Chronic Pain

When I was a young cowboy I brought in a sick steer for treatment because I could tell it was suffering.  The boss told me to send it back to the herd because it was a CHRONIC.  When I asked what that term meant the boss replied:  "It means he isn't ever going to get well, so there is no use treating him."

Some humans are CHRONICS too.  Unlike the steer I brought in, we get to keep on looking for a solution when doctors give up.  When conventional treatments fail some people will take the most outlandish administrations known to man.  They will let themselves be stung repeatedly by bees, shiver for hours under ice, immerse themselves in boiling steam, and come out none the better for treatment.

O. Henry might have described the best solution in one of his stories about a CHRONIC who got roped into the savage life of a cowboy on the plains.  After a long period of intense suffering the young fellow's system finally thrived.  

Unfortunately, visiting a modern dude ranch won't work.

 P A I N

As a child I marveled at the bully that could peel his fingernail on off when it came part way.  As an adult I marveled at the story of the Airman that held a ball of burning white phosphorus in his hands until they melted from the fervent heat, long enough to save the lives of the entire crew.

Daddy had one of his heart attacks and was being rushed to the hospital.  Over-zealous Emergency personnel said his heart quit beating on the way, and they initiated "life-saving" measures.  In doing so they broke 3 ribs.
These could not be mended and every breath he took was one of immense, intense pain.
He told me that if he knew that Mama would be taken care of that he would be glad to die.
He was serious.  He was in full use of his faculties.  I gave him my word that Mama would be taken care of.
That evening he quit breathing on his own.  Doctors put him on life support and on something better than morphine.
When doctors thought he was gone for real they asked for permission to remove life support, expecting him to pass away immediately.  They said that the family could be with him until he passed away and that I could ask them to put him back on life support any time before he did pass away.
I explained this to everyone and invited all of my kids into his room with the understanding that if anyone wanted him to go back on life support to say so and we would stop the show.
Once we were assembled in that room doctors removed life support.
Instead of dying, Daddy came awake.  He glanced around and numbered all of us.  He knew what we were there for and he knew that he would have to strain his system until his heart failed. 
All that pain, each breath nicking a rib, not once did he flinch or turn away.
I then had this ability to see everything happening in a room I'm in.  I watched for any sign from any of my girls that they wanted to deny him this right.  Pain I saw, but no flinching.  Daddy's blood ran true. 
We let him die.
Daddy had a great capacity for enduring pain.  He went to the doctor to have his tonsils removed.  He saved $40 by having the operation done in the doctor's office.  He saved another $15 by having it done without benefit of anesthesia.  Those tonsils were so big they had burst open, then grown back to his throat, then burst again, and grown back to his throat again.  The doctor had to whittle them out, piece by piece.  All the pieces were saved in a tall bottle of alcohol.  Daddy brought them home and set them on the table so he could look at them every once in a while.  Years, and years later he told me that the hardest part of the operation had been the years after it.. "Every time I took a deep breath my throat would collapse and I couldn't get my breath."  He was angry when he said it, as if he had done hard work and not been paid for it.
I remember another time that he must have been in pain.  Back when I was a kid the Caterpillars still used cables, instead of hydraulics.  Daddy could thread cables faster than anybody and if any broke within 10 miles of him, he was called upon to make the repairs.
Steel cables are made of steel wires woven like a rope, under very high pressure.  They have the tensile strength of cheap sewing needles.  When one breaks nobody knows where all the pieces will go.  We were putting one together, splicing and finding alternate anchors so the boss wouldn't have to buy a new cable.  When I put pressure on that cable it splintered, shredded apart with splinters going everywhere.  One end slapped - I guess it was his left arm and left a whole bunch of slivers buried in his arm.
We went to the doctor and Daddy rejected the use of pain control.  He laid his arm down on the table and the doctor began whittling the pieces out.  He must have saved the worst one for last because when he started on that one he had to cut deep, and deeper until at last Daddy took a deep breath, and nodded.  They had found that last, buried piece of cable.  It took another five minutes to get it out.  The doctor wouldn't take any money for the operation.  He bandaged the arm up and Daddy went back to work.  Daddy bragged about a lot of the things he endured; he never bragged about that one.
About 16 years later I saw Ray Lyons pull off a similar feat.  He was cleaning a bolt with the electric grinding wheel, wire brush.  I was standing there when he took the guard off so he could see what he was doing.  When he flipped the switch to resume work that wire wheel came to pieces, with strands of wire going everywhere, including into Ray's open right eye.  Those rotten wires broke off beneath the surface of the eye.
I took Ray to the doctor, only about 6 -- 8 blocks away. 
Ray sat there, staring straight ahead - without blinking - while the doctor probed for all the pieces, and removed them.  After the doctor had put a patch of cotton over that eye and taped it down so the eye wouldn't move Ray went back to work.  So far as I know, Ray never said a word to anybody about the matter. 
Ray's mother was Daddy's frail sister, Beatrice.  The only time she ever came close to yelping was the time a stupid nurse jerked Aunt Beatrice's leg straight out, and broke the leg at the knee.  Aunt Beatrice never walked again.  I won't be at all surprised to learn someday that Ray made sure that nurse discovered what pain was all about.
