(56): Fear and Pain: Thoughts on a Common Dilemma of Chronic Pain Sufferers
The Litany Against Fear
“I must not fear.
Fear is the mind-killer.
Fear is the little-death that brings total obliteration.
I will face my fear.
I will permit it to pass over me and through me.
And when it has gone past I will turn the inner eye to see its path.
Where the fear has gone there will be nothing. Only I will remain.”
— Frank Herbert, Dune, 1965.
When I first read Frank Herbert’s epic science fiction novel Dune, I was immediately impressed by the Litany Against Fear, the first use of which was by the young protagonist Paul Atreides as he was taking a particularly daunting test given by the Bene Gesserit sisterhood. The whole test was a box with an open end, into which Paul must place his hand. He is warned not to pull his hand out of the box no matter what. To emphasize the no matter what part, the Reverend Mother holds a small thimble-like metal finger sock with a needle on it to his neck. This, the gom jabbar, is impregnated with poison. If he pulls his hand out prematurely, he’ll be killed. So this is literally a life-or-death test.
The box, on the other hand, is an unknown, that is until Reverend Mother warns Paul that he will feel pain such that he has never known. This warning is given to spark the fear through knowledge of pain to be inflicted. He doesn’t know exactly how much or what kind of pain he will feel. But he knows that if he gives in to the animal impulse of the immediate moment, to escape the pain by pulling his hand out of the box, he will not only fail the test, he will die. So, is it easier to keep his hand inside the box because of the certainty of his own death should he remove it? In a way, I think it would provide just the motivation needed to endure the pain, but only if one analyzes the situation rationally as a human (for it was a test of humanity). After all, the pain and the test won’t last forever, will it?
Fear of Pain is a Daily Test
People like me, who suffer with chronic pain, also have this fear of future pain. However, we do not have the absolute structuring of the authority of a teacher promising that, if we react against the pain in a visceral, animal manner, we will instantly die. No, our fear is that the pain will make us wish we were dead, without the promise of an instant release. And there is also the uncertainty of just how bad the pain will be, so that the idea of dying to escape it is not always the most attractive option. We can outwait it, perhaps, or hold out hope that it will get better, at least for awhile. In this way I think the experience of chronic pain is a sort of mockery of Paul Atreides’ black box test. We pass it one day, only to be confronted with it again and again and again every day.
But isn’t life precisely this sort of ongoing test? Sure it is, but there is often remission of real life tests, a period given to us to rest up from our labors and return afresh to the fray. Often, we can choose to withdraw for a space of time, to recover. With chronic pain, there is no remission. We cannot simply take a vacation from it without consequences. We must take life’s tests on top of this ongoing background pain test. Thus, we’re always taking two tests at once.
My own black box test is the open-endedness of chronic pain, the knowledge that I’ll have to deal with some level of pain, and I’ll want to escape it. I’ll want to medicate it so that I don’t suffer as much. But the threat here (my gom jabbar as I recognize it) is the slow death of escalating tolerance and potential addiction that comes with the use of opiate and opioid analgesics. Those fears keep me walking the line on the edge of comfort. I endure a low level of constant pain so that I can avoid the walking, spiraling death of addiction. The test of chronic pain goes on forever, as long as I’m able to put up with it, or until I can find a way out of it.
The fight against chronic pain is not the only test I face, nor do others who do not suffer with chronic pain escape these tests. Life is full of such challenges. I fail these tests in other areas, such as interpersonal communication, and as a result, I am becoming isolated, at least in the physical world. I suppose it is lucky for me that each test of this type doesn’t come with a stern Reverend Mother holding a poisoned thimble to my neck. I’d have been dead long ago. All I can do is to be aware and work to identify areas in my own life where I’m avoiding the hard path because of fear.
Non-Pharmaceutical Coping Mechanisms
In a small way, I try to work through the pain by maintaining physical fitness activities such as yoga, swimming and weightlifting, but, adding to the fear side of the ledger is a relatively recent intensifying of pain in several areas of my body, mainly my lower back, neck and arms/shoulders. This has forced me to pull back on my physical activities, thus sparking incipient fears that one of my main coping mechanisms might be failing me.
I fight to maintain my regimen. I haven’t lifted any weights worth mentioning for a few months, but I still practice yoga (modified to accommodate my increased pain) and lap swimming. I haven’t managed to implement meditation to any regular extent in my practices, but I believe it might be the next step for me, as my physical practices become more difficult.
Fear Instigated by the Pain Clinic System
One fear that most pain sufferers who are obliged to report to a pain management clinic to obtain narcotic pain relieving medicines is that somehow they will run out of that medicine and be unable to obtain refills or stronger medications due to legal or bureaucratic strictures. The pain clinic I go to is invariably crowded with lots of other sufferers, most of them as old or older than I am. In most cases, their well-being is tied to their ability to have the proper pain medications when they need them.
I have experienced this fear of imminent runout many times, due to the extraordinary difficulty of getting in touch with the office to obtain a refill or reauthorization. When this happens, I must shepherd what pills I have left, lowering my dosage to avoid runout and withdrawal. This always entails extra pain. So I fear this situation. Even when I take pains to ask for a refill well ahead of runout time, the pain clinic is so inundated with calls and messages that I usually don’t get ahold of the helpful parties until the very last minute. And even then, I don’t know if there will be a hitch that will result in denial of medication. Can you see how this situation can cause a very real and rational fear of pain beyond the normal everyday “controlled” variety?
Fear Tied to Pain: Can it be Controlled?
My fondest wish is that this 18+ year bout with chronic pain I’ve fought on and off might disappear in a puff of logic (as Douglas Adams puts it) were I to completely lose my fear of being in pain. After all, pain is processed in the brain; if I could convince my brain that I’m NOT in pain, then perhaps it would all go away, just like turning off that black box with the power of my mind. So perhaps my own proof of humanity, as the Bene Gesserit sisterhood might define it, is the hope that fear=pain, and that to conquer fear is to conquer pain. This might be magical thinking, but it’s a working hypothesis that I reserve the right to modify as circumstances and information change.
There is research that points to fear as a definite influencing factor in a person’s experience of pain, and this, at least, is a reason to work on identifying my fear reactions and trying to minimize them to the best of my ability. That way I can hold out hope that I don’t inadvertently cause myself more pain than is already being induced by physical and neurophysical causes.
After the pain has gone on for long enough, can we differentiate pain from suffering, which incorporates fear as an integral part of the pain experience? As for my ability to conquer fear, well, I’m working on that. When I’m battling not only the fear but barely controlled chronic pain, that battle is twice as tiring and demoralizing. Sometimes, a good mood only lasts as long as tramadol takes to wear off. That isn’t very long, and it’s getting shorter all the time.
Note: The first couple of paragraphs of this post are taken from an earlier post of mine.
