The Modern Survival Guide #79
This is the Modern Survival Guide, a guidebook I’m writing for things I think people need to know about living in the modern world. The views expressed here are mine, and mine alone. And I am currently in a lot of pain. It was almost fortuitous, in a weird way; a couple of weeks ago I woke up, turned my head to the left, and fell over in bed from a pinched nerve. I was going to do this article anyway, but now I have a better perspective. Thanks a bunch, universe. Good timing.
So — it has been said that whatever doesn’t kill you makes you stronger. That’s bullshit. Usually, whatever doesn’t kill you puts you in pain, either temporary or permanent, possibly debilitating, always with a negative impact on your life. That’s a major issue for our modern survival, because the modern world (at least the modern American world) is not set up particularly well to accommodate people in pain. And eventually, every single one of us will be in that position. It’s as inevitable as breathing. We are all temporarily able-bodied.
Bodily pain is in all of our futures, and it dominates the present for a huge number of people. It behooves us to understand it — what it means, what it does, and how it affects us.
What is Pain, Anyway?
This is one of those things that seems simple but is actually kinda involved. What we call “pain” is the result of a huge variety of potential factors, some of which are intertwined.
All pain is the result of nerves receiving a signal that a Bad Thing is happening. They then report that the Bad Thing is happening, and your brain interprets that report as one of the types of pain we can feel. Sometimes your brain provides the information that a Bad Thing is happening all on its own and cuts out the middleman.
That concludes the simple explanation. From there it spirals; there are so many kinds of pain and ways of describing pain. Acute pain is “sharp” and short-lived, often an indication of injury. Chronic pain is often described as “dull,” or “achy,” and usually typifies a more permanent disease or pathology. Then we get into nerve pain, bone pain, muscular pain, soft tissue pain, psychogenic pain, and a whole host of other pain descriptors (here’s a short list courtesy of that old cancer-scare, WebMD).
Pain can be caused by injury, disease, psychosomatic symptoms, emotions, and degeneration of the body due to aging or environmental conditions, among other things. Pain also often begets pain.¹
Pains come and pains go (if we’re lucky), and modern medicine is increasingly realizing that sometimes we can be in pain for literally no reason at all.
What Does Pain DO, Anyway?
The whole point of pain is that it’s your body’s way of saying “stop it.” Whatever the “it” is, your body has decided that it is detrimental to your health and you should quit it or fix it. This is the old joke: the man goes to the doctor and says “Doctor, my arm was broken in three places!” The doctor says, “Stop going to those places.”
For example, my pinched nerve scenario: obviously, my body is telling me that sitting up in bed is to be highly frowned upon. No other conclusion is possible. I obviously should have gone back to sleep instead of getting up for work, and I will take this lesson forward in life.
But seriously, this highlights one of the problems with our experience of pain — it’s often damn impossible to actually do anything with the information the body is providing.
Alas, we are imperfect systems.
On a bodily level, long-term pain does a number of very unpleasant things. Chronic pain can cause:
- Increased heart rate and respiration rate
- Increased blood pressure
- Increased risk of infection
- Increased blood sugar
- Reduced rate of gastric processing and/or constipation
- Nausea and vomiting
- Muscle tension, shaking, and shivering
- Nerve damage
- Anxiety, fear, and depression
This makes it important to manage pain, particularly chronic pain, which is a bit of a problem in our modern narcotic-averse, opioid-paranoid medical world. Yes, drugs are bad, m’kay. But drugs can also be very good if used correctly. Pain meds really are supposed to treat pain. This may be a conversation you have to have with your doctor.
How Pain Affects Us
The most important thing to understand about pain is that people who are in pain need it to stop.
OMG, I just blew your mind, right? Duh. Of course they do. But that need can create some devastating follow-on consequences if it is not managed carefully.
Notice that I’m using the word “need.” Not “want.” Need. There is a functional difference between those words. A “want” is optional. A “need” is not. People in pain need it to stop, and that need can and will take priority over other parts of their lives. They will spend money, use relationships, beg, borrow, and steal in order to stop the pain, which is why opioid pharmaceuticals are a multi-billion dollar industry.
