Making Peace With Pain – Part II
Finding Meaning and Purpose
In this section, I want to demonstrate how I – and many others- faced the painful reality of chronic pain and suffering. It’s sometimes very tempting to give up when we see no hope. As I shared above, I often felt despair after my debilitating injury and thought of checking out permanently.
Fortunately, I was reminded by many people close to me that suicide was a permanent solution to a temporary problem. I needed HOPE!
Hopeless to Hopeful
Have you ever felt hopeless and helpless living with chronic pain? As you saw in my early years, I sure did. Take yourself back to a time when you felt fearful, overwhelmed, and hopeless. Remember how living in that state of mind seemed to drain all of your energy and hope for your future. To help you come up with your example, first let me share how one of my patients made this transition:
After being put on total disability, Sheena was told she would have to learn to live with the pain. Unfortunately, they didn’t tell her how she could do that and still have a functional, satisfactory quality of life.-Stephen GrinsteadOne of my patients, Sheena, had a workplace accident and broke several bones. A year later, she discovered she had also developed severe nerve damage. While her doctors tried various pain medications and physical therapy interventions, Sheena kept trying to return to her job as a carpenter. Each time she tried, however, the pain became unbearable and was forced to stop working again. After being put on total disability, Sheena was told she would have to learn to live with the pain. Unfortunately, they didn’t tell her how she could do that and still have a functional, satisfactory quality of life.
After she was referred to me, we worked with her doctors to find out why nothing had helped her pain so far. As I assessed her pain symptoms, I noticed that seven out of twenty of her identified pain symptoms were neuropathic. I also discovered that she had never had an MRI of her back. When she was finally referred for an MRI, the results showed significant nerve impingements and damage.
Just understanding what was really going on was the start of Sheena’s transition from hopeless to having renewed hope for her future. Within six months – and after some minor medical interventions – she had adequate pain relief and was undergoing vocational rehabilitation in computer programming. She was finally very hopeful and very excited about her future.
From Despair to Hope: A Recovery Story
Another client I worked with, Jerry, didn’t start out very hopeful. Jerry was a thirty-four year old, married man with a wife and three teenage children. Three years earlier, he was injured in a construction accident and had been unable to work since then.
At first, Jerry was very hopeful he would be able to return to work in a short period of time; he believed that everything would be fine. Although his injury was very painful and he had great difficulty even walking, his physician determined – without appropriate diagnostic testing – that Jerry was “only” suffering from severe muscle strain; he was prescribed analgesic narcotics and antispasmodic (muscle relaxation) medication.
Jerry attempted to return to his job on limited duty. He tried his best to cope with the increasing pain symptoms, but found it harder and harder to keep going. After two months, Jerry sought legal counsel and discovered that he had the right to seek another doctor. This began a three-year journey of confusion and frustration.
The new doctor ordered diagnostic testing, including an MRI and CT Scan, which determined Jerry had three damaged disks in his lower back. He was immediately referred to an orthopedic surgeon to discuss treatment alternatives. Jerry was very frightened, but at the time, refused to let anyone know how terrified he really was.
After a brief physical examination and review of Jerry’s diagnostic test results, the surgeon recommended an extensive surgical procedure. The doctor told Jerry that, without the surgery, he could end up being paralyzed or, at best, continue living in excruciating pain. The consultation session was very brief and Jerry got the impression that the doctor wasn’t really listening to his concerns. He felt rushed into making a decision, but because he had so much distress around his pain, he reluctantly agreed to the surgery.
During the next three years, Jerry had four surgeries. By the time I started working with him, the surgeries contributed to his pain becoming worse, instead of better. His surgeon declared the surgeries were “successful,” and there was nothing more he could do to help him. He discharged Jerry and referred him to a pain clinic.
After an extensive assessment procedure at the pain clinic, it was determined that Jerry could be helped…but it would take hard work and the implementation of an integrated multidisciplinary treatment plan. The pain clinic referred Jerry to me in order to assess his physiological and psychological/emotional pain symptoms, consult on his medication management, and recommend a multidisciplinary treatment protocol.
During my evaluation, I helped Jerry see that he had both physiological and psychological/emotional pain symptoms. The psychological/emotional symptoms were more predominant, which turned out to be a good prognosis for Jerry’s eventual recovery. I also determined that Jerry had become addicted to his pain medication and was experiencing significant negative consequences as a result.
