Chapter 1: The Good News About Pain
I have a little anecdote I like to tell my patients when they first come to see me: I've got some good news and some bad news for you. First the bad news: You're in pain. Now the good news: You're in pain.
Sounds ridiculous? It does to my patients as well, that is until I give them the same information I'm about to give you. By the time you're done reading this chapter, you will begin to look at pain differently and see it for what it really is: a teacher guiding you to a complete and accurate accounting of what problems are occurring in your body.
Pain is not your enemy. In fact, it is one of your greatest allies. The simple truth is that pain is nature's perfect alarm system, designed to alert you that something is wrong. When this alarm goes off, you are being sent an unmistakable message that something happening inside or to your body is causing you harm. Why is it so imperative for you to see pain in this light? Because misconstruing or ignoring what your body is trying to tell you can have grave, even crippling, consequences. I am going to teach you how to recognize and interpret the signals of pain so that you may heed the sirens of this built-in warning system.
I know it may be hard to perceive pain as anything but bad, especially when you or someone you know is suffering. And a whole lot of people are suffering. Pain does not discriminate. It can strike whether you are a young adult or of advanced age, male or female, rich or poor. It doesn't matter if you are a high-performance athlete or a couch potato, a yogi or a mommy. I am well aware from my own experiences how much being in pain reduces your zest for living. It robs you of the ability to be up for all the challenges and good times that life has to offer and seems to hurt much more than it can ever possibly help. And to a certain extent that's true, especially if you're talking about the kind of pain that just won't go away. However, I am not suggesting that I think it's a good thing to stay in pain. In fact, I wrote this book so that you could live your life pain free. I want to help you develop a deeper relationship and connection with your body than you've ever had before. When you make a friend of pain, you will be acknowledging and respecting the intricacies and nuances of your body's design. Thus the first step toward living a pain-free life is understanding that the good news about pain is that you can feel it.
Without the ability to feel pain, you would be unable to survive. (Until recently, children who were born lacking this faculty had an extremely diminished life expectancy.) It is one of creation's great paradoxes that you incur pain in order to avert pain. Think about it. Pain makes it possible to navigate your way through the perils that are often a part of daily life. For instance, when you touch a hot stove, the pain you feel demands that you pull your hand away to avoid any additional harm. If you suffer an injury, such as a fractured leg, the pain prohibits any further use of the limb until it has healed. Likewise, if you develop a disease or suffer a major trauma, the body responds by sending a clear directive to your brain: Pay attention and take action now.
Not all pain is created equal. Although it may feel the same, there are actually different kinds of pain. They are generally broken down into two categories: acute pain (sharp, intense, immediate) and chronic pain (recurrent, persistent, long-lasting). In the preceding paragraph, all of the examples illustrated acute pain. This type of pain is characterized as an instantaneous symptom of a specific injury triggered by some form of tissue damage. Acute pain can be mild, such as from a splinter, or it can be severe, such as when you have a tooth pulled. Its duration can vary from a matter of seconds, such as from a stubbed toe, or to several months, such as from a bad burn. The important distinguishing factor is that there is a direct correlation between cause (injury) and effect (pain). In addition, there is a reasonable, almost predictable amount of time between effect (pain) and recovery (no pain). Treating acute pain is also fairly predictable because the injury itself informs you of what needs to be done to remedy the problem. Whether you can manage this treatment yourself, such as by putting a Band-Aid on a minor cut, or require medical assistance, such as needing stitches for a severe cut, there are some obvious steps that will eventually lead to the alleviation of your pain. In other words, when you fix what's wrong, the pain goes away. All of these factors make it easy to see why feeling acute pain is so vital to our existence. However, things become a lot less clear when we start talking about the main focus of this book: chronic musculoskeletal pain.Chronic Pain: The Inside Story
No two words put together back to back inspire more fear, spark as much controversy, and cause as much confusion as "chronic pain." You cannot turn on the television, listen to the radio, open a newspaper, or surf the Internet without being bombarded by a plethora of information on this subject. I have found a lot of this information unnecessarily complex, often conflicting, and sometimes even highly inaccurate. Everyone, it seems, is talking about chronic pain because everyone, it seems, is in it. And that's no exaggeration. It has, quite literally, become an epidemic. The statistics in the United States alone are staggering:
More than 100 million people suffer from chronic pain.
