Monday, 16 February 2015

Not necessarily a good thing…

Engaging in thoughts or activities that distract attention from pain is one of the most commonly used and highly endorsed strategies for controlling pain. The process of distraction appears to involve competition for attention between a highly salient sensation (pain) and consciously directed focus on some other information processing activity.

Fourteen years ago, after suffering with permanent pain that could only be controlled (but not eliminated) by medication, with side-effects that were – in many ways – just as bad for me (and probably more destructive of my health: chronic pain cannot kill you; only the resultant physical and mental stress – unless you deal with it…), I enrolled on a pain management course, at the insistence of a very wise, and considerate, medic – Dr James de Courcy: a genuine everyday hero. (There aren’t many: which is why I will always remember his name and kindly face.) Even though the first pain management programme was established in the UK over thirty years ago, in Walton, by the remarkable Dr Chris Wells, such facilities were still pretty rare, outside of the United States; and I therefore felt immensely fortunate to have been given the opportunity.

It takes a certain kind of person to go through such an experience successfully, though – especially as you have to, before making any sort of forward progress, dig deep (and honestly) into exploring every facet of your pain, and how it affects you. (More of an ordeal than an audition: when you would do anything to make your pain go away.) A good programme, though – and the one I attended (and then went back to talk on, many times), now called the Gloucestershire Chronic Pain Service, certainly was – will then, mentally, ‘take your pain from you’ temporarily: only handing it back, in stages, as you are able to deal with it. It will also help you learn to get to grips with the depression that is frequently – and not surprisingly – a consequence of living in a body that you are no longer at ease with – in fact, may feel at war with. (Yes: pain is partly experienced in the brain – where, cruelly, it overlaps with your emotional centres – but not in an ‘it’s all in your head’ way. You are not in physical pain because you are depressed: if you are depressed, it’s because everything, and everything you do, hurts like hell. Permanently.)

The biggest benefit of the programme, though – apart from all the non-drug-related techniques you learn: which soon become a routine, reflexive part of your life – is spending time intensively in the company of people with similar histories. (I was a relative freshman, though: with only just over four years of constant hurt under my collar; some brave souls had lived with unspeakable – and unspoken of – agony for decades.) An amazing, amazingly happy camaraderie therefore quickly developed: and, for quite some time after, we would meet up for monthly get-togethers – always smiling and having a laugh, despite the invisible challenges we all experienced, shared, and understood. It was good to know that you weren’t alone. It was also good that, if something was troubling you, even years later, the medical staff would welcome you back, unconditionally. (A ten-week course is one thing: but it takes a lifetime to learn how to live with something so disabling – especially as it never leaves you; but grows old with you; and grows as you get older.)

Coping is not ignoring. In fact, it is the opposite… [learning] to live with… pain in a realistic context… the beginning of a series of steps that give a sense of understanding and a type of control.

Many of the pain management – or control (as in commanding, directing, influencing, regulating, restraining, etc.) – techniques learned (not really taught) involve mainly…
  • exercise – good for releasing endorphins (as I have mentioned previously); as well as keeping you fit enough to cope (see the above quotation – written by a very great man indeed – which has become something of a Bardic precept: which is why it will probably crop up yet again at some stage…);
  • relaxationessential for coping: which is why I still have Dr Polly Ashworth’s calming voice on my iPod, to talk me through a well-rehearsed series of relaxation ‘exercises’ – although mindfulness has recently become predominant; and
  • distraction – as well as, probably more powerfully, a combination of both relaxation and distraction (which for me, frequently involves reading and writing – the more I am in pain, the more I tend to write…).
After all that is said, though – and done… – “Many wise, calm, confident optimists still have chronic pain.” And, just because you’ve managed – on a good day – to get out for a walk; read a whole book (Robert Graves’ weird, wise, but wonderful Seven Days in New Crete, the other day); gone through your breathing routines several times; doesn’t mean that the pain is any ‘better’. It will never get better, either – comparatively, and completely – but you can make it feel so: at least for a while; if you wish.

Even though it is not part of any pain management programme that I know of – because it is about tackling acute pain; although it does involve distraction – I had known about (mostly from hard-won experience) the “hypoalgesic effect of swearing [which shows] that the use of profanity can help reduce the sensation of pain” for some time – and remember having it confirmed, very late one sleepless night, watching an episode of MythBusters entitled ‘No Pain, No Gain’. What I didn’t know – and what comes as a great disappointment – is that “This phenomenon is particularly strong in people who do not use such words on a regular basis.” Or, as Dr Richard Stephens, from the University of Keele’s school of psychology – who came up with the idea for the study “after swearing when he accidentally hit his thumb with a hammer as he built a garden shed” – put it: “Swearing is emotional language: but if you overuse it, it loses its emotional attachment.” Bugger.