Jerry had a difficult time accepting that he had become addicted. After all, he did have a serious chronic pain condition and doctors prescribed the medication.
I listened to Jerry and validated his concerns. Eventually he began to trust me enough to begin looking at the emotional pain he was experiencing around the trauma of the past three years. He realized that he was using his pain medication to escape those emotions.
Together with his doctor, we developed a more effective medication management plan that included epidural and trigger point injections, coupled with non-medication interventions like hydrotherapy and massage therapy. At the same time, Jerry and I started working on a psychological and emotional pain management plan, as well as developing a recovery plan for his addiction using the Addiction-Free Pain Management® (APM) Recovery Guide and the APM™ Workbook. To learn more go to our Freedom From Suffering NOW Bookstore.
It was not easy for Jerry; there were many days that he wanted to give up and he even considered suicide. Jerry had developed severe clinical depression due to his injury, multiple surgeries and significantly decreased quality of life. As his depression needed to be addressed immediately, I asked his doctor to consider an antidepressant medication while I worked with Jerry using cognitive behavioral therapy interventions. After four or five weeks, his depression symptoms significantly improved. This was a real turning point in Jerry’s recovery and pain management process.
After three years, Jerry finally began the shift from despair to hope. He was learning that, although he may need to live with chronic pain, he no longer needed to suffer with it. He learned how to communicate his feelings more effectively and started reconnecting with his family in a much healthier way. By continuing with his recovery and pain management plan, Jerry was able to experience a more positive quality of life.
From Demoralized to Revitalized
When we get to the point of demoralization, we are at risk of quitting or giving up. At this point, some people sink into the pit of depression. Like me, they may also become suicidal or even attempt to kill themselves. This is what happened to Jim, another of my former patients.
Jim had been on total disability for over seven years when I first met him. He was referred to me after completing a mandated stay at a psychiatric hospital for an attempted suicide. At this point he was heavily medicated with antidepressants and other mood stabilizing psychiatric medications. His depression was moderate to severe; on a 0 to 10 pain scale, he reported pain levels of 9 – 10 on bad days and only 7 – 8 on his best days – even with his pain medication.
After meeting with a pain management colleague of mine Jim started a medication to address both his depression and pain. The doctor chose Cymbalta due to Jim’s significant neuropathic pain symptoms. I helped Jim develop a cognitive behavioral plan and within a few months Jim shifted from feeling demoralized to revitalized. He felt like he had his life back.
From Victim to Victorious
People who get stuck in demoralization may start behaving like a victim and get treated like a victim by others. This is where people can alienate or burn out their friends and family. They often blame everyone else for their condition and use that as an excuse not to change. When they are in this stage, they use a combination of two forms of denial—blaming and strategic hopelessness (aka: diagnosing myself as “beyond help”). Another patient of mine, Shelly, is a prime example of this.
There is a dangerous mistaken belief in the healthcare community that, if you have real pain, you will not become addicted. This might be true for most people, but ten to fifteen percent of the population will experience medication abuse, pseudoaddiction, or addiction.-Stephen Grinstead
When I first met Shelly, she was hopeless, demoralized and felt like a victim. She was a medical doctor who was eventually arrested for diverting medications. She started out self-medicating for a back condition. Once she became addicted to the medication, she began forging prescriptions, then stealing medications from the hospital where she worked. She was put in a physician diversion program and was deemed “high-risk” for having her license to practice medicine revoked.
She was angry about being in diversion and believed it was always everybody else’s fault. When told she would be drug tested and could no longer take any psychoactive (mood altering) medications, she became depressed and hopeless. In addition to the denial mentioned above, she also believed “I can’t be an addict because I take prescription medication for my legitimate pain and I’m a doctor.”
There is a dangerous mistaken belief in the healthcare community that, if you have real pain, you will not become addicted. This might be true for most people, but ten to fifteen percent of the population will experience medication abuse, pseudoaddiction, or addiction.
Fortunately for Shelly, she finally accepted that she had an addictive disorder, that she was responsible for it, and that she could successfully complete her diversion program and go back to the job she loved. She ceased being a victim to her pain or her addiction. The paradox was that she had to admit she was powerless over her addiction before she could experience the victory of recovery.
