“Who, except the gods/can live time through
forever without any pain?”
(Aeschylus, Agamemnon, 458mB.C.)
“Pain and death are part of life. To reject them is
to reject life itself.”
(Havelock Ellis, “On Life and Sex Essays of Life and Virtue,” 1937)
“Who breathes must suffer, and who thinks must mourn/ And he alone is blessed who ne’er was born.”
(Matthew Prior, Solomon on the Vanity of the World, 1718)
“If pain could have cured us we should long ago have been saved.”
(George Santayana, “The Life of Reason: Reason in Common Sense,” 1905-06)
“Pain is inevitable, suffering is optional.”
(Dali Lama)
When folks ask me how I’m doing these days, I reply — in a paraphrasing of the great Mark Twain: “The reports of my demise are not that greatly exaggerated.” Yes, I’m still here kicking and screaming, but lately, like this essay — it’s all about the pain. I hate to bore you with the many details of my current bout with pain, but much of it will be necessary in dealing with the topic at hand. Listen, before I get into this any further, I just want to assure all of you that the initial discussion of my personal situation is just a jumping off point, a segue into a larger discussion of pain that most human beings will experience at some point in their lives. As I attempt to do with all of my essays, these views are not meant to be the final word on the subject, but merely a perspective that I hope will pose some questions — and if I’m lucky —will perhaps answer some questions. With that out of the way, I’ll begin…
At some point in December of 2022, I started to experience the beginnings of intermittent pain in my hamstrings. Not enough to stop me from doing normal, typical everyday things, but still noticeable. I questioned my GP about it and he suggested that I get a spine x-ray.
It showed that over the years, my spine had compressed and that was most likely exerting some pressure on the nerves in my back. So, I said to my doc, “I guess we can blame this on old age?” He smiled and said: “Probably that, as well as the fact that you used to be 5, 8 and a half and now you’re 5, 7.” That’s me, the incredible shrinking man.
Doc said the pain might just go away, but he gave me a script for PT. Well, I started doing some lower body exercises on my own to see if that would help, but after several months, I decided that I needed some professional physical therapy. Two months of that didn’t seem to improve anything, as I continued to experience intermittent pain in the hamstrings, particularly bad in the morning.
I was still functioning fairly well, but what I had started referring to as “sciatica” was beginning to bug me. So, I decided next to see a good chiropractor in the area. I did a program with them for two months and still did not achieve a solution to my basic problem. And, I can’t prove it, but I almost think that the traumatic “cracking” of the vertebrae in my back on the treatment table may have made things a bit worse, if anything. *
*(Note: “One of the most common uses for chiropractic adjustments is to treat sciatica. Chiropractic adjustment may slightly improve low back pain, and it might be a safer alternative to opioids and other pain relievers. Guidelines from the American College of Physicians recommend spinal manipulation for acute and chronic low back pain — even though there is little research to confirm whether adjustments work for this condition; and the evidence on its benefits is limited” {WebMD})
Eventually I decided to consult someone in pain management. There was a local pain and spine institute that came highly recommended. They promoted conservative approaches that included acupuncture, injections and minimally invasive surgery. On my first visit, they felt that my symptoms indicated that I had spinal stenosis of some kind; so, they gave me a steroid epidural injection. It didn’t help in any way, not immediately or even after a week’s time. Then I went for an MRI, after which they gave me nerve-block injections to assist with a further diagnosis. No help from that either. Finally, they recommended a minimally invasive procedure to perform a laminotomy. The result of the surgery? You guessed it: no improvement in my condition whatsoever! All the while, through the weeks and months during which I was attempting to become pain-free, the intensity of the pain kept increasing (I explained to anyone who cared to listen that at times my hamstrings were “screaming”); mornings continued to be the worst time for me. As the hours wore on, with the help of tons of Advil, I was somehow making it through each day!
Okay, since I was getting nowhere fast — or, slow — I thought it was time to move on to a spinal neurosurgeon. Fortunately, I found a highly recommended physician, Dr. Y, at a leading area hospital. He reviewed my MRI, took x-rays and a cat scan, and decided that I needed a fusion at L4-L5. The reason for the fusion is because my vertebrae are out of alignment, with nerves being impinged. Normally, these nerves send signals to the muscles, but in my case those signals are interrupted or interfered with. Since the muscles in the lower back can’t respond, what happens over time is that they get weaker, affecting mobility and causing pain. Exactly my problem. After a date for surgery was established, Aetna, of course, denied coverage until I complete six weeks of PT first. So, sadly, that’s where I’m at right now — in the midst of fulfilling my PT requirement
I know this has been a lengthy and painful read on your part, and I do appreciate you hanging in there all this time. But, trust me, this hurts me more than it hurts you right now. However, I felt that the description of what I’ve been though over the last year and a half would be instrumental in conveying the level of discomfort that I’ve experienced during this long, drawn out and frustrating chain of events. I wanted you to get a real sense of what I’ve lovingly dubbed “My Journey of Pain.”
