Coping With Chronic Pain: A Psychiatrist’s Personal Journey

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At least 50 million Americans and more than 1.5 billion people worldwide live with chronic pain.

During my 30 years as a practicing psychiatrist, I often treated patients with chronic pain. I was part of pain management programs and up on the latest approaches, including the use of medical marijuana.

I never expected, though, to become a patient myself where I would have to apply this knowledge and expertise to my pain and suffering. Overnight I was crippled with a disabling form of sciatica requiring me to shift from physician to patient. The excruciating pain prevented me from sleeping more than one to two hours a night. I could not walk without a cane because the impairment to the sciatic nerve caused “foot drop,” a disabling neuropathy with long-term implications. The pain was unrelenting despite using the multiple pain meds prescribed by my orthopedist and neurologist. After two months of being in this miserable state, I became depressed, thinking that I may never recover, or if I did, I would be left with a permanent disability.

Thankfully with the help of the team that I had assembled with PT (physical therapy), osteopathic treatments, mind-body exercises, medications and supplements, and the support of family and friends, I began to see some signs of hope. Now six months later, I’m happy to report that I require very little pain medication and am walking more and more without using a cane.

There are many lessons that I’ve learned along the way, and I hope by sharing them it will help lighten the burden of those living with chronic pain.

Tips for the Optimal Management of Chronic Pain

1. First and foremost, find a well-regarded pain doctor and clinic in your area. Pain medicine doctors (typically anesthesiologists, physiatrists, neurologists, or psychiatrists) receive extra training and can become board certified in this subspecialty. The American Board of Pain Medicine has a directory that will allow you to find a qualified doctor in your area. What’s best is finding a pain clinic comprising a supportive, interdisciplinary team that offers not only medication but procedures and treatments such as epidural injections, PT, massage, complementary therapies such as acupuncture, and mind/body therapies all under one roof.

2. Getting an expert, accurate diagnosis is mandatory for understanding your pain's root cause and establishing a realistic prognosis. Often testing with MRI, CT, and EMG (electromyography) is necessary and sets up an important reference point. In my case, I needed an MRI to determine if my condition could be treated with an epidural injection and or surgery. There are, of course, different treatment approaches available depending on whether your pain is cancer-related, arthritic, neuropathic (pain related to nerve damage), post-surgical, or simply a sprain or strain.

3. Medications are often necessary to help manage the pain. There are several different classes, and they all have strengths and weaknesses.

• Opiates are most appropriate for short-term use following surgery or longer for severe cancer-related pain. Long-term use, however, carries a significant risk of dependency addiction, overdose, and severe side effects of constipation, nausea, drowsiness, and other cognitive effects. These are now tightly regulated to ensure safer prescribing.
• Antidepressants (such as the older “tricyclics” Amitrypline, Nortriptyline, or newer ones like duloxetine) can be effective adjunctive medicines for nerve-related pain syndromes with anticonvulsants such as gabapentin and pregabalin. They usually require a few weeks to achieve optimal results, and they, too, can cause various side effects.
• NSAIDs (non-steroidal anti-inflammatory drugs), like Ibuprofen and naproxen, are generally more effective than acetaminophen for muscle-joint inflammation, but like aspirin, there is a risk of GI bleed and one should avoid long-term use. I discovered that Thorne’s “Meriva,” which is high potency curcumin-turmeric supplement that's been widely studied, worked as well as NSAIDS without causing much in the way of side effects or risks.
• Medical marijuana, cannabis, which requires a doctor’s prescription, combines different levels of THC and CBD and can be very helpful in a variety of pain syndromes. It may also help patients who want to wean off opiates. CBD gummies, which are widely available without a doctor's prescription, can be quite effective in reducing pain and inflammation and do not induce a "high" as with THC. There are brands, that combine CBD with melatonin, which can help with sleep.
• Other meds and procedures like dorsal column stimulators, electric stimulation, ablation surgery, and epidural injections can achieve substantial results and need to be prescribed or performed only by an expert in pain medicine.

4. Physical Therapy. Finding a good physical therapist can be essential to your recovery. It’s ok to ask if they have expertise treating your particular condition, what modalities they use, and how long and often they think you’ll need to come in. Even with the best physical therapy, you must comply with daily home exercises to achieve optimal results.

Trusting my physical therapist and working through the fear of pain helped me fully appreciate the saying, “no pain, no gain.” Massage, osteopathic treatments such as craniosacral therapy, myofascial release, counter strain, chiropractic, and other forms of bodywork are enormously helpful and effective. Hopefully, your physical therapist will incorporate some of these approaches into their work.

5. Mind-body therapies such as mindfulness meditation, hypnosis, yoga, tai chi, qi gong, and Feldenkrais are time-honored methods to bring about the needed relaxation and sleep that aids in healing. Nowadays, these are offered at most hospitals and clinics and readily accessible via watching Youtube videos or apps.

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6. Relationships and support. We all need each other but even more so when suffering chronic pain. We are often at our worst, which places an extra burden on the caregiver. If this leads to tension and conflict that cannot be resolved, counseling can be very helpful to help both you and your significant other learn better coping skills.

7. Nutrition and diet. Eating a diet rich in antioxidants and nutrients will aid in healing. We can reduce inflammation by eating a lot of fresh fruits and vegetables, and by avoiding excess sugar, fat, alcohol, and sweets. Consider adding turmeric or curcumin (as above), garlic, ginger, green tea, blueberries, and other powerful antioxidants to your diet.

8. Music-art therapy. These can be a healthy distraction and creative outlet that allows the mind and body the relaxation it needs to heal.

9. Work and interests. When we are engaged in a meaningful activity we can experience temporary relief from pain and suffering. Be creative in coming up with innovative ways to adapt, given our limitations.

10. Spiritual and religious practices such as prayer or meditation can bring about peace and tranquility. The feeling of being connected is essential for healing from the trauma of chronic pain. Taking time for contemplation also allows us to find our hidden strengths and learn valuable lessons from this journey.

11. Psychotherapy and or psychiatric treatment is necessary when depression, anxiety, alcohol or substance abuse, and or relationship issues are growing out of control and mandatory if there is any suicidal ideation or intent. CBT (cognitive behavioral therapy) is a short-term therapy proven to help manage chronic pain.

Most importantly, it’s necessary to develop realistic short and long-term goals. Working incrementally daily and watching for even small signs of progress and healing help keep our hope alive. Staying connected with your treatment team and loved ones is essential.

Soon after I opened up to my friends and family, I found that many others had gone through similar episodes. Sharing our stories helped me recover by discovering useful tips and realizing that I wasn’t alone in my suffering.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist, visit the Psychology Today Therapy Directory.