Painfree - NOT!

A recent discussion on a doctor's listserv started with the topic of opiate prescribing and worked its way around to a discussion on what contributes to pain and the more philosophic discussion about how different people experience pain differently.

I have chronic pain; I have had it almost all of my adult life. Most of the time I use various distraction techniques to deal with it and most of the time one or the other works.

When our father was dying of amyotrophic lateral sclerosis, some of his children donated blood to a Winnipeg specialist who was doing a genetic study on auto-immune diseases. (We never did know what happened to the study.) I was a first year medical school student so, without the assistance of doctor Google, didn't know enough to ask exactly what he had tested. When each of us returned for results, the doctor predicted that two of us, one sister and I, had a 50/50 chance of developing an auto-immune rheumatological disease. My sister developed lupus in 1991. The lumps on my fingers and the x-ray changes of my joints tell my doctor that I have osteoarthritis.

Back when we were in our early 40's, we sat around the table with our friends sharing our experiences of entering our "middle age". What perspectives had changed? Almost everyone had children so the changing attitudes towards child-rearing made for some of the conversation. Wrinkles and grey hair started a round of the changes that we had in physical expectations. When it came my turn to share,"my hot joints became painful". Someone giggled but everyone looked at me, "hot joints? What do you mean, 'hot joints'". I was surprised to learn that joints which felt "hot" were not a universal experience.

When did the sensation begin? I think that it was in my early 20's. I broke my sacrum in a freak direct-blow sledding accident when I was 18 so back pain was always with me causing great problems when Marlene and I flew, sailed, trucked, trained or bussed around South America in 1966.

By the time I was 40 years of age, I was popping pain pills. By 46, I had discovered that NSAIDs had a positive effect on menorrhagia but my stomach was a mess. Acetaminophen with codeine caused constipation, stomach cramps and an annoying peri-oral hypaesthesia. Acetaminophen by itself caused a central headache. I vomited with morphine and had incredibly distracting dreams with oxycodone. Tiaprofenic acid, a discontinued NSAID, helped. Generally, I was miserable. When I wasn't busy, I drank beer or wine. 

In 1989, I picked up a pamphlet on exercises for the ailing back. There was probably nothing new about the activity - if literature would have removed the chronic back pain, I'd have been cured for I had collected practically every piece of literature on back cures. This time was different because I actually started to do the exercises. To my surprise I started to experience a decrease in pain so I went to a physiotherapist for more exercises.

In April 1991, I had a back-pain-free week! Getting rid of back pain, however, gave me a chance to experience joint pain. On the basis that exercise will do no harm and probably would do good things, I now have a 50 minute back/yoga exercise routine in the morning and about 30 minutes in the evening.

When I injured my back three years ago, investigations showed a 60 degree rotoscoliosis and severe osteoarthritis as well as osteocytopenia. The broken sacrum with its irregular healing could be seen. The x-ray looked like that of a woman much older than I.

While my back is not often the primary site of pain nowadays, it always lingers in the background. If I fail to do my morning exercises, I can predict that it will be back. Other joints behave like OA, right now my hot painful swollen joints are my CMCs and my MCPs (both of the joints on the both thumbs) but the pain in my knees, ankles, and hips is present as well, just not as noticeable as the thumbs.

How do we measure pain? By the truly subjective method of comparing the "worst pain ever experienced with the current pain"! The worst pain that I've had was after the reimplantation of an amputated distal digit. If that is rated a "10", my usual pain is a "3". Some mornings it is a 5 or a 7.

I think that pain is part of being alive.