CHRONIC PAIN- THE UNINVITED GUEST

When Carmen first contacted me about what happened to her son, she thought it was too late. Her voice cracked over the phone and I could hardly hear her through bouts of uncontrollable sobbing.

“Bobby– my son– he was just released from the hospital. He collapsed on the playing field during a game,” she wailed. He’s alive. Breathe, I kept telling her. There is always a solution. She took a few minutes to gather herself, the tears subsided, and her voice fell low, thin as a whisper.

“The doctors tell me he may have an addiction to pills,” she said with the confidence of a convicted felon. “Opioids.” I told her. “I guess that’s what they call them. I thought they were just pain pills for after his surgeries his junior year in college.” As an addiction specialist, this wasn’t my first rodeo helping clients and their families work through chronic pain and addiction that resulted from prescription pain pills.

In the United States, 133 million Americans experience chronic pain and 65% of all Americans say they seek care for persistent pain at some point in their lives. In total, chronic pain affects more lives than diabetes and heart disease combined.

An estimated $100 billion is spent annually to manage pain, including healthcare expenses, lost income, and lost productivity at work and home, according to NIH Medline Plus.

How has chronic pain grown into a crushing dilemma that so many Americans experience? To arrive at an answer, we must first unpack and distinguish between acute and chronic pain. Acute pain lasts no more than 90 days, a short-term health issue that heals on its own. Think of when you scrape your arm on a low hanging branch. You clean it up with ointment and a band aid and it heals in a few days, good as new. Or a broken limb – a doctor puts a cast on it and weeks later your bone heals. Chronic pain is much nastier.

“Chronic pain develops when pain is experienced longer than three months,” Pam Garton, a health professional in rehabilitation and pain management wrote in, How to Explain Chronic Pain to Family in 7 Simple Steps. “After those three months, there are changes to the nervous system.” Due to the nerve changes, our brain is hijacked by this uninvited guest and we become attached to the pain, a faceless monster that disrupts families and their loved ones’ lives.

This is exactly what Carmen’s son experienced after a sports injury cut his junior year of collegiate lacrosse short. “What was the surgery for?” I asked her. “A torn ACL. He’s a lacrosse player in college.”

Carmen shared her son was a straight-A student, captain of the lacrosse team, and a member of a community service fraternity. “Not one of those where they just get drunk at parties and haze each other.”

She told me the only time he got in trouble was for taking Adderall to prepare for a rigorous series of final exams. The dean dismissed the case because he found her son to be so committed to athletics and team leadership, his character reflected a good young man with a promising future.

Then it happened. Carmen said her son was hit on the back of his leg during practice, sending him crashing to the ground. He landed in such a way that his ACL tore to pieces. After multiple surgeries to repair the damage, he was prescribed pain pills to which he learned to pop like Skittles.

“He said it hurt to bend his knee and I believed him. So, he kept getting refills on the pills. I thought as long as he was using them to numb the pain while his body healed, that was fine.”

By the time Bobby’s senior year came around, he was at the top of his game. “He seemed fine… scoring goals, helping out his teammates.” But when I talked to Bobby a month after he made his first ever visit to the emergency room, he told me he was anything but fine.

“When I would get out of bed in the morning after my injury, it felt like pins were sticking through my knee. And that was several months after the surgeries.” Bobby said when he started practice again for the upcoming season, the pain was unbearable. “It just wouldn’t go away,” he told me. “I didn’t know what to do.”

Bobby’s story of isolation in his pain and eventually developing into chronic pain and addiction is tragically common in sports, athletics and conditioning. Athletes feel immense pressure to succeed – to score that winning goal, reach the summit, go the extra mile. As such, injuries such as Bobby’s may develop into a larger problem threatening to sideline their athletic career. Secrecy and shame make the problem grow.