Contempt for pain never was one of my gifts.  I have winced a lot, but I have worked on the lack of this great gift and I have gotten a little better at enduring pain.  I remember working to clean out the courthouse in Searcy.  We had to swear we could lift 40 pounds to get the job.  Our work time was from 6 in the morning until 10 at night, with 30 minutes off for lunch.  We were carrying 40 pounds of books at a time down 3 flights of stairs. The next morning only me and another man returned to work.  All the others had called in and quit rather than come back.  The same thing happened that next day, and the day after too save that we were loaded up with 60 pounds of books for each trip.  The morning after that I was the only one that had not called in and quit.  We were allowed off on Sunday and I never moved from the bed.  Monday morning they upped the load to 100 pounds of books on each trip.  A few men had to be replaced before dark.  I was the only familiar face on Tuesday morning.  Wednesday, same thing, Thursday, same thing but in that turnover we acquired 2 little wet backs.  They couldn't lift their load of books - but nobody else could either because the weight had gone up, I suspect to 140 pounds, maybe 150.  3 flights of stairs.  To this day I shudder when thinking of those weeks.  All day Thursday I carried my full loads.  The others would empty their containers out, and carry only a few of those massive deed books down at a time.  There was no supervision; those that filled up our containers never seemed to notice that I was the only one that returned for another load.
Friday morning those 2 wet backs and I were the only familiar faces on the new crew.  The new members soon quit, walked off and never returned.  The illegal aliens quit even pretending that they were working.  They followed me down those stairs, and back up again, jeering, laughing, making fun of me -- one before me, one after me.  On that Saturday it was again just the three of us show up that had finished out the previous day.  They did no work on Saturday either but simply harassed me, down and back up, always there with nothing varying except that in the afternoon they became mean and began trying to make me stumble under my load. The rest of the crew stopped and stood on the landing as if they were just taking a break, in case either of our supervisors ever stuck a head out the door to see why I was the only one that came back in for another load.  Wordlessly they watched the taunts and threats of the illegal aliens -- then just as wordlessly they made motions that they were to depart the building and such was the force of that communication that I never saw either of those 2 again, or anyone else on that crew either, for that matter.  By the time we finally quit that night my right knee was gone and I was going down the stairs sideways. 
Sunday again I was off.  My every muscle was in such agony that I could not bear to blink.  My right knee was throbbing.  I was hurting so much that I told Media that I could not go back.  She made sure that she had heard me right, then she looked me in the eye and hissed in my face:  "You will go back and you will keep working even if it kills you, or don't you come back here."
Years later I reminded her of that, and she swore she had never said it.  I know she did though because no other thing on earth could have made me go back to that job on Monday.  There was another all new crew that day, save for me only.  Book weights went back down on Monday and they stayed light all that week, but it was too late for me; my right knee was gone, every step was like running it through a meat grinder.
Tuesday I returned to a brand new crew.  I think they were a good crew, working hard but on Wednesday I was again they only one that returned.  Thursday brought another new crew and it seems like 1 or 2 returned on Friday.  We were finally finishing up and that day's crew was really good.  They pushed past me constantly to get the work done and they never said a word to me; when they passed me, there was only silence.  I was too tired, hurting too badly to care.  There was another new crew on Saturday; it seemed like they were just zipping past me, down, back up.  As the afternoon came on I couldn't possibly walk back up those stairs.  I sat down and pushed myself up them backwards, one step at a time.  I never heard a human voice until darkness fell, and we kept going.. 7, 8, 9 and then 10 and we still kept going until it was after 11 and I kept telling myself that I could not go on.  About 11:30 that night  the supervisors came out and said we would be working late that night as we only had a little bit more to do. 
When they turned around to go back into their room I put down my last box of books and I followed them inside.  "I can't make another trip.  I have to quit."
Quitting before the crew quit meant I had no ride home.  But I couldn't help that.  I literally could not haul another box of books down those stairs.
One of the supervisors looked at me for a long time; it must have been for at least a minute or two.  Then she said:  "I want you to go down into the basement.  There is a Coke box down there.  I want you to watch that Coke box.  Don't let it out of your sight."  There was a long pause and then she said: "Do not let anybody steal that Coke box.  Guard it with your life until I come to get you."
How long that was I don't know.  I do know that I guarded that Coke box with my life.  Nobody moved it an inch while I was there.
We finished that job that day and we went home.  A short time later I moved out and everybody was happy about it but me. 
That knee hurt me for 13 years and ever so gradually I learned how to live with the pain.  I think that I finally learned how to live up to my heritage.  But even today, I know that if it had been up to me to endure the pain of crucifixion so that the whole world would be saved, that instead, all of us would have gone straight to hell in a hand basket as I failed and limped and wobbled off the other way.
"Pain, Pain, Oh. The pain."