.Moving forward at this point, you’re probably thinking — and rightfully so — does Frank think he’s the only person in the world who’s experienced pain (albeit, chronic pain)? No, of course not, but since pain has been my unwanted sidekick for months now (seems like years), it’s the very first thing I think about and confront each day, multiple times a day. I don’t want this to come across as “woe is me” in the guise of a sincere and serious essay. But while I’m using my current, extended bout with pain in order to write about the many aspects of it I’m well aware that compared to some family members and friends who have gone through excruciating, almost intolerable pain, perhaps my suffering is probably more like a rough walk in the park. I won’t name names, but there are three or four of those people who I have thought about, admired for their resolve, prayed for — and, to — as I’ve gone through my own pain experience.
Fortuitously, a few weeks ago, while I was firmly ensconced in my pain, wallowing in my discomfort, behold, I happened upon this article in The Atlantic: “Pain Doesn’t Belong on a Scale of Zero to Ten.” I was obviously intrigued and decided to investigate. The concept of reducing pain to a single number dates back to the 1970s. The McGill Pain Index was developed at the venerable Canadian university from which it gets its name. Now, we’ve all been asked by our doctors: “How do you rate your pain, from 1 to 10?” As medical writer Jason Tougaw asked; “How can people know how to rate pain on a scale from I to 10? In relation to what? The history of pain? The pain of others?” (Jason Tougaw, “Pain and Its Metaphors,” Psychology Today, February 9, 2022)
Of course, with my recent foray into the world of spinal stenosis, I’ve been asked a number of times over the last several months what I felt was my pain level. After my PA at the Pain Institute put forth that query, she quickly added; “Of course, if it’s a 9 and a half or a 10, you’d need to be in the hospital.” At that moment, in her office, I was probably at a 6 and a half or 7; but, I had definitely felt that during some of my early morning “attacks” at home I was pushing a 10! Those would be the times when in trying to get up and out of bed I’d be screaming “shit, shit, shit,” or something worse. When I struggled to even pull my pants on, tie my sneakers, or, god forbid, try to pick up something off the floor.
And, speaking of God, over the last number of months I would also occasionally question Him about what I did (in another life?) to deserve this — while always making sure to pray for forgiveness. Not exactly a “take this cup from me” moment, but I’ve definitely been asking for some relief from my burden. So, as you can see, I’m equal opportunity — experiencing both swear and prayer moments.
In the course of my current research, I came across a Pain Rating Scale that actually attaches a description to each number. Geez, what a novel idea. IMHO, it would really help a patient in making a more accurate assessment of their pain level. A printed chart should be posted in any physician’s office where they’re dealing with patient pain:
Most pain scales use numbers from 0 to 10. A score of 0 means no pain, and 10 means the worst pain you can have. Use the list below to find the number that best describes your pain.
0 = No pain.
1 = Pain is very mild, barely noticeable. Most of the tine you don’t think about it.
2 = Minor pain. It’s annoying. You may have sharp pain now and then.
3 = Noticeable pain. It may distract you, but you can get used to it.
4 = Moderate pain. If you are involved in an activity, you’re able to ignore the pain for a while. But it is still distracting.
5 = Moderately strong pain. You can’t ignore it for more than a few minutes. But, with effort, you can still work or do some social activities.
6 = Moderately stronger pain. You avoid some of your normal daily activities. You have trouble concentrating.
7 = Strong pain. It keeps you from doing normal activities.
8 = Very strong pain. It’s hard to do anything at all.
9 = Pain that is very hard to tolerate. You can’t carry on a conversation.
10 = Worst pain possible.
Roughly 30 years ago, “ pain management” became a niche specialty. Physicians even pushed the idea that pain should be measured at every appointment — as a “fifth vital sign.” The American Pain Society “went so far as copyrighting the phrase. But unlike the other vital signs — blood pressure, temperature, heart rate, breathing — pain had no objective scale. How to measure the unmeasurable?” (Elisabeth Rosenthal, Pain Doesn’t Belong on a Scale of Zero to 10,” The Atlantic, June 24, 2024)
Eventually, an increased use of opioids was employed to try and deal with the pain problem. We all know how that turned out. In recent years, other approaches have come to the fore:
“A few drugs — such as gabapentin and pregabalin for neuropathy, and lidocaine patches and creams for musculoskeletal aches — had become available. There was growing awareness of the incredible complexity of pain — and that you would have to find the right drug for the right patients.” (Rosenthal)
(Actually, as a side note, I’ve recently begun taking gabapentin and Tylenol. No impact yet, I’ll let you know.)
