Where (and why) does it hurt?
After more than 14 years, my family is well aware that, when my pain is bad, I’m bad. I’m no fun, I snap at everything, and I cry a lot. Where does all this emotion come from, and what has it got to do with pain?
Some of this is self-pity (God I’m so tired of this), some is exhaustion (God I just want to lie here and not move), and some is pure emotion, and it spills over into my every day life. I weep when I see those bank commercials where a school in an underserved neighborhood is being painted in bright colors by a team of smiling volunteers, or where a child is helping an old man plant a vegetable garden. I sniffle when my son talks about sending out college applications. But most often I don’t need any new reasons. I just curl up and cry.
The pain/emotion thing forms a sort of vicious cycle. When you hurt, your body wants to react in ways that will ease the pain. In my case, when my neck is aching, my shoulders pull up and tighten to “guard” the sources of my pain. The tighter muscles begin to ache, and finally, the emotions tied up in hopelessness and tension and pain come out.
There is a partial explanation for this, and it makes me feel partially better to know that. When your finger touches a flame, the peripheral nerves in the outer layer of skin ignite like the spark in a car’s starter. These nerves shoot their message, like “Ouch!,” or “Drat!” along the spinal cord and up to the thalamus in the brain, which can be compared to the switchboard room in “Mad Men” where millions of messages are sorted and sent off to the right department (or area of the brain) for processing.
In cases where the risk is small, you may not notice any pain until later, maybe until you are in bed relaxing and the brain has had time to work through its entire “to do” list.
So where does the “hurt” actually happen? If my nervous system were to fail, would I fail to suffer? If a tree falls in my neck, what would actually feel the crash? Pain happens in the brain, and provides a warning that something is wrong or broken, or that a flame is hot and must be avoided.
Special gatekeepers filter pain messages from the body and determine if they are serious enough to involve the brain’s intervention. Messages relating to pain are triaged by three different regions of the brain: the somatosensory cortex that locates the pain; the frontal cortex that tells you what caused the pain and what to do; and one final place called the limbic system, which coincidentally also relays emotions like sadness or joy or panic to the rest of the brain.
Even thinking about this pain cycle is painful. Why does the pain alarm need to sound continually? Why can’t my brain issue an intermittent warning to tell me I need medical care like my microwave does when the food is done cooking?
There are some steps that can be taken to ease the pain that our brains process every day. In fact, there are dozens of things to try. I’ve tried many options, and I’ll share my experiences with you. More to come on this next time.
Halloween, Horror and Pain
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Ironically as a pain sufferer, I am a sucker for horror films. In fact, although it turned out to be a big mistake, I went to see “Freddy Vs. Jason” the day before I had surgery to remove a damaged disc in my neck and replace it with a new one made of titanium.
Most classic horror films have become a familiar part of our lives, with a new sequel coming out every other year or so. Saw 6, with its own unique blend of moral and psychological terror, opened recently although to smaller box office than earlier Saw films. Although the Halloween series seems to have run its course, Michael Myers is still a vital member of our horror culture, as are Freddy Krueger and Old Leatherface.
It is not that hard to understand our perverse fascination with merciless, mindless killers who chase us through the night to stab us, chop off our limbs, or carve us up with knife-blade fingers. The terror of fighting for life in a maze of darkness and death is compelling especially when we can still hope that one or two of the heroes will make it out alive.
But the fear of pain is worst of all. The right torture can crack the toughest tough guy. Even James Bond looks worried as the laser beam approaches his crotch in “Goldfinger.” We all still wince when we recall the dental scene in “Marathon Man.” And then the needles and electrodes move closer and closer Han Solo in “The Empire Strikes Back,” we could feel his pain as well as that of his friends who were forced to listen and imagine what was happening.
Part of the horror of slasher films is the fact that they show us pain and horror that we cannot really understand. The kind of pain associated with receiving multiple stab wounds while taking a shower at the Bates Hotel is not comprehensible in any real way. Even the pain of childbirth is kindly blotted out from our memories just a few weeks after the event. But we all have just enough understanding of pain to empathize while Alien takes his first bite at your leg.
