April 3, 2106

I have been thinking about the words "chronic,” and "pain" and about what happens when you put the two of them together.  As awful as chronic pain can be, it seems to me that this phrase is itself  more inflammatory -- and less precise -- than it needs to be.

Technically speaking, pain is considered chronic whenever it lasts longer than it should, given the underlying cause: a successful surgery leaving pain long after the wounds have healed; a broken bone that heals leaving nerve pain  long afterwards; a patient whose successful cancer treatments leave her body  in pain, seemingly unconnected to the disease that has been cured. They say that, as a rule of thumb, if it still hurts after six months, it is called chronic.

But this clinical definition doesn’t fully explain the valence of the term. No one ever says: "she is chronically joyful" or "I am chronically peaceful." Anything chronic is, by definition, undesirable, out of control and, usually, sad.  It is not just that it is with us all the time but that it is with us against our will.  We can make peace with all kinds of unplanned things, but the word “chronic” doesn't suggest a productive peace process. It doesn’t suggest anything fluid or manageable.  When a conflict is chronic, even a ceasefire seems unlikely. It is more like of a war of attrition – it just drags on and on.

And then there is pain. We think of pain as something solid rather than malleable, out of our control, something, at best, to be endured. Most of the time, we feel viscerally that pain is destined to go away.  And it usually does. Except when it is chronic.

When pain is with us, it is also outside of us: it is forced upon us. We feel that we have no control. No negotiation or integration is possible. Pain -- as opposed to, say, sensation – is unpleasant, aggressive and beyond our control. It insists on being in the drivers seat.

And when we put these two words together things really get intense.  With chronic pain, you are up against a formidable adversary.

But when you enter the world of pain management you need to (gradually, step-by-step) unlearn these things in order to regain a sense of control. Until I had chronic pain -- and began to research some of the ways to deal with it -- I never imagined that you could soften pain, work with it, integrate it into your life, to turn pain into mere sensation. All of this is easier said than done. Managing chronic pain is about learning a variety of practices that once sounded flakey to me. These include meditation, biofeedback, breathing exercises and various techniques of occupational and physical therapy that often touch on the seeming minutiae of they way you conduct your daily life.

You learn to distinguish between primary and secondary pain, about how habits of the mind can inflame our pain. You learn techniques to reprogram your brain (really!!) so that you don’t turn a relatively minor pain into something worse  than it needs to be. (BTW: this is something that happens all the time. There is an underlying biological reason for it. It keeps us running from the threat that caused the pain in the first place. But in the case of chronic pain it is dysfunctional: the wild animal that attacked us is long gone, so the “fight or flight instinct” only inflames things further without helping us to escape the predator). I can’t really explain the neuroscience of all this, although some of it has been explained to me over and over. But I can say that as a twenty-first century person, it is hardly shocking to hear that our minds are not fixed and inflexible, that they are constantly changing through various neurological processes and that we can deliberately influence how this happens. I can even believe that the phrase "chronic pain" suggests some outmoded concepts about how our minds and bodies work and about how we can influence them.