Pain, my friend

Dana Jennings, who blogs about his prostate-cancer ordeal in The New York Times, wrote an interesting post about pain. He writes:

I have no patience these days with the Nietzschean cliché, “That which does not kill us makes us stronger.” I’ve found that the deepest pain holds no meaning. It is not purifying. It is not ennobling. It does not make you a better human being. It just is.

I've been thinking a lot about pain, not surprisingly, and I'm intrigued most by how many varieties of it my body can throw at me. Like colour or music, pain can be measured on different scales: intensity, texture, location, duration, type (ache, stab, burn, spasm, throb). What amazes me is how I can tolerate some pains and not others, but intensity is not always the determining factor.

Off and on since my 20s, I suffered from sciatic pain stemming from post-scoliosis arthritis (and spondylolisthesis, to be technical about it) at the base of my spine. At times it was excruciating. The location of the pain was hard to pinpoint; eventually I was able to say, "It's in my outer right thigh," but for the longest time it seemed to simply hover somewhere around my leg. It felt as though it stemmed from my brain as much as from anything.

The triggers were simple and predictable: it hurt when I stood in one place. Leaning against something, walking, sitting and lying down took the pain away (much later, though, walking became difficult, too). I got so used to it that even during periods when it wasn't bothering me (some of which were gratifyingly lengthy), I retained a pain reflex: when forced to stand in one spot, I automatically and unconsciously groped for something to lean against or hold onto (and you thought I was just overly friendly).

At its worst, the pain was distracting, and, especially in my late 20s and early 30s, it constrained my social life because it made attending parties uncomfortable -- I always had to sit down, which made mingling impossible -- and listening to music in bars meant having to arrive early enough to secure a seat and hope the audience didn't become enthusiastic enough to stand up en masse and ruin my view. When I had to converse with someone while on my feet, I sometimes had a hard time concentrating on what my companion was saying. It was as though a little pain demon sat on my shoulder and shouted in my ear, "BLAH-BLAH-BLAH-BLAH! PAY ATTENTION TO ME!"

But I never took pain medication for it. The couple of times I tried an analgesic of some sort, nothing happened, so for 20 years I just withstood it. After a while, I began to think of my pain as an entity, a companion that I simply had to lug around with me. I learned to observe it rather than experience it, I suppose. Perhaps this was possible because it was easily relieved by sitting down.

Dana Jennings writes that he's "been surprised by the degree of pain you can become used to."

... One side effect of all these operations is that common day-in-and-day-out bumps and bruises don’t get much of a rise out of me. Stubbed toes and headaches, spider bites and bee stings? Whatever. The bracing prickle of alcohol sloshed onto a cut or a scrape actually feels pretty good to me. And after all the siphoning, and replenishing, of my blood over the years, I don’t flinch at needles.

I felt pretty much in control of my pain for a long time. Then the worst pain of my life arrived. This gets into the too-much-information department, but I suppose if Jennings can write about the removal of his prostate and his rectal bleeding in The New York Times, then I can admit that I had an anal fissure, which was eventually corrected by surgery, but not until I'd suffered two years of on-and-off hell. The details are too horrible, but suffice it to say that my neighbours may have suspected I was giving birth each morning in the bathroom (UPDATE: I realize now that the previous sentence contains a highly misleading description of this malady's actual symptoms. God, this is awkward; in any case, the pain probably does NOT occur in the bathroom). I was loud and I was shocked; it was unbelievably intense. But the attacks were short-lived, if daily, so taking a painkiller didn't seem sensible. Avoiding cheese and sitting on a cushion was the best I could do until (this sounds familiar) I recognized the symptoms in a book I stumbled upon while using the office of the Maclean's health editor during a weekend proofreading job and realized I'd been misdiagnosed; a skilled surgeon fixed the problem permanently, to my everlasting relief.

So my experience with painkillers has been minimal. The only thing I ever took them for was headaches, which luckily I'm not usually plagued with. But that brings me to my point: why can we tolerate some kinds of pain and not others? A moderate headache will send me to the Motrin bottle, or even codeine, but I never took a thing for my sciatica. I suppose I feared using potentially dangerous drugs for a chronic condition; long-term use frightened me. I was also pretty sure nothing would work, and I wouldn't have known when to take any painkiller that had short-term effect. No doctor ever recommended any drug until the lower-back thing got a lot worse and my GP suggested an NSAID, which I rejected.

It wasn't until my upper spine collapsed a year ago (and my lower-back problems completely vanished, incidentally) that pain became so intolerable I had to resort to drugs. But even then, because I got relief from lying down, I didn't go overboard. Now I am popping up to six Tylenol 3s a day. Can I honestly say that this pain is worse than pain I've had in the past but didn't take drugs to alleviate? I'm not sure it is. What seems to make me perceive it as worse is that it's in my middle; somehow that feels more debilitating, and it also tends to make me feel slightly sick to my stomach. Plus, now everything has reversed, the pain is at its worst when I'm in a resting position, and somehow that's just not tolerable.

Or maybe I'm just turning into a wuss? Anyway, last night was pretty bad in the sense that I could not find a comfortable place or position to sleep in and so spent much of the night listening to music -- at one point dancing with remarkable abandon to Michael Jackson tunes in my darkened kitchen, iPod in hand, the Big Dipper looking down on me through the window. The scary part was that two doses of Tylenol 3 did not seem to have any effect at all, and I'm worried that I'm developing a tolerance. This on top of the constipating effect that painkillers so kindly deliver. So today I have been trying to go all day without any pills, and so far just feel kind of miserable. Not screaming miserable, just occasional-moan miserable.

It helps a little that I have a little curly-haired dog named Winston lying in my lap. But that bottle of pills in the kitchen is battling with old Nietschze.