From Powerless to Empowered
When some people experience a sense of powerlessness about their chronic pain, they can quickly move into feeling demoralized and hopeless. When they feel powerless, they give up and sometimes can become so depressed they become suicidal.
One tool that I use and teach my patients is the Serenity Prayer — it has been made popular by AA (Alcoholics Anonymous) — I’ve copied the prayer below for your review:
“God grant me the serenity to accept the things I cannot change; the courage to change the things I can; and the wisdom to know the difference.” ~ Reinhold Niebuhr
For some of my patients, I re-frame the Serenity Prayer as the “Courage Prayer.” It helps them focus on the courage to change the things they can. For example, Shelly had to accept that she really did have an addictive disorder. Her next step was even more important. She had to be courageous enough to admit that she had a problem and then be willing to take immediate action to get out of the problem and find the solution she needed.
As I mentioned earlier, there is a difference between pain and suffering. When people hit this powerless stage, I remind them that even thought they are powerless over the ascending pain signals, they have great deal of influence over their descending pain signals. Suffering is a choice. They don’t have to suffer – if they are courageous enough to make friends with their pain and take steps to effectively manage it.
Once into acceptance, empowerment quickly follows. When people feel empowered, they are more likely to do whatever it takes to effectively manage their pain and improve their quality of life. People start to believe that they really will be able to survive their pain condition. This is an important stage, but more work is needed to realize true freedom and learning how thrive despite their pain.
From Surviving to Thriving
When people get to this stage, I remind them the journey is not yet over; if they stop here they will miss so much. It’s like climbing Mount Everest and getting to the last base camp – then stopping when the summit is only one more day away.
As I mentioned, I was almost stopped at the hopeless and demoralized stage and considered suicide as a viable option. But as I was going through vocational rehabilitation and my psychotherapy process, I finally accepted what had happened to me and decided to go on.
Part of my vocational rehabilitation included going back to school to become a counselor, which required personal therapy. Lynn Weise, my psychotherapist for many years, helped me work through the last stages of my grieving process for my lost level of functioning and quality of life.
One of my biggest breakthroughs was finally being able watch my former Dojo mates compete in a major Karate tournament. I went through a gamut of emotions and almost ran out several times, but I owed it to myself to stay until the end. From that point on, I quit looking back and focused on what I wanted my future to look like instead of what I lost and what I didn’t like.
On my personal journey, thriving was also the last stage of a grieving process I needed to work through. I always believed that acceptance was the last stage of the grieving process, but I discovered there is another step: reintegration. This means I can honestly say that, today, my life is better than ever. Yes, it’s different — but I have a life filled with great purpose and meaning. I am living with chronic pain and thriving despite it.
…today, my life is better than ever. Yes, it’s different — but I have a life filled with great purpose and meaning. I am living with chronic pain and thriving despite it.-Stephen Grinstead
An important part of moving from surviving to thriving is making friends with pain, instead of fighting it or being afraid of it. Sometimes I help my patients with this transition from enemy to friend through art work. I still remember my patient Sue, who was suffering with her pain, feeling victimized by it, and feeling let down by the healthcare system.
At the beginning of our work together, I asked Sue to create an artistic interpretation of her pain at its worst. The picture depicted a very ferocious and frightening dragon drawn in black and blood red. The dragon had fire coming out of its mouth. It had large sharp fangs and claws.
As we got close to completion of our treatment process, Sue created a new interpretation on her relationship with her pain. This time it was a beautiful framed drawing of a cute cartoon-like green dragon playing with a little cartoon rabbit (she said this was her) holding a toy wooden sword with a cooking pot on its head.
In the drawing, the dragon was touching the end of the sword with its front paw and the caption said “Ooh! Sharp!” The pain was still much bigger than her, but the playfulness and friendliness was evident. She gave me that drawing as a thank you; I keep it in my office to remind myself and others of what’s possible when we make peace with our pain and choose to thrive.
Next week in the third installment of Making Peace With Pain, we’ll discuss the need to stop making pain your enemy, evaluate the role friends and family play in the process and talk more about achieving freedom from suffering.
Images Courtesy of Shutterstock/iStock/Stephen Grinstead