Full disclosure: These pieces written on health cannot possibly do justice to all of the knowledge and experience that informs decades of professional healing practice; i.e., there is a lot more to pain and pain treatment than can ever be written. We mean to help here by sharing a grossly oversimplified and incomplete — yet valid and useful — introduction to some common pain management concepts.
Pain is meant to help, not hurt. Pain shouts “Danger!” to us, to you, to me. Pain is an unwelcome guest bringing discomfort and dis-ease, the way momma scrubbed behind our ears in the tub so hard it hurt, and then we were clean. Pain told us we were doing enough and too much to clean our bodies, and when to stop. So pain is an unwelcome guest that warns, helps and can still harm.
How does it harm? Pain harms when it stays too long, when the danger is gone, when we have done just what it told us to do to keep our bodies and ourselves safe, and then it does not leave. Long after we are healing, we can keep hurting from our scars of life — in our bodies, our hearts, our minds, our memories, our disappointments and even our loves and our hates. Hate is also pain.
Sharp pains that go away in a few days are felt in the “top” of the brain. If they do not go away over time, they can slowly change and move to be felt in the deep, oldest “bottom” part of our brains. Here, they get tangled with dull, aching pains full of anxiety, panic and depression. Then they try to stay by literally reshaping and rewiring these deep parts of our actual brains. We call this very different, unhelpful, super awful, never-ending pain that is always here “chronic pain.”
By the way, chronic pain is at the heart of our opioid crisis. And yet, we have always had an opioid crisis. Morphine has been addictive since the first opium poppy was enjoyed thousands of years ago. Opium dens were a scourge for centuries. For decades, heroin in our inner cities destroyed communities; was that not a crisis?
Medical leaders have written that we began using the word “crisis” and throwing much more public money at the problem only once its victims became richer and whiter. Now, the sick logic of our for-profit marketplace throws diluents back at us at all costs, killing our children and friends with ridiculously unsafe products containing fentanyl, xylazine and who knows what next.
There are safer ways to treat most of our chronic pain. Treatment is more than just medicines. It is not just more pills. But we will start here.
Chronic pain can be unwired. We can slowly disconnect it, redirect it, and not have it rule our lives. Seizure medicines can slow down pain paths through nerves. Antidepressants can soften pain signals inside and outside of the brain. Antidepressants also help us sleep and cope more with such useless pain by not letting it depress us. Every pain feels worse when we are depressed. And we get more depression from our pain. Do you see the vicious cycle here?
There are many cycles. This constant recycling around and around in our heads is the rewiring and results from the rewiring in the brain. It is another cycle, and these cycles help cause chronic pain. Chronic pain gets very complicated very quickly. It can take months and years to get back on our feet. And you can do this.
Other medicines include muscle “relaxers,” which are a mish-mash class of sedatives of all different kinds that can still help when muscles react to pain signals by tightening too hard, causing more pain signals (another cycle). Medicines to dissolve anxiety called “anxiolytics” are very helpful, but some are addictive, and this is another cycle to avoid starting. Such benzodiazepines should not be used for more than a few days.
Pepper creams, menthol ointments, hot water bottles, ice, stretching and physical therapy — lots of physical therapy — can bring you back from the brink. We are talking miracle improvements for some patients and significant improvements for most people* if we do our exercises every day.*
Over-the-counter pain medicines like ibuprofen and acetaminophen do help some patients and, yes, they do not help everyone. It takes weeks and months of different tries with different doses and combinations. You work together with your healer to find the most help with the least side effects and harm.
Scientific studies tell us to combine medicines with other treatments for the most help with the least harm. Daily exercise, regular support groups, weekly counseling and focusing on what you want to do — your functional goals — help a lot more than counting your pain scale “from 1 to 10” each day. Acupuncture, herbal and some hands-on touch therapies have helped my patients sometimes, depending on the root cause of their pain.
Opioid addiction and tobacco addiction both create their own chronic pain, and tobacco can block pain medicine from working fully. Alcohol addiction kills nerve cells and brain pathways, and alcohol also creates chronic pain. Yes, taking a drag on a cigarette or a swig from that bottle seems to help kill and cope with pain “now.” But addiction every day makes chronic physical, emotional and spiritual pain worse. Stop smoking. Stop drinking. Get help, please, right now, today.*
We first want to run from chronic pain. Anyone would. And running from it begins to turn those wheels of panic and depression that become a cycle of chronic pain. We can ease pain often and sometimes even end pain, and yet we can always help each other. Sometimes there is meaning in pain, and it teaches us about ourselves. For better and worse, chronic pain can change, and change us. You are not alone.
* Find AA And NA Meetings in Greenfield at na-aa.org/meetings/massachusetts/greenfield.
Dr. Stefan Topolski is an academic physician and country doctor serving Franklin County. Dr. Topolski welcomes any questions you may have at public@cottagemed.org. His opinion is for educational and informational purposes and should not be used for diagnosing or treating any health problem without first consulting with a licensed physician. Never disregard or delay seeking professional medical care because of something that you read. The views expressed here are those of the writer, their research colleagues and no other organization.