of bone disease, this is bone pain. Or, if you have nerve damage, this causes nerve pain. These are simple classifications, but you probably already know the feel of each one—most of us have pulled a muscle in our time or overdone it and had a sore back.
Sensations
There are a lot of different ways that pain can feel. No two people experience pain identically, and you are the only person who is feeling the pain that you’re feeling. No one else can tell you how it feels. It is important that you can name your pain, describe it, and distance yourself from it. Not only will this help you to understand it, describe it to your doctor, identify what is happening in your body, and analyze your possible responses, but it will also help distance you from it emotionally. You are not your pain, and your pain does not define you. Try imaging your pain as a really unwelcome, disliked family member you simply cannot get rid of.
Here are some helpful words that you can use to describe the feel of your pain(s):
| spasmachingdullsharpacutestabbingpoundingrasping | tinglingnumbitchingburningcoldshockradiatinggrinding | episodicpersistentirritantticklingpricklingthrobbingboringswollen | stingingsearingtwingecramptendernessinflamedpinchinglacerating | rawthumpingtightpressure/vise-likemildintensepulsingnagging |
Common Causes
of Chronic Pain
Chronic pain can be anything that lasts longer than three months, but some chronic pain ailments are permanent and others are, ultimately, temporary. There are many different illnesses that can cause chronic pain; below are just some of the most common. Even these can come with complications, comorbidities and unusual presentations, so this is not intended to be an exhaustive or prescriptive list—just a rough guide to the most widely diagnosed chronic pain ailments at present.
Arthritis
Arthritis is the most common cause of pain, affecting almost one in every two adults over the age of sixty-five. Arthritis is not simply a disease of the elderly, however, with over a third of working-age adults experiencing it in some form at some point in their lives. Arthritis affects the joints through inflammation and can make movement painful.
Chronic Back Pain
According to research, almost 85 percent of adults will experience chronic back pain at some point. This may be due to injury, accident, arthritis, or through normal wear and tear, but anyone who has suffered this particular issue knows it can be immobilizing and very difficult to treat. It is rare for chronic back pain to become permanent.
Fibromyalgia
Fibromyalgia affects the nervous system and is associated with widespread pain in the muscles and bones without apparent cause. It can cause severe fatigue and general bodily tenderness, as well as cognitive impairment. It is the second most common condition affecting bones and muscles but, because of its amorphous symptoms, is often misdiagnosed.
Psychogenic Pain Disorder
Pain problems associated with psychological factors only, without physical cause, are known as psychogenic disorders. They can be caused by stress, anxiety, depression, or mood disorders and can present as headaches, migraines, back pain, stomach pain, or muscular pain. Given the wide range of possible affected areas, psychogenic pain is usually diagnosed when all potential physiological causes have been ruled out.
Chronic Headaches
Headaches are commonplace, but some people suffer from headaches which last at least fifteen days per month, for consecutive months, thereby becoming officially chronic. These can be tension headaches, migraines, cluster headaches, or eye-related headaches, but are exhausting and debilitating, whatever the cause.
Sciatica
Sciatica occurs when the sciatic nerve, the largest peripheral nerve in the body, running from your spine down your leg, becomes irritated. This is most common among patients with a herniated spinal disc but can also occur due to accident or other injury. Symptoms include electric-shock-like pain down the leg, numbness and tingling, and muscle weakness. Sciatica can be persistent unless the root cause of the problem is addressed.
All pain is personal, because it’s happening to you, but that does not mean it is you. As we’ve seen in this chapter, pain is an evolutionary tool that can and does get out of hand, but that doesn’t mean you are lacking in control. Sun Tzu advises us to “know your enemy,”2 so become acquainted with your pain. Give it a silly name if it helps. Talk to it. Scold it. Describe it. How can you expect to live with it if you don’t take the trouble to get to know it?
One of the most helpful tools you can use to understand your pain and to help your caregivers understand is to create your own pain profile. This can seem like a lot of work, but once you are practiced at it, it will become second nature and allow you to objectively understand what you are feeling and what, if anything, you need to do about it.
Start by keeping a simple pain diary. Every day, record the following for each individual pain you can identify:
•Location of pain
•Duration of pain
•Intensity of pain
•Description of pain
•Activity immediately before pain
•Medications or action taken for pain and their effect
You can use the list of descriptive words shown earlier to narrow down the feeling of the pain you are experiencing. It is vital that you are able to perceive how your pain manifests and its effect on your day and your world.
Performing this exercise while in pain can be tough, but do the best you can. It may be easier for you to wait until the end of the day, and record every instance you can remember at once—this also helps you to separate and categorize different types of pain you have felt through the day.
Talking to your doctor about, well, anything, can be tough, embarrassing, strained, rushed, complicated. Even the simplest problem can be difficult to talk about with someone who may well be almost a stranger. But here’s the thing: you cannot afford to treat your doctor as a stranger. Yes, you may have only met him/her a few times. Yes, you may not like them very much. But you need to be able to give them detailed, personal information so they can help you as best they can. There is no avoiding this. No one can do it for you, and, if you don’t do it, it won’t get done. A doctor will not magically guess the right treatment for you. It’s up to you to give him or her all of the relevant information.
In the last chapter we said that pain was not infallible. Well, guess what? Neither is your doctor. Unless you are reading this from an incredibly privileged position of wealth, the overwhelming likelihood is that your doctor is overworked, underpaid, stretched across too many patients, and working without enough sleep, support, or resources to properly help his or her patients. Appointment time varies by country, but the average is just over ten minutes—significantly less for more than half