Pain is generally divided into two categories: acute and chronic. Acute pain is stubbing your toe or burning yourself on the stove. Once the injury heals, the pain usually resolves itself. Chronic pain can be from a medical condition, such as arthritis or cancer, but in many cases, there is no identifiable cause. Then there is neuropathic pain, which results from damage to peripheral nerves, the spinal cord or the brain, and is most often described as a burning or stabbing sensation. (“How We Feel Pain,” National Vulvodynia Association, 2015)
We know at this point that pain can be very subjective. No two people will probably feel pain exactly the same way in response to a very similar situation or injury. Certainly, each of us has our own threshold of pain, allowing us to tolerate, or not tolerate, a specific intensity of pain. (“The majority of people have similar pain thresholds; however, it has been shown that the threshold of pain can be increased 50% in most people through acupuncture, relaxation hypnosis or imagery. Pain tolerance also varies, and appears to have a genetic component. Some patients are simply less willing or able to cope with moderate levels of pain. “ George R. Hansen, MD, “Management4 of Chronic Pain in the Acute Care Setting,” Science Direct, 2004)
With all of this in mind, here is a list of the 20 most powerful types of chronic pain:
•. Cluster headaches
•. Herpes zoster or shingles
•. Frozen shoulder
•. Bone fracture
•. Complex Regional Pain Syndrome (CRPS)
•. Heart attack
•. Slipped disc
•. Sickle cell disease
•. Arthritis
•. Migraine headache
•. Sciatica
•. Kidney stones
•. Appendicitis
•. Trigeminal neuralgia
•. Endometriosis
•. Gout
•. Acute pancreatitis
•. Stomach or peptic ulcer
•. Fibromyalgia
•. Post-surgical pain
While the above listing is not presented in order of perceived intensity of pain, from my research it seems that CRPS * and childbirth** (which for some reason was not included) seem to rank at the “top of the list” for pain intensity.
*Complex Regional Pain Syndrome/CRPS is chronic arm or leg pain developing after injury, surgery, stroke or heart attack. Exact cause is not completely understood but may involve abnormal inflammation or nerve dysfunction. It is characterized by pain that is greater than would be expected from the injury that caused it.)
(**Obviously, not having had the opportunity to experience it myself, I’ve always heard that the agony of childbirth was among the most intense categories of pain. I’ve always thought that if men were the ones who got pregnant, one guy would tell another what is was like to go through childbirth, and there’d be a lot less births overall. And I’m thinking there would be quite a few vasectomies being performed, probably ending up with way more vasectomy clinics than there are abortion clinics currently.)
So, how can you help yourself in dealing with your specific pain situation? Obviously, there is physical therapy, drugs or surgery. In addition, many people today have investigated using one of the popular pain apps that have become available. Here is a brief description of five of them:
Lin: What makes Lin Health unique is its focus on holistic, personal and compassionate solutions to manage your pain. A web-based app, you can access a team of physicians, pain specialists, psychologists and other experts at any time from the comfort of your own home through your browser, tablet or mobile phone. Lin stands out because of its integrative, multidisciplinary approach.
Pathways: Built around the premise that chronic pain is impacted by biological, psychological and social factors. While the app isn’t tailored to each user, it does offer multiple features that will benefit most people who suffer from chronic pain. Once signed up, users can access a variety of classes on different topics, including physical therapy, yoga, exercise, meditation and pain education.
Curable: Another therapy that applies a biopsychological approach concentrating on the idea that chronic pain is the result of multiple factors. The app provides its users with guided meditations, visualizations and lessons on pain education, training the brain and expressive writing. Curable assigns all users to its virtual chatbot Clara, who fills the role of a chronic pain coach.
Dare: There are many different aspects to online pain management. In the case of the Dare app, its goal is to specifically help folks who are experiencing anxiety, worry, panic attacks and insomnia. After it determines which area pertains to you, the app provides audio clips (they can range from 3 to 20 minutes in length) with soothing music/sounds, breathing techniques, guided training and psychoeducation.
