Table of Contents
Part I: Pain and Suffering: Understanding the Challenge
Chapter One: Treatment of Pain Throughout History
Chapter Two: How Pain Works
Chapter Three: Understanding Chronic Pain
Part II: Finding the Road to Recovery
Chapter Four: Medical and Surgical Rehabilitation: Your Role and the Doctor’s Role
Chapter Five: Understanding Medications for Pain
Part III: Physical and Nutritional Rehabilitation
Chapter Six: The Miracle in Medicine Is Exercise!
Chapter Seven: Nutritional Rehabilitation
Part IV: Emotional, Social and Occupational Rehabilitation
Chapter Eight: Emotional Rehabilitation: A Look at Depression
Chapter Nine: Emotional Rehabilitation: Dealing with Anxiety, Stress, and Tension
Chapter Ten: Fake It Until You Make It!
Chapter Eleven: Social Rehabilitation: Anger Makes Pain Worse; Laughter Makes It Better
Chapter Twelve: Occupational Rehabilitation Is Important for Recovery
Part V: Rehabilitation from Addictions and Self-defeating Behavior
What You Should Know About Opiates
Chapter Thirteen: Rehabilitation from Addictions Dealing with Self-Defeating Behavior (Bad Habits)
Chapter Fourteen: What You Should Know about Opiates
Managing your Chronic Pain: How to Take Opiates
Understanding Opiate Problems
Part VI: Spiritual Rehabilitation and Summary of What it takes to Recover
Chapter Fifteen: Spiritual Rehabilitation
Chapter Sixteen: How Does One Regain Spirit?
Chapter Seventeen: A Summary of What It Takes to Recover
Part VII: Exercises, Meditations, and Medications
Chapter Eighteen: Home Exercise Routine
Chapter Nineteen: Guided Meditations
About the Author
“Insanity is doing the same thing, over and over again, but expecting different results.”
Raising the Curtain on Chronic Pain
At age 30, I had my first symptom of MS (multiple sclerosis.) In my forties I fell and injured myself, later developing a constant pain in my back and legs. Nothing the doctors did had any lasting effect. I gained weight and got depressed. What I discovered over the next five years getting my life back, changed the way I practiced psychiatry and led me to work with medical patients, many of them with depression and chronic pain. What I learned working with physicians to put together a pain clinic for the poor is chronicled in my first book, HEAL: A Psychiatrist’s Inspiring Story of What It Takes to Recover from Chronic Pain, Depression and Addiction….And What Stands in the Way. I could see that neither doctors, nurses nor their patients really understood what chronic pain was or what is needed to bring about recovery. I found patients for the most part very resourceful once they understood what they had to do to get better, but the medical system was intransigent. Doctors and nurses were too wedded to the standard medical approach to shift to what was really needed by patients. The doctors tended to prescribe too many pills, and failed to evaluate or treat the many factors other than medical or surgical conditions that contribute to pain. At the time even the university pain clinic only managed medications or nerve blocks, focusing more on what insurance would pay for rather than what patients needed. Since I started writing this book, that situation has only become worse and now my home state of Alabama leads the nation in the consumption of opiates. Opiates are overused everywhere in America which now consumes 80% of the worlds pain medications.
For that reason in this book I want to explore in detail, all aspects of the rehabilitation process from medical and surgical, through physical and nutritional, then emotional, social, occupational and ultimately spiritual rehabilitation. That way if your pain or depression are not getting better, you can know what you have to do to facilitate your own recovery. Furthermore, family and friends can benefit from understanding the complex issues involved in chronic pain and its treatment so they are better able to assist those they love and develop helpful routines for themselves. In this recovery doctors play a very important role, but in my experience, doctors order too many medical tests, do too many pain blocks and even too much surgery where stretching and the right exercise would be a better approach. Certainly they use too much medication and do not explore the many other interventions that affect pain and suffering. Full recovery involves a lot from the suffering person if the goal is not only to get better, but to return to a full life.
Is Recovery Possible?
The tendency today is to tell patients they must get used to having pain and must accept that they will always hurt. In my experience, that approach merely salves the conscience of the doctor who is aware he has done all he can do, but not all that can be done to deal with pain and pain’s partner, suffering. Rather than help patients accept reality and get on with their lives, setting a negative expectation can become a self-fulfilling prophesy that adds to the suffering. In addition from what I’ve seen, such a statement is not even true in most instances. Let me make this clearer. Since I have multiple sclerosis, I will always limp and have clumsy movements. However clever and creative, my brain will always have to cope with certain damage to my nervous system. Also, I am getting older with all the changes time and gravity bring to the body. These limitations are parts of me that I have to take care of for the rest of my life.
But pain and depression and anxiety and anger are emotions that reflect how I am relating to the world, not permanent changes that cannot be overcome. These emotions are intimately connected to my physical being and to the events in my life. For example, if I sit too long for too many days, I start having trouble standing up straight and my back starts to ache. But the experience of pain, like depression, anxiety, and anger can shift, and that is why it is so important to take every reasonable step to address these emotions and not just let them fester and make us worse. Important? Yes, because these are the emotions that can destroy one’s life.
