Introduction

This is some of what I have learned about pain in the last 6 months. Everyone tells me their pain story and I have my own to learn from so I learned a good deal. Here it is.

Useful pain is the body telling us not to do things such as, grip hot pans and don’t walk on damaged hips. Less useful is long term chronic pain which has “no obvious medical origin” which is a phrase the shows up in medical notes, but this pain is real nonetheless. The latter is what I am talking about here.

Some nine months after I had a new back installed I was told by a back specialist my spine had fully healed, that whatever pain I felt was forever, and I should no longer be on opioid pain relief. This was a lot to absorb and also a shock given others were saying it would take 3 to 5 years. Who was right?

I suspect the answer is both. The actual pain signals coming from the back are constant. But the mind can be trained, mostly by distracting it, to ignoring the pain. The pain is always there and it can either dominate your life, or not. It is largely your choice.

I found light woodwork as good as drugs for pain relief. Whole hours could pass woodworking without me thinking about pain. Novel social situations have the same effect. Every day you emerge full clothed you learn to ignore the feel of the shirt on your back. The skin is sending shirt-sensing signals to your brain all the time. You know you put the shirt on and you can see it. Despite all these sensory inputs the pain/sensation analysis part of your brain does some brilliant information curation and stops noticing it. (Autism is partly the failure of this process)

Opioids get less and less effective so there are two responses. Take more opioids, or accept the fact and take less of an increasingly unhelpful input. Opioids gave me intensely vivid dreams in which I was trapped in a range of situations I could not get out of. Not nightmares exactly but a relief to wake up from. The suggestion the opioids were messing with my head were a big motivator to get off them.

Hypnotherapy has helped me. I listen to the podcast ……always sends me to sleep. I do not enter a trance or anything entertaining. Hypnosis trains the conscious brain to accept that pain can be ignored and encourages the natural process of information curation. A chum was advised to talk out loud to her back before a painful operation. Same logic.

My experience with acupuncture was mixed. Most sessions are pretty painful and the early ones had little effect. But recently after 5 sessions I feel less pain the morning after a session than I did before. Anecdotally I hear this is common. Also, acupuncture is the only treatment I get and thus an important boost to morale. Otherwise you feel very stuck.

There is a strange link between pain and mental state. Stressful situations such as missed trains etc certainly raise pain levels. I cannot now hurry anyway. Hurrying is by definition a stress and it causes new pains in very specific areas and goes beyond simply noticing pain which is always there but had been forgotten. The familiarity of home, bed and favourite chairs reduce stress and thus pain.

My new go to book is in the excellent LadyBird Expert series. Author Irene Tracey just appointed vice chancellor of Oxford university. She is a neuralgic pain academic. My big take away was “people get the pain they expect”. People told a particular procedure will be painful report more pain than those who are told it will not hurt. This points to hypnotherapy for chronic pain where the goal is to convince the brain’s pain analysis function there is little or no pain.

So in summary, chronic pain is to a large extent a mind game. Regardless of whether this is 10% true or 90% true, for each person the mind game is the part we can control so it is worth concentrating on.