Pain Hurts, Even When We Don’t Notice It

We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.

It is easy to get used to a certain level of pain. That level may vary from patient to patient, person to person, but a basic fact of human existence is that we all adapt somewhat to our environment, and that includes our experience of what “feeling normal” is like.

I have been living with “chronic” pain for all of my adult life. A pulled muscle in my back that never fully healed, knees that took a bit too much abuse from long-distance running in my early teens, a heel bone bruised by a rock, a minor neck injury from an automotive collision made worse by a chiropractor who decided to “adjust” it without permission, carpal tunnel syndrome, spinal issues, nerve damage, a fractured ankle that set improperly, fallen arches; these are all part of a slowly expanding list of ailments that I generally choose not to talk about, and certainly not collectively.

Chronic Pain That Comes and Goes

Chronic pain is usually defined simply as a pain that lasts longer than three months. It is also often resistant to most medical treatments. So, while it may be possible to tolerate it, such pain simply does not go away. Acute pain, on the other hand, typically alerts a person to an injury or is a passing reaction. My migraines, for instance, though persistent, would fall in the acute category. And frankly, most of the time, I do not notice the various pains that my body exhibits. Especially after living with issues that eclipse them.

In my experience, my chronic pains appear to come and go. Some of them I am vaguely aware of most of the time, others only bother me when something draws my attention to them. And there are rare times, after decades of dealing with these issues, when I will have a few days where they all appear magically gone. Then, like a switch being flipped, I will get a sudden and jolting reminder of each one of them.

My time on chemotherapy made me forget most of these pains; in a way, it worked like a narcotic, dulling their effect to the point where I no longer noticed what hurt. Part of this might have been mild neuropathy, though that can cause its own phantom sensations. Part of it might have been simply that everything was uncomfortable and therefore nothing stood out. After my 40 rounds of chemotherapy were completed, it took relatively little time to begin noticing sometimes subtle, sometimes profound pains in areas that, in my former lifetime, I had been used to having them. It was an unpleasant way, perhaps, of reminding myself of a more pleasant time.

Pain Reminds Me of My “Old” Normal

I do not begrudge these pains; in fact, though some of them hurt more than I remembered, they remind me of my “old” normal. I know that I will likely get used to them again, readily ignoring the throbbing and the needle-like pricks and the dull aches. I will get used to the unconscious stretching and obligatory pacing and hopefully not slip into the irritable, quick-tempered zone in which I had previously often found myself. I recognize, but do not begrudge these pains, because they remind me of myself before my cancer diagnosis. They remind me that I am alive. And while pain is not preferable, it is still part of living, and therefore, if for no other reason, is another glass through which we can assess the beauty of our world.

I say this about the pains that are tolerable, if persistent, and with full awareness that it requires work to avoid the depression that chronic pain might lead to. It is also important to me that I do not minimize either the subjective nature of pain nor the importance of pain management, especially for those patients with very advanced stage disease. After many years of little or no relief from over-the-counter painkillers and only marginal help from physical therapy, I appreciate the limited and controlled use of effective medication when it is necessary.

Thousands, probably millions of people are living with persistent pain every day. It is pain they may ignore, or pretend is not bothering them, or that they have simply gotten used to living with, and they may not ever complain about it or show it on their faces. But it is there, under the surface, affecting every minute of their lives. After some time, many of these people might not even be aware of the pain they are experiencing. Such is the nature of our existence, our subjective normals. Obvious or not, it still hurts.

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