“But,” I can hear you say, “my pain is real. It’s not just emotion!”
As a culture, we are so wedded to seeing psychological events, emotions, as signs of weakness that we resent anyone suggesting pain does not have to be part of the physical picture. But the brain is highly creative and can allow us to be aware of pain, or not, to serve its own interests that are often outside of our awareness! Think of the broken leg that doesn’t hurt while a passenger escapes a plane crash, or the burns that don’t hurt while a father rescues his son. We would like to think we make conscious choices about everything, but our clever brains can assess the situation and let us hurt if we need to take action, or block hurt if we need to be doing something else. That means there are many ways to address pain. We must allow ourselves to recognize that pain doesn’t always operate the way we assume that it does. This is why I have explained in this book just how pain works and all the steps I observed as important to the recovery process from chronic pain and suffering.
In medicine, we call suffering “depression” or “anxiety” or “sleeplessness,” because we have a pill for these conditions. Addressing physical matters is essential, even the physical changes that result from suffering, but they are only some of the tools available for recovery. And I do mean recovery. Not to be burdened with the pain and suffering means you can use your creative brain to build the best life for yourself, whatever your limitations or physical challenges. Sometimes we feel we are too far gone to do better. We have lost faith in our ability to improve. We are too confused, angry, stubborn or lost to make the changes that will benefit us. Some are addicted to the medication while others suffer from depression and suicidal thoughts.
“But,” I want to shout, “I have observed people in all these circumstances grapple with issues that keeping them from doing something different, and turn their lives around. You can do it too!” That is why I want to explain what is involved in each step. I hope to show you important ways to change you might not have considered before. And inspire you to try something new.
Seeing Pain and Depression in the Context of History
Anyone who has been through surgery recently can attest to the marvels of modern medicine in controlling pain. Today, many conditions lend themselves to medical treatment. Not only can we treat infections, joint replacement surgery is almost routine. But amazing as antibiotics and corrective surgery are, they are only the beginning of a rigorous journey of recovery for the patient. Doing well depends on getting your muscles strong and keeping them strong so the joints will stay in place and not hurt. Even when pain results from a medical condition like an expanding tumor or rheumatoid arthritis, regular exercise may make it easier to tolerate the pain. Attention to all the elements that make pain worse and better can be liberating.
In the coming chapters I will try to distill complex issues into simple concepts and activities to help those of you who feel stuck, get out of your present trap. I hope to provide some useful information you may not have considered before, and inspire you to try some new approaches. At the very least you should be relieved to see how much you are able to do to help yourself. I have been surprised how often people are able to change once they have been freed of old ideas and shown a path to new behavior. On the other hand, I am painfully aware how often we humans get stuck with our old assumptions, prejudices, addictions and other self-defeating behavior, and how often this can derail our progress. For that reason, if these suggestions do not free you up to do better, find someone to help you.
From the success of some traditional healing therapies as well as from modern medical research, we know that chronic pain and depression can get better. If you have trouble taking the hints in this book, you may be too stuck to do it on your own. In that case, finding a therapist or doctor to help you face your resistance to change would be an important first step. However, be sure when you do that you find a new approach, not just get another pill! You are looking for someone to evaluate all the factors contributing to your pain and help you develop a comprehensive treatment plan. You want someone who can help motivate you to change your behavior and help you work through your resistance to change when that emerges, as it will from time to time. You are, after all, human, and humans resist change mightily. Remember, it doesn’t matter how famous your doctor is, only if the connection to you helps you through tough times. Find several professionals to work with. Find some friends, buddies, even internet sources to educate and inspire you. Find a psychiatrist or psychologist to help you with your resistance. Join a therapy group or twelve step program where others can confront you about what you are doing while they encourage your progress. Do not be alone in your misery. That can kill you.
The Opiate Challenge
Humans are so afraid of pain that they will go to any lengths to seek help or escape the suffering. The history of man’s attempts to relieve pain covers every conceivable approach to its elimination including the use of medications that make them worse and even cause death. For that reason physicians struggle with the practice of giving patients opiates, under what circumstances, and for how long. Fear of addiction periodically has led doctors to withhold opiates when they might help and at the same time, driven an overuse of opiates when doctors have been too lax in their prescribing practices. This misguided generosity has proven lethal to some patients. Some well-intentioned physicians have even gone to jail on this account.
Opiates have their place in the treatment of chronic pain, and handled well, they can help you get stronger and be more willing to participate more fully in life. But they must be seen as only part of a comprehensive treatment program where the goal is to be off all daily opiates for pain. Perhaps even more important, their use must always be aimed at improving your overall well being not just make you feel better. Patients who take pain pills and just lie around will do worse. Taking medicine must be part of a plan that involves increased activity, dealing with emotions, useful occupation and a commitment to others and the world. That’s what I hope to demonstrate in this book.
 The New Yorker May, 5, 2014 edition