In honor of Halloween, here is my Top 10 horror stars of all time (to date!):
10. Damien in the Original “The Omen” - Maybe the smallest bad boy in horror history, Damien hits the big time when he pushes his mom over the banister with his trike.
9. Dracula in “Dracula” - My favorite from the kindler, gentler days of horror films. Although evil to the core, it’s hard to resist his dark charm and that really neat cape.
8. Jason in “Friday the 13th” - Summer camp will never be the same since Jason romped among the cabins killing off the beautiful but bratty teen residents.
7. Old Leatherface from “The Texas Chain Saw Massacres” - Garden tools have never been the same after this genre classic, which even rated a remake in 2003.
6. The Alien from “Alien” - Even through the original and three sequels, this guy still haunts my best nightmares.
5. Chucky from “Childs Play” - OK, I was wrong; Chucky is the smallest, and maybe the baddest, of the ax-wielding youngsters in film.
4. Norman Bates in “Psycho” - Well, to be fair, I should list Mrs. Bates instead of Norman. But since he plays both roles, the shower-scene slasher gets the nod.
3. Hannibal Lecter in “Silence of the Lambs” - It is Hannibal’s intelligence that makes him so darn scary. His taste for blood is unique in the genre.
2. Freddy Krueger in “A Nightmare on Elm Street” - Freddy is special because of his positive attitude about his work. He’s one of the few serial slashers who always has a snappy comeback to every scream.
1. Michael Myers in “Halloween” - He’s tall, dark, silent, and really persistent, coming back through 9 sequels and remakes and still trying to make his “point.”
So on Halloween, it’s fun to get a little scared. Enjoy the thrills that can’t hurt you in real life.
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Welcome to my pain
Ever since I’ve had a pain in the neck, I’ve been a pain in the neck.
My pain, which radiates down my neck, across my shoulders, and down my left arm, has been shadowing me for 15 years. Although it was not caused by trauma or accident, I can remember the night it started. I was bathing my 1-year old son. I reached for a red tug boat that he wanted, and a zing of pain shot through me. Now, my 16-year old son’s birthday reminds me of a different anniversary.
I ended up going to the emergency room that night. I was examined and told that I probably had a pinched nerve that would resolve with time and rest. I was given valium and vicodin to help me along with that. What I actually had, as I would learn much later, was a condition called degenerative disc disease.
One of the worst things about pain is that the pain can make you feel things that are almost as bad as the pain. I have felt like a whiner when I am too tired or worn out to last through family outings or parties. I’ve felt like a weakling, knowing that people with cancer, fibromyalgia, and other pain-related disorders are suffering more than I can probably imagine. I’ve felt like a criminal when I’ve pushed to have prescriptions refilled early. I’ve been depressed so deeply that I’ve had to force myself to shower and dress in the morning. And I’ve felt like a loser, unable to pursue my dreams or show my daughter just how great I used to be.
The medical community, as far as I can tell, is sharply divided on how pain should be managed. Some general practitioners are happy to provide pain medications for patients, but usually for a limited period of time. Follow the spectrum to pain specialists, who can be so conservative with the prescription pad that patients like me have relief for 8 hours and life-affecting pain for the remaining 16.
“The big fear here is dependence, or even addiction,” said one east bay specialist. “If a patient who is not end-stage becomes addicted to pain killers, the prescribing doctor can lose their license. No one wants to see suffering, but have to walk a fine line here.”
For patients, where is the fine line’s edge? What are the non-medical options to managing long-term pain? When is surgery recommended, and when can it make matters worse? How can the side-effects of pain such as depression and fatigue, be minimized? Dealing with pain can present challenges and choices you’ve never considered before. But there is help, and things can get better. I’ve been on a 15-year odyssey with pain. I’ll share my discoveries, setbacks, and experiences, while exploring new options from the world of medicine and well beyond.
