over, a look of anguish on his face that announced what he was feeling: six months of severe pain following an operation.
When he complained to his surgeon, he was told it would pass. When he could no longer bear it, he consulted other doctors. All of them essentially suggested that pain from his surgery takes a long time to heal. Jonathan was angry and scared. Some days he tried to live his life as he had before, but he was in agony. Other days he gave in to it, engaging in little physical activity; that didn’t help, either. He continued looking for doctors who could tell him what was wrong and how he could make the pain go away.
This scenario is familiar to many of the nearly 40 million Americans living with chronic pain. When pain is acute, our bodies mobilize to find the source and fix it fast. With a chronic condition, the pain itself sometimes becomes the root the problem: The brain may not recognize that the cause has been eliminated; it persists, like phantom pain following an amputation. Other times, as with Jonathan, the problem cannot be remedied.
The natural reaction to pain is to brace up against it, says psychiatrist Sarah Whitman, an assistant professor at Drexel University College of Medicine. Yet fear and anxiety make it worse. Friends and physicians often do, too. When well-meaning people try to minimize the agony or offer simplistic solutions – “be strong,” “look at all the good things in your life” – those who are in chronic pain feel frustrated, misunderstood and alone.
Perhaps this is part of the reason 30 percent to 50 percent of them become clinically depressed. Another reason, according to Whitman, is the anatomical similarity in how pain and depression appear in the brain. That’s why antidepressants are often used to treat chronic pain.
There are other options. Hypnosis and acupuncture have good track records. Meditation, guided imagery, physical exercise and psychotherapy are helpful. Before, during or after any of these strategies, however, is an essential step: understanding and accepting that while pain can be diminished, it might not ever go away.
Jonathan continued to pursue a cure for his pain by consulting with various surgeons. During his sessions with me he expressed anger and great fear that he would never “get to the bottom of this.” I encouraged him to entertain the idea that his pain might be chronic, but he could not; his search went on.
And then one day he came to my office with a different expression on his face. More peaceful. He told me he finally realized that there would likely be no cure for his pain, and that he would have to find a way to live with it.
Jonathan went through a long period of mourning. He gave up some of his athletic equipment, and many of his dreams. In the process, the pain became part of his life – rather than the focus of his life. Indeed, it was only after he accepted this fact of his life that he was open to taking antidepressants and learning meditation, both of which helped.
Not everyone is as fortunate as Jonathan was. Sometimes pain is so severe it’s hard to have faith in tomorrow. Even as the population ages and the number of people in pain inevitably increases, however, researchers are finding other avenues with potential. Whitman describes one that uses a functional MRI to identify sites in the brain that are active during periods of pain. Patients learn techniques to diminish the pain while watching a live scan of their changing brain activity. Although not ready for pain relief in prime time, this intervention – an offshoot of biofeedback that is known as neurofeedback – shows much promise.
Jonathan gave up hope that his pain would be cured. He mourned what he had lost. And then he developed hope that he could once again enjoy the life he had.