It seems now, though, that simply uttering “Ow!” (or your local derivative – most of these words being quite similar, aurally and orally, across the globe) has the same outcome: modulating pain – possibly – through a “simple sound that requires little articulatory control, while maximising volume output.” As the NHS Choices webpage that also reports the recent experiment – which was peer-reviewed – cautions, though:

The research team weren’t able to explain the biology behind their result, but speculated the automatic messages travelling to the vocal part of the brain may interfere with the pain messages. But this was speculation and is not proved by the study itself….
     Overall, we should take the results of this study with a pinch of salt. More evidence on the topic needs to accumulate before we can say vocalising pain helps people, or we can devise ways this could be useful to people in a healthcare setting.

Heinrich Heine when gravely ill wrote “Thank God that I have a God again so that in extreme pain I can allow myself to curse and blaspheme. The atheist is denied such solace.”

In a similar way to swearing, or just yelling meaningless expressions of pain; pleading to a god, or chanting a religious incantation – for example, the Buddhist ‘medicine’ mantra “Tayata Om Bekanze Bekanze Maha BeKanze Radza Samudgate Soha”: especially in its use of prolonged distraction (akin to mindfulness – see below) – although perhaps not strictly comparable – may help those who believe in some form of deity. But I do wonder whether such obvious “emotional language” (as Dr Stephens warns, above) loses or gains in power, as a result of its already deep meaning to the devotee. Perhaps what gives it such potency is a form of comfort, or conviction? Certainly, when shown images of the Virgin Mary, “Brain scans of volunteers who were subjected to electrical shocks revealed that Roman Catholics felt less pain than atheists and agnostics” – a source of pain relief that is not only “based… on the power of the mind”, but which must also depend on deep faith and veneration.

Research has also discovered that “Religious persons were less likely to have chronic pain” (or admit to it?); but that, when suffering such permanent pain, “Individuals… were more likely to use prayer and seek spiritual support as a coping method” – which is eminently understandable. Religion and spirituality may, however, cause an increase in pain in some: “perhaps by an unhealthy focusing on negative symptoms or through the physical manifestations of hysteria, as claimed by Freud.” And, “Although chronic pain patients today reap enormous benefits from the explanatory and therapeutic power of scientific medicine, science does not answer questions that are inevitably raised by the chronic pain.”

Perhaps then, all a pain management programme need achieve (on top of those rigorous scientific explanations and methodologies) – and which, I believe, from experience, they already do – is (especially for non-believers, such as myself) demonstrate a parallel method of invoking the psychological well-being and efficient coping strategies that come with (or are part of) faith: instilling a systemic/systematic belief in all attendees that they can reach Nirvana, and attain some form of control over their suffering – particularly through “consciously directed focus on some other information processing activity”. Relaxation and mindfulness (which can trace its roots to the Buddhist practice of Sati – one of the steps to enlightenment), I think, can be seen as analagous to prayer, in many ways – certainly to meditation. And sharing your experience with those with identical goals forms a congregation of intense support – both physical and spiritual – watched over, and directed, by the clergy of psycho- and physiotherapists, anaesthetists, and other specialists.

I do not believe that sheer suffering teaches. If suffering alone taught, all the world would be wise, since everyone suffers.
– Anne Morrow Lindbergh

Strangely (to me), though, “suffering plays an important role in a number of religions” – but not just in trying to relieve it (compassion and charitable acts that I do understand, of course; and which, to me, are organized religion’s best aspects). Nobody expects the Spanish Inquisition; and yet I am always horrified to see – usually, for Christians, during Lent; although other religions also practice such ‘purification’ rituals – photographs in the news of people (usually men; and that I can only describe as ‘fanatics’) trying to gain “spiritual advancement through… self-imposed trials (mortification of the flesh, penance…)”: scouring their own backs or legs (scourging their own souls) with what appear to be instruments of torture; or even going so far as to re-enact Jesus’ crucifixion. There is also a long tradition of religious fasting and other hardships: which are seen as (demonstrative?) steps on the road to some form of ‘higher’ meaning.

I would do many things to try and ameliorate the intense pain I suffer (which I do not believe is punishment from any sort of god: because I do not believe in any sort of god): but I do not hold that my experience of such continual distress and discomfort – “virtuous suffering” – makes me in any way a ‘better’ human being; nor do I believe that, were I permanently painless – i.e. ‘normal’ – I would deliberately subject myself to such flagellation to make myself one; or pay penance for what others tell me are my sins. Self-harm in any form is in no way “good for the soul”.

Surely, it is better to try and reduce the amount of suffering there is in the world? “Chronic pain is a major clinical challenge: across Europe approximately 18% of the population are currently affected by moderate to severe chronic pain.” So, if long-term pain affects you, personally, please see your GP for a referral to your nearest Pain Management Programme (PMP) as soon as you can. Or start by ordering yourself a copy of Robert Lewin’s The Pain Management Plan – which is often used as a self-help resource alongside many NHS-delivered programmes. Whatever your beliefs, such courses do help: and will provide you with strategies and techniques that will improve your quality of life, for the rest of your life. You certainly do not need to suffer in silence – or alone.

I hate pain, despite my ability to tolerate it beyond all known parameters, which is not necessarily a good thing.
– Hunter S Thompson

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