The Subjectivity of Pain
Over the past twenty years, a part of my private practice has been the evaluation of adjudicated substance abusers. These involve drinking drivers mostly, but also defendants arrested for being under the influence, or in possession, of other illegal drugs. Recently, I had the occasion to evaluate a poised professional woman found to be in possession of heroin. She explained that she had been injured in a car accident four years ago. She had developed a dependency on Vicodin originally but had terminated her use of that prescription drug when her physicians were unwilling to continue to provide scripts for it. She stated that she had turned to buying heroin illegally when she would experience occasional “flare-ups” of back pain.
As we discussed the role of pain management, I shared my experiences with pain as I narrated the details of my recent heel injury. (See “What’s a calcaneus?” from an earlier newsletter on this site). My client was clearly fascinated as I explained my decision to terminate the use of narcotic pain relievers. (An aside: While these substances are more often referred to as “painkillers,” my acute discomfort clearly survived the assault of medication!). Although I disclosed how the medications helped, I had also come to realize that I was developing a tolerance for them. Making the decision, a few weeks after my surgery to terminate their use, I gratefully discovered that my body began to control the discomfort on its own.
Once again, my client was struck by my decision to cease taking the meds. She stated, “It was certainly alright for you to take those drugs. You were still in pain, and the doctor gave them to you.” Considering her words, I could find little disagreement with her statements of fact. The drugs were legal, and I was still in pain.
So why didn’t I take them? It certainly was nothing noble or heroic. Mostly, it had to do with my fear of potential dependence that I had observed in myriad clients over the years. And, my heel was healing. Additionally, I never enjoyed the drugs; I never got high from them. But I think there was another factor at work: mindset.
The core of “snowman therapy” is housed in our belief systems. I think that my forty-something year old client had the following belief:
I shouldn’t have to endure pain to any degree.
Based upon that belief, she continued to take any pain medication available to her, legal or otherwise. My belief might be expressed with the statement below:
Medication can be a temporary “bridge” but, mostly, we heal ourselves.
Certainly, this belief does not apply to those suffering from horrific, debilitating pain. For those victims, pain medication may be the only option in order to achieve any real quality of life.
But I also have learned, in my five-month journey with a shattered heel, that pain is indeed subjective. New pain truly hurts more than old pain. Believe it or not, you get used to it, provided it is remotely tolerable. I don’t like it, certainly, but I’ve become accustomed to it. Compared to not being able to walk (or other far more serious medical conditions that many people endure), my small limp and discomfort seems inconsequential.
So, why does my client take heroin? She would say (truthfully, in her mind) that she needs it. I am certain that she would pass a lie detector test if one were administered.
I would suggest that it is her belief about pain that has led to her recent arrest. What is the solution to her problem? She would likely say that she needs her back to get better. I’d offer that her head, her beliefs, need to get better.
As Shakespeare told us, some 400 years ago:
Nothing is either good or bad, but thinking makes it so.