The most recent MMWR report on the prevalence of chronic pain from the US Centers for Disease Control (CDC) continues today’s unfortunate trend of over-dramatizing chronic pain and feeding the frenzy that sends the message “this is horrible; medical science has gotta DO something for these poor people!” There are simply NOT 20 million people in the USA suffering constant agony from debilitating chronic pain. There ARE a lot of people with chronic aches and pains, and most of them are coping with it just fine, thank you.
The two crude questions that the survey asked people to answer -– and the way their answers were interpreted, especially the way they defined “high impact pain” -– makes pain look like a bigger impediment to a good life than it actually is -– for most people. And, more importantly, I believe the list of questions failed to identify the group that most desperately needs better help.
Information about pain was collected through responses to these two questions:
- “In the past six months, how often did you have pain? Would you say never, some days, most days, or every day?”
- “Over the past six months, how often did pain limit your life or work activities? Would you say never, some days, most days, or every day?”
Chronic pain was defined as pain on most days or every day in the past 6 months. High-impact chronic pain was defined as chronic pain that limited life or work activities on most days or every day during the past 6 months
Aches and pains, both short-lived and long-lasting are an unavoidable part of everyday life. Acute pains are the result of being out and about, being active, and using the body like it is designed to be used — exercising muscles harder than usual, dropping something on your toe, tripping over a curb, or getting a sore throat or a tension headache. Chronic pains are usually the residual of various kinds of accidents, illnesses, traumatic events and other untoward events in life — including the progress of aging.
To me, that means PAIN as well as LOSS — and adapting to them — are “natural” consequences of being alive. How many people who have lived a full and eventful life have no “scars” or “tricky joints” of any kind to show for it? How many old people have you met who DON’T have any aches and pains? The question is: how do we view our pain, how do we manage it, and how have we adapted to it?
I, for example, am old. And I meet the CDC’s criteria for chronic pain, and even for “high impact” chronic pain. I have some pain in the joints of my hands and feet due to age-related osteoarthritis — with maybe some extra wear and tear on my feet due to several years on tiptoe and in toe shoes as a dancer more 50 years ago! My fingers and toes ache virtually every day, especially when I move them a certain way or use them a lot — or I part my hair on the wrong side 🙂
The range of motion in some of my fingers and toes is limited. Sometimes a nerve gets caught on something inside my foot — which suddenly creates a searing stabbing pain – which hurts like stink. My stiff, increasingly deformed, and chronically achy finger joints have certainly affected my ability to use my hands for forceful pinching and gripping. I have also had to adjust the kind of shoes I buy, and sometimes I have to avoid walking long distances — on those days when my feet really hurt. Sometimes, the numb, burning sensation in my forefoot forces me to limp. When it gets too bad, I have to stop walking and attempt to “readjust” the position of the structures inside my foot. A successful adjustment is accompanied by a clicking sensation and a sharp searing needle-like pain, and then complete and sudden relief.
However, I don’t believe I’ve ever taken an aspirin or tylenol because of my chronic joint pain. I have not gone to a doctor about it because my discomfort is quite tolerable, the extreme pain is very occasional, and I have no need to do a lot of physically-demanding walking or gripping. And I am certainly not interested in surgery – I see little point in allowing someone to muck around in the complex structures of an old arthritic foot that is going to continue to get MORE arthritic due to natural processes.
In short, I am quite able to work around my chronic pain. I have adapted to it, and quietly and without (much) whining made adjustments in what I do and how I live. Perhaps others would not approve of my personal adaptation strategy — I’m awfully sedentary — but it is working for me. My pain is NOT dominating my life, is NOT the main focus of my attention, and is NOT sucking the joy out of my existence. In fact, I am really enjoying my life as it is.
