Darkness: The Abyss of Chronic Pain

“The Abyss”

One afternoon, I was listening to a patient attempting to describe the depth of her suffering and it hit me how deep and hopeless this hole of chronic pain is for most people. I realized that words were inadequate to encapsulate the degree of misery. Since no one seemed to have any answers, there was no apparent way out. The description that seemed to fit for this dark, bottomless pit was “The Abyss.”

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A recent research paper documented that the effect of chronic pain on one’s life is like the impact of terminal cancer.¹ You hadn’t anticipated the possibility of your life being consumed by pain. The paper showed that chronic pain was worse in that with cancer, you at least know the diagnosis and there is an endpoint, one way or the other. This statement might sound harsh in that suffering from terminal cancer is horrible, but ongoing pain without knowing if there is an endpoint is even worse.

A stark example of how uncertainty can eat away at you is illustrated in Dr. Viktor Frankl’s book, Man’s Search for Meaning.² He was an Austrian psychiatrist who was imprisoned in a concentration camp during WWII. He lost several close family members and experienced unspeakable horrors. As he describes his personal experience, it is difficult to imagine anyone enduring even a fraction of what he witnessed and endured. Yet, he points out that the worst part of it all was not knowing when it was going to end.

Life in The Abyss

Patients are trapped by pain and the medical system is not consistently showing them a way out. They become discouraged (despondent). My equation for it is:

The Abyss = Anxiety/Anger x Time

Why isn’t pain part of this equation? It is because anxiety is the pain. It is a word that describes the sensations created by your body’s physiological responses to physical and mental threats. Since it is the most basic survival reaction, it is intended to be extremely unpleasant to compel you to take action to resolve the situation. It is also a gift. It is how life evolved and we stay alive. The species of life who did not effectively respond to cues of danger disappeared.

Pain is only one of many different types of danger signals that are sent to your brain and this unpleasant neurochemical state is the response. The intention is to be this way for as little time as possible and indeed your body automatically responds in a manner to avoid discomfort most of the time. When you are stuck in a whirlpool of relentless anxiety and frustration, that life goes dark.

How Deep Is This Hole?

Here is a short list of the suffering I have encountered both personally and witnessed in my patients. Losses include:

• Independence
• Financial
• At the mercy of the disability system
• Capacity to enjoy good music, friends, fine food, and hobbies without the experience being marred by pain
• Peaceful family life
• Feeling good—there are over 30 symptoms created by a chronically activated nervous system
• Integrity—people don’t believe you and often the harder you try to convince your friends, family, peers, employers, and health care providers, the less you are believed.
• Being labeled—malingerer, drug-seeker, lazy, not motivated, and difficult
• Unlimited physical activity
• Hope—this may be the worst aspect of it all

You’ve lost control of your happiness, ability to engage with your career, family, friends, and hobbies. Understandably, you’re angry.

No Way Out

Consider the depth of “The Abyss.” Your soul is being pounded into the ground by a pile driver of anxiety and anger as you remain trapped in your body, riddled by pain. Your life is being systematically destroyed, but in some cruel cosmic joke, you’re alive to bear witness—without hope. This dark place in your mind is unusually deep—bottomless. And no one is listening…

The Common Basis for Chronic Disease

Essentially all chronic mental and physical diseases have a common link of sustained levels of inflammatory markers and increased metabolism (the rate your body burns fuel). Over time, both processes physically destroy your own tissues to ensure survival. Where else is your body going to mobilize energy from to deal with sustained threats? It is well-documented that low-grade chronic stress consistently has been associated with many disease states, including chronic pain.

One review³ outlined four factors that lower chronic inflammation. They are:

• Sense of control
• Optimism/ hope
• Positive affect (“can do” mindset)
• Social connection

Loss of any one of these fires up your fight or flight response and inflammation. Chronic pain usually affects all four of them. It is also bidirectional in that the inflamed state sensitizes your brain and the speed of nerve conduction, so you feel more pain.

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There Is a Way Out

This circular situation seems hopeless and impossible to solve. But it is solvable by sequentially addressing each of them.

The first step is to understand the nature of chronic pain. Like any challenge, the deeper your understanding of the problem, the greater the chance you have of solving it. The recent neuroscience research has revealed the nature of chronic pain and it is not difficult to understand. You now have a sense of control.

With control you have hope. It is reinforced as you listen to many stories of people who have successfully escaped The Abyss. Each one of them is inspiring and I am continually amazed at the resiliency of the human spirit. Hope will increase as you gain more skills and confidence,

Your mood will improve, and you will have the energy to commit to a consistent practice. There are many hurdles and setbacks, but you have tools to keep moving forward. In fact, an important hurdle is living life is a dynamic process and it is not possible to live in a state of endless bliss.

Finally, chronic diseases wreak havoc with relationships. You become isolated even amid being around a lot of people. You don’t have the energy to positively interact with them and maybe many of your conversations have been focused on your troubles. If you are frustrated, your family members may become your targets. The essence of meaningful relationships is being aware of other’s needs. Anger and awareness cannot simultaneously exist in the same room. Reconnecting in a healthy way with friends, family, and society requires a deliberate effort, including repairing relationships. Social connection is a powerful aspect of healing.

So, all four of these factors are addressable and anti-inflammatory. You are directly inducing positive physiological changes in your body that halt or reverse physical symptoms.

But you cannot go from the depths of pain to normal health with willpower and belief. It requires methodically acquiring knowledge and skills to be able to successfully accomplish dealing with these variables.

Recap

Chronic pain is one of many chronic disease states that are inflammatory and hypermetabolic (actively draining energy reserves). It is a terrible cycle in that pain itself is a threat and it also creates threat by you feeling trapped, losing hope, depressing your mood, and cutting you off from your social support. All of these are also inflammatory, which physically worsens your symptoms.

At this point in the process, allow yourself to comprehend the depth of your suffering and degree of damage your pain has inflicted on your life. Awareness is the first step in successfully reversing this downward spiral.

The other message is that chronic pain is a complex problem and random treatments can’t and don’t work. It is necessary to break your unique situation into its component parts and systematically deal with them. Chronic pain is not a problem to be managed. With engagement and learning effective skills, it is usually solvable. Right now, you are at the bottom, except there is no bottom...