Aside from athletic-related injuries that cause chronic pain, many Americans experience chronic pain in the form of headaches and migraines, lower back pain, arthritis, crohn’s disease, fibromyalgia and muscle pain. Physical therapy, surgery, and nerve blocks are common forms of treatment as well as CBT, DBT , alternative approaches like acupuncture, mindfulness, breathing exercises, Qigong, spinal manipulation, exercise, anti-inflammatory food diets and massage therapy.

Even with these available therapies, opioid prescription pills in
the form of hydrocodone, oxycodone, codeine and others are commonly prescribed after surgery, injury and health conditions. According to data from the CDC, 58 prescriptions were written for every 100 Americans in 2017. Imagine how many lacrosse fields were filled with opioids. No wonder we’re in the midst of a fiery opioid epidemic that claimed 72,000 lives last year.

Chronic pain and opioid addiction are closely intertwined. Many Americans – through no fault of their own – turn to prescription drugs which have been prescribed to address their chronic pain. And because chronic pain cannot be seen or heard – a phantom that is subjective to the person experiencing the pain – it can be hard to gauge what is an appropriate amount. This inadvertently sparked the opioid crisis, a catch twenty-two whereby the cure for pain coupled with over-prescribing sparks an addiction that causes serious harm.

For Carmen, watching her son topple over in the middle of a game made the harm real. “He came off the field at the half and just fell over. It was as if all the life had left his body.

Once Bobby made a full recovery at the hospital, he confessed that he had been taking the pills long after the surgeries and prescriptions ended. Bobby shared he had a new course he was taking and that was taking him away from who he was. He found himself lying, cheating, and showing up at games trying to beat the pain game with a locker full of pills. The pills kept him going – he wasn’t going to miss a game. “Senior year was my last chance,” Bobby told me.

I was able to get Carmen’s son into a behavioral health treatment program that specialized in chronic pain and addiction. No pills were involved. Bobby also agreed to speak with a therapist about unpacking his identity tied to sports and to find his center. He learned to deal with the depression and anxiety he felt without sports. Further, Bobby learned how to channel his energy into an internship to develop his professional skills for the real world awaiting him after graduation.

Carmen’s and Bobby’s story shows that a healthier, happier life is achievable when we talk about these issues, seek professional help and employ alternative therapies. Chronic pain and addiction can be difficult to discuss amongst family and loved ones. However, these conversations can take place when we understand chronic pain and its impact. In conjunction with Pam Wharton’s website Survive Strive Thrive, here are ways to talk about chronic pain with families :

Pain impacts us physically, emotionally and socially.
A family member with chronic pain may experience fatigue or stiffness and other physical conditions. The feeling of persistent and long-term pain may then open the door to anxiety and depression, emotions that flare up and feed the pain. In this way, emotions drive chronic pain and a vicious cycle forms. When the chronic pain sufferer isn’t feeling like themselves physically and emotionally, they may find it difficult to socialize, thus, alienating themselves from the essential connection of family and loved ones.
Pain management requires hard work.
Alternative therapies to pain pills take patience and discipline,
a commitment to long-term recovery. Family members are encouraged to ask about their loved one’s participation in these therapies, successes and opportunities for improvement. Families will learn and grow through this process and take on new ways of interacting and communicating.
Opportunity to change pain.
The human brain’s ability to morph and change is called neuroplasticity. This means that the brain can be taught new ways of functioning. In effect, pain patterns learned during peak chronic pain experiences can be reoriented toward healthier ways of feeling pain.

Chronic pain can manifest in many forms. Families and loved ones like Carmen and her son, Bobby can work through the challenges with open communication, seeking appropriate help and knowledge of the topic.

“You saved my son’s life,” Carmen wrote in an email to me months after the ordeal. “Look for an invitation to his graduation in the mail next year. You’re an honored guest.”

  • All characters in this article are fiction. Any resemblance to real persons is coincidental.

Dr. Louise Stanger – speaker, educator, clinician, and interventionist www.allaboutinterventions.com

Roger Porter is a writer and educator.