Chronic Pain

My pain is a cruel and jealous lover. It dictates my days and dominates my nights. It sulks and whines when it feels ignored. It consumes me.

I bargain with it. “Just give me one night, one night to sleep without you, and you can have me tomorrow.” Pain acquiesces. I nestle myself in a barricade of pillows and heated herbal packs that soothe my twisted limbs and drift gratefully off to sleep, only to have Pain invade my dreams. I cry out, though the torture is phantom. I awake, exhausted, to find Pain perched by my bedside, gleefully prepared to exact my promise.

Grimacing, my middle-aged patient described a somatic pain radiating out from a deep-seated void. This decades-old ache manifested itself as intractable muscle tension or tenacious migraines or debilitating heartburn and was always accompanied by emotional anguish.

At the void’s root lay existential angst, exacerbated by dark skies, loneliness, major decisions, and life’s transitions. Her genogram revealed deeply entrenched generational trauma. Her lab workup was normal. She sought out various modalities—medication, acupuncture, psychotherapy, psychic readings, herbal remedies. Her flares were fewer, but they struck randomly, disrupting her life for days.

Like everyone, I was taught as a child how to walk across a room on my own and how to hold a spoon to feed myself. As an adult, I never paused to marvel at these ordinary acts, while strolling to the mailbox or eating dinner with my family—until they slipped from my reach, replaced by chronic pain and deformed limbs.

Now, a week before my sixty-fifth birthday, as my home health care aide gently drapes a towel over my chest so I can attempt to feed myself, my embarrassment over the mess I will undoubtedly make of my cottage cheese and baked beans on that towel reminds me all too sharply of what I’ve lost.

The hospital CEO asked me to accommodate a new patient in my pain clinic, a young woman visiting for a few days, granddaughter of his colleague. “Of course,” I said.

“Jessica” was sixteen-ish, thin, athletic-looking, brunette. As usual, I addressed my questions to her, expecting her to tell me about her pain. But she replied, “Mom, you tell her.”

A doctor rarely imagines becoming a victim of workplace violence leading to chronic pain. I was a young, idealistic geriatrician fresh out of my training when I began working in a memory care facility. It was a high-turnover unit, with residents dying or moving and new patients with dementia admitting almost daily.

Pain has been my constant—and cruel—companion for eighteen years. My suffering when bone was hitting bone in my left jaw led to the first of five maxillofacial surgeries. None worked, even when I had radiation to prevent more bone growth. I have had Botox, acupuncture, physical therapy, medication—but nothing alleviates the pain that radiates from my jaw to my ear, eye and head. The prosthetic device in my head prevents me from opening my mouth to any great extent; going for a dental cleaning is excruciating, while having dental X-rays is impossible.

Dear readers,

If I had to start my medical career from scratch, I’d devote more time to studying chronic pain. Specifically, I’d want to arm myself with more and better tools for alleviating it.

Over the years, I had many patients with chronic pain, and my success at treating them was spotty. Pain relievers were helpful–sometimes. Physical therapy and acupuncture were helpful–sometimes. A pain-management referral was helpful–sometimes. A conversation about past emotional traumas was helpful–sometimes.

But there were patients whom nothing seemed to help.