When I am in pain, and I mean serious pain, I have to be very careful. I know I am more aggressive, and more irritable. Things like manners and politeness stop mattering as much; other people’s needs start to take a backseat. The world recedes to a distance as the red throb of ache takes center stage. This is a natural response, and I expect it. That allows me to recognize when it’s happening and try to pay more attention to my manners and outlook. And even so, with a mindful approach and all, I’m still an irritable bastard when my back is acting up.
When someone in your life is in severe pain, you should expect this behavior. It’s only human. What does not kill us makes us selfish, testy, snippy, and cruel. If a person in severe pain is still being nice, recognize that as a monumental effort of will and triumph of their spirit, and make sure you acknowledge it. If you are in severe pain, recognize that you will probably exhibit negative behaviors. It’s only human. It’s totally natural. It’s still something you should work to contain.
Because the thing is, the really nasty thing is, that the rest of the world (aside, if you are very lucky, from a few people who love you and a few sympathetic friends) will not give a shit that you are in pain.² Your job will not cut you much slack, unless you are very lucky. The people in your life will not cut you much slack, unless you are very lucky. Your life does not go on pause.
That means that you have to maintain the strategies you use to get through life, regardless of the fact that your brain is screaming at you that all that stuff doesn’t matter compared to the pain.
The real effect of serious pain is to try to divorce us from the world. Pain tries to turn us into insular, gyroscopic personalities who only care about making it stop. But you can only get away with that for a little while before the rest of the world moves right on past you. It’s a harsh reality. It is what it is.
Realities of Stopping Pain
For most of us who suffer from chronic or recurring pain, the reality isn’t “stop the pain,” it’s “manage the pain.” These are very different things. Stopping the pain is what you do with acute pain. Managing pain is what you do with chronic pain. It may involve stopping the pain at particular points, but it’s much more about maintaining a lifestyle that minimizes the impact of pain on your life.
This can be a serious issue, because as we have noted elsewhere, doctors can have a really hard time managing their patients’ pain. It’s not a visible phenomenon, in many cases. There’s no bleed they can clamp, no discoloration they can analyze, no malformation to correct. A lot of times, pain is invisible. In such cases it becomes very difficult for a doctor to tell the difference between someone who is genuinely in pain vs. a drug addict who is attempting to scam the system. In an ideal world, the doctors would be with it enough, and have access to sufficient medical records, to be able to tell the difference. We do not live in an ideal world. Doctors are generally predisposed to view reports of pain as drug-seeking behavior. Thanks again, opioid crisis.
Therefore, a big part of managing pain is to convince your doctor that it is actually real. There’s a separate article on how to do that. And this is where this article ends, because we have abruptly run out of my area of expertise with one simple piece of advice: if you are suffering from chronic pain, get a referral to a specialist from your doctor. Your general practitioner is not trained or equipped to manage chronic pain conditions. Specialists are. They understand the issues better, they are more likely to believe you, and they are more likely to have access to treatments that work. The exact specialist you see will depend on where the pain is, which is why you need the referral from your GP.
Otherwise the best I can say for fellow sufferers is this: keep your head. Pain isn’t good for our bodies, minds, or lives. Do your best to ensure that your pain is brief, managed, and does not dominate your life. And good luck; if you’re dealing with the US medical system, you’re going to need it.
¹For example, I suffer from recurring back pain; my body sometimes doesn’t know when to stop with inflammation, and as a result from time to time it sets up a feedback loop where my muscles become inflamed from activity, which causes pain, which causes tension and spasms, which cause more inflammation, which cause more pain and so on and so forth. Bodies really need a control panel.
²Aside from the people who make money on pain medications and the medical industry as a whole, who make their money on this. Watch and see how many times your doctor asks you to come back for follow-ups (with associated billing, of course) when you’re in serious pain.