The people whose pain IS dominating their lives, IS the main focus of their attention, and IS sucking the joy out of their existence are the ones who most desperately need help. And maybe what they need most is a re-orientation – to make LIFE the point of their life and learn techniques for how to control their own symptoms and put pain on the back burner of their brain — instead of keeping it on the front burner as a blinking red bad and pressing problem that must be solved.
So, personally, I think we should stop talking about pain and loss as though they are terrible things that shouldn’t BE — and instead make it clear that the job in front of us is to learn how to (1) adapt to and cope successfully with the unavoidable and unpleasant things that happen while we are alive, AND (2) find ways to minimize their impact on our everyday experience by focusing our energies on creating a good life anyway.
Over the last several years, I have been following the science of pain treatment and collecting tools and resources that can help people learn how to achieve a victory over their chronic pain. Among many other techniques, acceptance and commitment therapy (or ACT) seems to be a very promising technique in this regard. So are several other techniques that help people who are stuck living with pain give up on being angry at it or trying to “get rid” of it. That’s because our brains are arranged so that what we pay attention to stays on the front burner. What we resist persists.
The American Chronic Pain Association’s website has a wide array of free and low cost resources for people living with chronic pain and who want to move “from patient to person” again. Among my favorites are the ACPA’s Ten Steps From Patient to Person and the ACPA Resource Guide to Chronic Pain Management which begins with self-directed therapies. The ACPA also has a network of chronic pain support groups in local areas.
Dear Dr. Christian,
I love your attitude of self-reliance and staying active as an approach to your pain and to life in general. However, as a doctor who treats thousands of patients each year, I can tell you that this approach does not work for everyone. There are individuals with pain who are debilitated. There are individuals with pain who take a lot of pain medication to function. There are individuals with pain who can’t go to work and there are individuals with pain who can barely take care of themselves.
This speaks to the heterogeneity of the human experience. Some of the principles you have described are invaluable (stay active, pay attention to things other than your pain, etc.). These are part of the pain program I use, and described in my book, Think Away Your Pain. However, I would not minimize the impact of chronic pain. There are half a million patients subjecting themselves to major surgery (spinal fusion) for back pain alone, each year. Chronic pain is a huge problem and we need better approaches. I personally find that exploring the psychological context is crucial in many patients. (published research as well)
I look forward to continuing a dialogue about diagnoses, methods and approaches that combine the best of what you’ve written here and a more nuanced bio-psycho-social perspective on health and illness as well.
David Schechter, M.D.
I’d like to share this story that carries the essence of Jennifer’s remarks. On a 2016 cross-country flight, my new seat companion eased herself down to buckle up, upon boarding. She introduced herself graciously: she was 85, a retired RN, professor and (former practitioner) of neurosurgical nursing. With a smile, she admitted feeling “a bit creaky.” Her spritely manner belied this, though she also seemed sage, even grave in her remarks. An unexpected delight was a wide-ranging, friendly conversation addressing the gamut of our respective families, professional training and work, and finally, our respective beliefs and values about work and life.
A standout remembrance, told nearly as a parable for the perplexed, was a remark she shared with me, once offered by her “favorite young surgeon.” “The best thing that can happen to a person,” she passed along in his words, “is to come down with a serious diagnosis of chronic illness, not necessarily life threatening. The thing is to experience this when old enough to understand the responsibility we all have for our own health, whether ill or not; and while young enough to learn how to live effectively with it.” My seatmate told me she believed this was the secret to a predominantly healthy life, though she herself “couldn’t get out of bed every day now, and do anything worth doing, without a gulp of water and a hydrocodone.”
Warmly serene, kindly but wry in her reflections, she seemed as gracious as we deplaned 3 hours later as she had been, settling down. I felt I’d met a secret treasure in human form! She spoke straight to my heart and mind, 17 years then since I was first diagnosed with rheumatoid arthritis. “The job in front of us is to…adapt to and cope successfully…with the unavoidable and unpleasant things AND find ways to minimize their impact.” I’ll add, we do best celebrating little victories every day, and sharing received wisdom.