Pain, and her many handmaidens

I am in pain as I write this. My right wrist has a hot ache, which runs up to the base of my fingers and cuts through my palm. Both of my elbows are stinging – Familiar tendonitis, startlingly unpleasant and made worse by the action of typing. My index fingers feel as if they’ve been caught in thumbscrews, and stretched and snapped. My back, from the base of my skull to the tip of my tail, is sore, with particularly tight, crushing pains at the nape of my neck and across my lumbar vertebrae. No matter how much I move, it feels as if I am being folded and twisted and wrung out. My right hip feels as if it’s being torn out of the socket, bent around backwards as far as it can go – Of course, it’s actually crossed in front of me, Indian-fashion, the most comfortable position for a femur to be in.

 

1) Pain comes in many different qualities. I have tried to categorise them a size (The physical area they cover), pervasiveness (How easily the pain is ignored, or how much you can continue with your life whilst in the pain), intensity (How much it hurts), immediacy (How suddenly the pain appears, or increases/decreases), duration (how long does it last for) and finally the very subjective quality or pitch (Is it stabbing? Shooting? Electric? Crushing? Twisting? Burning? Tingling? I always think of it as pitch, because I feel pains as either high- or low-pitched; An ache is a bass rumble, the electric zap of a migraine is a high treble, a dislocated hip is a contralto howl, a dislocated shoulder is a mid-tenor at full voice). Trying to categorise pain on a one-to-ten scale is meaningless.

 

2) Not everyone reacts to pain the same way, and not everyone reacts to different pain in the same way. Someone may hiss out-loud at a cut finger or a touched blister (Size: small, pervasiveness: high, intensity: low, immediacy: high, duration: less than a second, pitch: high), scream at having a tooth pulled, but go completely vacant and soft at having a shoulder dislocated. Or indeed, the same dislocation might on day one cause nothing more than a grunt, and on day two result in the same person curling up into a ball and sobbing.

Because pain is, by its very nature, subjective.

 

3) Damage causes pain, and pain causes damage. We all know that if something hurts, we should probably stop doing it,  but the corollory to that is that we should stop pain becaus ethe pain itself is damaging. Pain increses cortisol, increases the heart rate, makes muscles cramp and spasm, which can damage tendons and ligaments and tear the muscles themselves.

Pain decreases appetite, meaning that you don’t eat enough and thus don’t have the energy to repair damaged tissues as cleanly. Pain makes it difficult to sleep, which means that the muscles don’t get time to relax, and can cause themselves more damage.

 

4) Pain still has effects, even when you’ve taken analgaesia. If you’re in enough pain that your blood pressure is spiking and you feel faint, it’ll take more painkillers than just the amount needed to block the immediate pain to deal with that. You might still be light-headed or dizzy  or making descisions as if under a lot of pressure, just because of the residual effects of the pain.

 

5) The double-bind of pain. There are certain people in the world who do this;

-If I’M not crying out in pain, it’s because I have amazing willpower.

-If YOU’RE not crying out in pain, it’s because you’re not in much pain.

-If I’M crying out in pain, it’s because I’m in the kind of pain that you can’t even imagine.

-If YOU’RE crying out in pain, it’s because you’re weak-willed.

-If X is the worst pain I’VE ever felt, it’s because there is something special about X pain.

-If X is the worst pain YOU’VE ever felt, it’s because you’ve not been exposed to the really bad stuff.

-If I say “X is no worse than Z”, where Z is something like a bee sting, I’m being brave and noble.

If YOU say “X is no worse than Z”, then you probably haven’t really felt X.

Even people with very good intentions will do this. People who are trying to get across that their pain is more severe than yours will do this, even when it is perfectly valid to say that their pain is worse than yours. People who are trying to reassure you will do this. People who are trying to suggest that they are better than you will do this. Basically, everyone does this. I know I’ve done this, and it’s taken a LOT of training to stop myself, since it’s something so ingrained into how we determine status.

 

6) Believe people when they talk about long-lasting pain. Just trust me on this, it’s hard to explain how constant pain can become a normal part of daily life, but it can. It’s not something that you “Get used to” or “Get over”, but it’s something that you can get on with life whilst having. It’s not less painful, just because it’ been around for a while.

 

7) There’s a difference between chronic and recurring-remitting pain. Broadly speaking, chronic pain is chronic, recurring pain is episodic. Both have flare-ups, but chronic pain tends to be neuropathic in origin and thus never *quite* goes away, whereas recurring-remitting can be gone for hours to weeks before returning in full force.

 

8) Be gentle with yourself when you’re in pain. This should be obvious, but you know when you’re in pain, and there’s a strong, instinctive urge to just lie down and rest? Or to sleep? Or to let someone else finish building the wall or carry the bags or make the tea? Take notice of it. Take painkillers as soon as you feel a twinge, allow yourself to write off the day, and do something low-energy. Listen to the radio, watch TV, daydream. Cultivating a fairly in-depth inner world is the way forward, because then you’ve got somewhere to go when your body hurts too much to even think about reality. If you need to meet work or academic deadlines, tell the people in-charge of them well in advance that you sometimes have pain days, so that when you are in pain you need only send them a one-line email or a quick phone call, and they’ll know what to do.

 

9) Learn the difference between safe pain and unsafe pain. This isn’t a perfect world, so sometimes you’ll have to push through pain to get things done. Work out which pains you can “defer”, and deal with by resting properly later, and which ones need to be adressed immediately. All pain can cause long-term damage, but only some of it will immediately put you in danger (The pain that precedes muscle weakness and falls, for example). Learn, and it’s very personal to you, which pain can be temporarily ignored for the greater good, and which can’t. There is a sliding scale between “Pain that I will ignore in order to do a fun thing” and “Pain that I will only ignore if the alternative is being hit by a train”, and where you put those lines is up to you.

 

10) I can’t think of anything else right now, but there’ll probably be a part two later.

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