Pain is conceptual. Dr. Smith -- erstwhile hero of all the shattered hypochondriacs in the world -- may have been hurting more than any of the others, except for the robot, on that first Star Trek voyage that got Lost In Space. 

Pain hurts on its own level, according to the challenges we've been through, and those we have imagined.  A score of 10 to a pencil-pushing clerk might be a deep paper cut.  One of my outdoor guides didn't even blink when his knife cut his thigh open to the bone.  Then he poured lamp oil into the wound I held open for him so we could go on hunting.  

Here's the strange part about pain; the guide might have fainted from the pain from a paper cut while the clerk might not have noticed the knife wound for an hour or so after it happened.

Pain is different for every one of us.  

Pain is different even on different parts of our bodies.  
This is good to know for those of us who must take injections.  Slant the needle point towards you and pull the needle away from you, spot by spot until you find a spot which produces no pain.  Here you can give yourself a shot almost painlessly.  

Pain is different on the inside, or the out.  

Pain is different when you have a fever, or don't.  

Pain is different if you are alone, or if an enemy is watching you suffer.  

None of us even feel pain in the same way each time it hits.

McDowell and Newell {McDowell I, Newell C (1996) Measuring Health: a Guide to Rating Scales and Questionnaires. Oxford University Press, New York} points out that pain is a stimulus which cannot be measured directly. 

Adrian White, Dept of Complementary Medicine -- Postgraduate Medical School, University of Exeter (UK), says:  "It (pain) must be judged from the patient’s response, which can be greatly influenced by individual genotype, culture, conditioning, education and so on."

Senseless as it is, the nurse's question above is asked in virtually every U.S. hospital.  It is a crude attempt to get a verbal measurement from the patient on the level of pain.  There are more refined tests, like squeezing some part of the body in a vise until the patient feels more pain there than the pain s/he came in complaining about.    "Gee, that test gave us some good news;  You are only experiencing 10 dol of pain.  Rambo can take 50 before he faints."

In 1965 Canadian psychologist Ronald Melzack and British physiologist Patrick Wall suggested a gating mechanism within the spinal cord that closed in response to normal stimulation of the fast conducting "touch" nerve fibers; but opened when the slow conducting "pain" fibers transmitted a high volume and intensity of sensory signals. The gate could be closed again if these signals were countered by renewed stimulation of the large fibers.

In 1929, the National Research Council launched a forty-year drive to develop an analgesic stronger than aspirin but without the addiction potential of narcotics. More than 500 compounds were developed, several of which appeared to induce analgesia in animals.  Now, isn't that something to marvel at?  Aspirin, at the top of the list for pain relievers?  "Take two aspirins and call me in the morning" may be still sound medical advice for anyone in pain.

Over the counter pain relief can be found in:

• Acetaminophen (Tylenol, Aspirin Free Excedrin)
• Nonsteroidal anti-inflammatory drugs (NSAIDs; aspirin, Motrin, and Aleve)
• Corticosteroids (Cortaid and Cortizone)

Applied right where it hurts the most, ointments, creams, lotions, or sprays like Salonpas, Aspercreme and Ben-Gay may be even more effective than the above medications in some situations. Salonpas is a favorite of Orientals for pain relief. Euromericans who have been introduced to it by their Oriental friends like the patch for its quick and clean application.  "Slap it on and you can go back to work."  

Prescription pain relievers include:

• Corticosteroids
• Opioids
• Antidepressants

Antidepressants are that class of drugs that can treat pain by adjusting the patient's levels of neurotransmitters (natural chemicals) in the brain. These medications can increase the body's own signals for well-being and relaxation for people with chronic pain conditions who do not respond "right" to the usual treatments.

Doctors who specialize in pain management may recommend certain types of physical therapy or TENS, a procedure that uses patches placed on the skin to send signals to the body that stop pain.

One problem with pain is that patients don't want it to stop until the problem has been solved -- solved, not just identified.  If their problem cannot be fixed then the sooner they accept that fact, the sooner they can resign themselves to learning how to manage the pain they have.