90 percent of the population will experience back pain during their lives.
70 million workdays are lost from pain a year, costing industry more than $100 billion a year in lost wages and insurance.
50 million people are partially or totally disabled by their chronic or long-term pain.
45 million people have severe and chronic headaches.
40 million people suffer from arthritis, 26 million of them women.
20 million people experience jaw and lower-facial pain.
10 million children under the age of 18 suffer from chronic pain.
6 million people suffer from fibromyalgia, a general diagnosis for the myriad aches and pains afflicting muscles, joints, and tendons.
You may be reading this book because you are already one of these statistics. Or you may be reading it because you don't want to become one of them. Either way, the information in this book will provide you with the help you're looking for. I'm going to let you in on a little secret: In nearly 100 percent of these cases of chronic musculoskeletal pain, the symptoms can be rapidly relieved and the conditions themselves prevented.
The word "chronic" comes from the Greek word for "time." Generally speaking, chronic pain could be characterized as any pain that recurs or persists over an indeterminate period of time. Like acute pain, chronic pain can run the gamut from mild to severe; and the duration of each bout can last from minutes to months, even years. What distinguishes the two is that while the source of acute pain can be attributed to an obvious injury or illness, many who suffer from chronic pain (barring the chronic pain associated with disease, such as cancer, or trauma, such as the chronic pain associated with nerve damage) do so seemingly in the absence
of an injury. For instance, how many times have you experienced pain that seemed to just pop up out of nowhere? How many times have you said that "without warning" you couldn't move your neck or that "suddenly" your back went out? If these experiences are true for you, you're not alone. Millions of people around the world have reported the same thing. Likewise, whereas the recovery from acute pain seems to follow logically from the treatment of the injury itself, chronic pain persists in spite of, sometimes even because of, treatment. In fact, quite often there seems to be no logic at all; no discernible direct link between cause, effect, and temporary recovery. Chronic pain seems to come as mysteriously as it goes. Of course, there is a reason for the sudden onset and dissipation of chronic pain, as I am about to show you, but the lack of objective evidence pinpointing an actual injury has led to a great debate in the medical community on the very nature of chronic pain.
Because of its vexing and ambiguous qualities, many health professionals have been reluctant to even acknowledge chronic pain as a real ailment. I cannot tell you how many patients have come to me over the years after their doctors told them that their pain was imaginary, a manifestation of hypochondria, or a desperate ploy for attention. Although I am always appalled when I hear this, I am never surprised. Western medicine is dependent upon the tangible for analysis and care -- seeing, cutting, poking, and prodding. But chronic pain is intangible and cannot be quantified by most extrinsic standards, except that the patient is clearly feeling something. Because many of the empirical methods commonly used today for diagnosing chronic pain, such as CAT scans, MRIs, X-rays, and blood tests, are inadequate for formulating proper treatment, many doctors feel frustrated and impotent in the face of the growing crisis. Some have even dismissed it altogether. The situation has become as critical as it has in large part from widespread misdiagnosis, mistreatment, and ignorance.
The failure on the part of many health professionals to adequately deal with chronic pain exacts a devastating psychological toll on its sufferers. To be in physical pain is bad enough; to be given little support and offered no solution only leaves one feeling utterly helpless and depressed. The severity of this emotional trauma cannot be overestimated. Fifty percent of suicides give pain as motivation.11 Changing the approach to chronic pain has literally become a matter of life or death. Lately, the medical community has acknowledged an urgent need to reassess their position, and slowly a new attitude and understanding is emer...