Welcome to the current newsletter issue of
Advances in Medicine (AIM) - Take AIM against pain.
Feel free to send me an e-mail with your own thoughts
and experiences. Email: timsams@mypainreliefdoc.com.
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VULNERABILITY
The day-to-day suffering from pain is mostly intangible and
utterly unique. Some people believe it gets easier the longer
you hurt, but this is usually a myth. Your resistance to pain
wears down and your biochemical pain tolerance decreases.
For many people, it gets steadily more difficult to manage
life's demands with pain. It can feel like no one could ever
understand the first half of your suffering, and the second
half, you can't articulate well enough even to yourself. This
is especially true of the sense of vulnerability and fragility
that chronic pain can cause.
Most people perceive themselves as having been nearly
invulnerable before their pain. The memory of psychological
stresses and the strain of daily hassles fade in the reality of
current pain. Physically, you were so much more functional and
effective than now. You had so much more energy. You could and
did keep going. You counted on your body to help you through
the difficult times. You could be sleep deprived, exhausted,
even sick, and usually still kept going. Second and third winds
were just around the corner. You could cheat your body,
overextend yourself, and proudly get away with it.
With pain comes the inevitable chronic fatigue or lethargy.
Second and third winds are not waiting for you. When you
overdo, you pay for it-big time. You can't count on your
body to carry you through, or to keep going, no matter what.
You may develop a sense of fragility-an awareness that you
have limited energy and you'd better budget it.
Physical limitations bring a sense of vulnerability. It may be
nearly impossible for you to perform daily activities like
laundry or shopping that people take for granted. Your
awareness of this reality can fill you with dread. You may be
afraid of being caught out with other people in so much pain
that you can't function mentally or physically. You may fear
being dragged by others into an event or series of activities
that you know you will pay for.
Around every corner is encouragement to overdo-to cause
yourself more pain. Some people have the types of pain (low
back, knee, etc.) that make them afraid of being in crowds, of
being knocked down, or pushed. This is especially true if you
need help ambulating with a cane. For some people, a simple
touch in the wrong spot can be excruciating. You may find
yourself in crowds feeling tense, hyper-vigilant, and hardly
able to "enjoy the moment." This profound sense of physical
vulnerability and fragility is part of what drives people to
hole up in their houses, over time making it less and less
comfortable to be outside with others.
There are often dramatic psychological fragilities as well.
Before pain, you may have prided yourself on your memory,
perseverance, common sense, problem-solving, multi-tasking, or
being proactive, or goal-oriented. After pain, you don't
sleep as well; the meds have an effect, as can depression,
anxiety, and the stressful sequelae of pain. Your memory may
deteriorate, particularly for the incidental things that happen
in a day. Your ability to concentrate, to read, even to follow
a storyline on TV can be impaired. It gets harder to problem
solve, and to organize your activities.
When single-tasking is a challenge, multi-tasking may feel
impossible. Your awareness of these changes can make you feel
vulnerable and less safe with your own function. It would be
natural to feel increasingly out of control and incapable of
caring for yourself. Unfortunately, the worse your pain and
function, and the greater your insight into your pre- and
post-pain changes, the more vulnerable you will feel.
If you have people in your life to lean on, you may find
yourself relying on them more than you have to. When you feel
hurt and scared, it is easy to be more dependent on others than
is necessary. If you refer to the most significant person in
your life as your "caretaker," you are probably more
dependent than you have to be.
If you are obsessive-compulsive leaning, or functioned at an
extremely high level before pain, the pre- and post-pain
differences can be terrifying with a profound sense of
"losing it," and a desperate need to hang onto stability, wherever
you can find it. You can imagine the terrible choices this state of
mind can lead to. Every day I see people who have abandoned the
most basic responsibilities to their significant others, driven
largely by their tragic sense of fragility and incompetence,
and the desire to feel secure by relying on another.
Blended into this sense of fragility is the natural devolution
from aging-the loss of inexhaustible energy, boundless
optimism, and the belief that we can make things better. If you
are fifty-seven years old with a twenty-year history of pain,
it may not be your pain that prevents you from playing in a fast
pitch hardball league. Chronic pain inevitably makes you feel
like you are aging prematurely, even if you aren't. Yet, the
younger you are when your pain starts, the more infirmed you
may feel in comparison to same-age peers. People in their 30s and
40s are still expected to function at a high level (I can't wait
to turn 50).
I can offer you a few, over-simplified strategies for dealing
with this sense of vulnerability and the existential fear it
causes. Get in the best physical shape you can. If you are not
exercising daily, you are making yourself more fragile daily.
Vigorously, relentlessly maintain as many of your previous
activities as possible, modify or dump some, or take on new
ones, which are more consistent with your physical condition.
When simple fear challenges you, go over, around, or through
it, but never retreat. Use any scary event as an opportunity to
feel a little less vulnerable, and a little stronger. Finally, try
as hard as you can to maintain a structured day. Part of what
keeps anyone going is the momentum of structure and familiarity. A
body at rest tends to stay at rest, and dependent on the world
around it.
You can be stronger. You can feel stronger and more confident.
One day at a time, one moment at a time, you can feel less
vulnerable and fragile. What can you do this moment?
Good light,
Dr. Tim Sams
My Pain Relief Doc
www.mypainreliefdoc.com
Copyright 2007. Dr. Tim Sams and My Pain Relief Doc.
All rights reserved. www.mypainreliefdoc.com
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include the entire article, along with the web links
and copyright information. Thanks, Dr. Tim
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