Nerivio: Offers drug-free migraine relief to its users. Along with your app comes a wearable device that has been clinically proven to alleviate the symptoms of migraines. Worn on the upper arm, the device uses a technique called Remote Electrical Neromodulation (REN) to inhibit headache pain. (Shannon Dougherty, “6 Best Chronic Pain Apps in 2022,” Health Insight)
To anyone who has lived on this planet for any length of time, it’s probably obvious that pain and suffering are a key part of human existence. Psychotherapist William Berry has said: “Existence is suffering. Perhaps beneath everything, there is inescapable pain.” (Berry). According to the First Noble Truth of Buddhism, The Truth of Suffering: “Life is full of unavoidable suffering; it can be caused by physical or emotional pain.”(www.britannic.com). Toiugaw writes that “pain is an obliterating certainty. It dominates consciousness. Suspends time. It sees itself everywhere.” And then he quotes Emily Dickinson, in order to capture the philosophical dimension of physical pain:
Pain has an element of blank;
It cannot recollect
When it began, or if there was
A time when it was not.
It has no future but itself,
Its infinite realms contain
Its past, enlightened to perceive
New period of pain.
(Emily Dickinson, The Collected Poems of Emily Dickinson, “Pain has an element of blank,” 1924)
As I mentioned earlier in this piece, each of us has our own, individual threshold for pain. And that’s what makes my pain so different from yours. As Jason Tougaw expresses it: “Whatever pain achieves, it achieves in part through its unsharability, and it ensures this unsharability through its resistance to language.” Tougaw explains further how hard it is for someone to put pain into words; he writes that Virginia Woolf complained that:
“English, which can express the thought of Hamlet and the tragedy of Lear, has no word for the shiver or the headache: The merest schoolgirl when she falls in love has Shakespeare or Keats to speak her mind, but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry.” (Tougaw)
And, perhaps that inability to share with others exactly how our pain affects us — even to those who are concerned and empathetic — would seem to confirm that we are on a journey by ourselves, all on our own, at times a very lonesome journey. It brings to mind the words of Woody Guthrie:
“You gotta walk that lonesome valley,
You gotta walk it by yourself.
Nobody else can walk it for you,
You gotta walk it by yourself.”
As each of us walks through our own, individual valley of pain, we ultimately have to arrive at a decision about how we need to proceed, how we need to address the situation, how we have to cope — in order to get to the other side. British journalist Cameron Walker wrote about her own dealings with chronic hip pain and how she came to a new understanding of her suffering: “Things started to shift when a new physical therapist described pain not as a threat, but as information I could use.”
On the Curable pain app, they presented this idea;
“Our nervous system gets programmed over time by all of your life experiences, and your responses to these experiences. And, prolonged periods of stress, or just feeling unsafe, can cause the nervous system to get set on a very sensitive setting. It’s been trained to anticipate threats, be more responsive to threats, and get a little more trigger happy with the fight or flight syndrome, which can actually produce or intensify pain symptoms. So, the person who has this type of nervous system is probably more likely to develop chronic pain.”
Sounds like a promising theory, and if this describes you, don’t worry, they say they can help you out.
I’d like to go back to a quote by the Dali Lama from the beginning of this essay: “Pain is inevitable, suffering is optional.” I take this to mean that though all of us will experience pain, some of us will somehow, in some way, choose not to “suffer.” Be that by using the Curable app or others like it to work through the pain. Or, perhaps to compartmentalize and view the pain as additional “information” to help find a positive solution. Perhaps to just suck it up, bear the pain and offer it up in the name of someone else’s suffering.
A few writers throughout history have suggested that perhaps it is simply a matter of will, of overcoming what the pain intends to inflict upon us by not giving in and not accepting the suffering. Personally, I’m doing my best on that front, but it ain’t easy. And, for me, some days are better than others. Or perhaps I should say some days are not as bad a others. Some days I see the glass half full, other days, half empty.
Ultimately, each of us has our own personal pain and we must embrace it and try to overcome it in any way, by any means, that we can. I’ll end with three possible proposals for dealing with pain in our lives:
“Life is not without pain; but life concerns itself with how we handle that pain, or joy, or confusion or triumph.” (Michael A. Stackpole)
“Much of pain is self-chosen/It is the bitter potion by which the physician within you that heals yourself.” (Kahlil Gibran, “On Pain,” The Prophet.)
“If you are distressed by anything external, the pain is not due to the thing itself, but to your own estimate of it; and this you have the power to revoke at any time.” (Marcus Aurelius, Meditations, 2nd C.)
——————————————————————————————————————————————————————————————————
Resonance 