The Pain of One’s Life
Dedicated to the strongest fighters and most resilient survivors who are fighting their battles against chronic pain in silence.
“Pain is inevitable, suffering is optional.”
— Haruki Murakami
Murakami is right about the inevitability of pain. Beyond a doubt every one of us has felt — and will again feel — pain as we live and breathe. So universal is this sensation, it has become easy for us to overlook the nuances, hence allowing chronic pain to elude us.
For most of us, acute pain is a byproduct of an injury or disease. Its duration is short, and it dissipates as injured tissues heal. Its purposes are adaptive: to warn us that not all is well, encourage us to seek medical attention and prompt rest and recovery. Chronic pain, on the other hand, shares none of these characteristics. Its definition, according to the International Association for the Study of Pain (IASP), is pain without apparent biological value. Not only does it persist longer than the usual healing time, the pain is also non-responsive to treatments and often intractable from its sufferers.
On a scale of one to ten, chronic pain fluctuates erratically over time. Some days chronic pain patients are greeted with a lenient three or four, while others they are ambushed by ruthless paroxysms of nine. There is no roster or cycle for the dynamic of pain levels, nor is there any underlying pattern to anticipate and brace ourselves for. Its unpredictability is a raging sea of randomness that drowns out our innate inclination for rhyme and reason. With a myriad of variables in the equation of chronic pain, pain is the only constant.
But perhaps what warrants visibility more — preceding the condition itself — is its virulent repercussions on one’s mental and emotional well-being. Acute pain however unbearable, is made less so by the assurance of its brevity. There is unfortunately, no light at the end of the tunnel for chronic pain patients, so to speak. Perpetual anguish is aggravated by the trepidation of what seems to be a never-ending series of suffering, and indeed that can break a person from within. It robs us of our exuberance and kills any hope of recuperating, leaving behind self-loathing, nihilistic sentiments that consume our thoughts like parasites.
As much as people with chronic pain dislike it, our inadequate understanding of pain circuitry has narrowed their options of pain relief down to narcotics and surgical anesthesia. After all, if the pain cannot be treated the alternative would be to numb it out. But drugs have always had a bad reputation in both history and the status quo. With drugs always came addiction and subsequently, the deterioration of both physical and mental health. Influenced by this stigma, health policies are therefore structured with the aim of curbing substance abuse — rather than the recuperation of patients — in mind. Despite the best of intentions, this hinders chronic pain patients from accessing their sole avenue to alleviate pain. Perhaps we can learn a thing or two from Portugal and emulate their approach. With that being said, the recent prominence of behavioural science may introduce prospective coping mechanisms which omits the side effect of opioid addiction.
There is however, a fine line of distinction between exploring the psychological approach and labelling chronic pain as a mental disorder. Clustering chronic pain as a psychopathology simply because somatic and neurological expertise cannot fathom its intricacies is an act of wilful ignorance. The excessive emphasis on cognitive processes in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) creates an “it’s all in the head” misconception; that the pain is not real but merely imagined. Given the weight this literature carries in the field of mental health, this fallacy could pervade across both laypeople and practitioners — the latter resulting in misdiagnosis or malpractice.
Pain is also idiosyncratic, so while other people may or may not relate to certain extents, there remains a part of pain that is personal to the sufferer. Imagine pain receptors and neurons incessantly firing up without rest; chronic pain patients live in a mundane routine of exuding pain so traumatising it drives people to the brink of their sanity. Trivial errands become unattainable luxuries that require ample effort to complete. Its debilitating nature thus molds antisocial tendencies in people with chronic pain: cancelling plans by the eleventh hour, abrupt taciturnity or reluctance to deal with other people. Their desire for companionship is masked by a facade of surliness, and the least we can do is refrain from ostracising them. Remarks like “you don’t look sick” or “just take more painkillers” are repulsively insensitive, and only add insult to their injuries.
But is suffering really a choice, as Murakami suggested? Chronic pain patients beg to differ: the only choice they are left with is Hobson’s choice. For them, suffering is not an option but an eternity. They envision a world without pain; a world where ibuprofen and paracetamol are sufficient for pain relief. While that may be wishful thinking, good rapport with the chronic pain community is not.
