~ It Couldn't Hurt ~
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Definition of Chronic Pain
Pluming the depths of my father’s medical library, the usual suspect dictionaries and the internet, I found many definitions of “chronic” and “pain” but very few of “chronic pain” as an entity in and of itself. Even those definitions I did find for “chronic pain” were so vast in their scope, so nebulous, so, actually, undefined that I was unable to come up with a single definition that precisely addresses the issue.
To site only a handful of the definitions I found:
Stedman’s Medical Dictionary, 1949: chronic; of long duration, denoting a disease of slow progress and long continuance.
Stedman’s Medical Dictionary, 1949: pain; suffering, either physical or mental; an impression on the sensory nerves causing distress or, when extreme, agony.
Dorland’s Medical Dictionary, 23rd Edition, 1957: chronic; long, continued; not acute.
Dorland’s Medical Dictionary, 23rd Edition, 1957: pain; a more or less localized sensation of discomfort, distress, or agony, resulting from the stimulation of specialized nerve endings.
Webster’s New World Dictionary, 1980: chronic; lasting a long time or recurring often, perpetual, constant, distinguished from acute.
Webster’s New World Dictionary, 1980: pain; a sensation of hurting or strong discomfort transmitted through the nervous system.
Webster’s II Dictionary, 1984: chronic; of long duration, subject to habit or disease of a long time period.
Webster’s II Dictionary, 1984: pain; an unpleasant sensation, occurring in varying degrees of severity as a consequence of injury or disease or emotional disorder.
MedicineNet.com, 2005: chronic pain; pain that persists or progresses over a long period of time.
National Cancer Institute, 2005: chronic pain; pain that can range from mild to severe and persists or progresses over a long period of time.
WebMD, 2005: chronic pain; pain that continues for three months or longer.
Wikipedia, 2005: pain that has lasted six months or longer.
Oddly, to me, the earlier definitions I found in the medical dictionaries (1949, 1957) are more precise, more accurate. Well, they at least use the word “agony” and don’t define the time period in which it is polite to be in the state of pain. While WebMD at least acknowledges that a person shouldn’t be categorized as “acute” for longer than three months, Wikipedia isn’t as generous and thinks someone should have to deal with “acute” treatment twice as long.
If I sound cynical, it’s because I am. The difference between “acute” and “chronic” is the difference between Tylenol and Vicodin; the difference between “chronic” three months and six months could be the difference between Vicodin and corrective procedures or other, stronger, pain treatments.
Of course, the emotional and mental health issues involved in the time period of diagnosis are many and often extreme. In my case, the strain of on-going, untreated pain that stretched mostly unalleviated over a thirty year period was far reaching and barely addressed.
It’s difficult to discuss the many stages of emotional distress I’ve endured because of the long period of time in which I have been in chronic pain but being young when all this started probably did me no favors. Understanding what is happening to you is often a large part of healing, of being able to take control of your healing and I was far too young to be able to fully understand my situation. On top of being in my teens when my initial injury occurred, I was told that nothing was wrong with me for many years following my accident. Both being so young and having my pain dismissed put emotional stress on me that is incalculable.
Now, being older and having gone through everything I have, looking back I can see disaster after disaster that took place over the first ten years following my injury. That technology and medical knowledge simply wasn’t up to the task of diagnosing me sooner is understandable, that everyone who held power over me – parents, doctors – couldn’t have known any different and, so, filed my complaints under “teenage emotional angst” is also understandable. But it doesn’t change the facts. I had a serious injury that went untreated, an injury that was causing extreme physical pain that went untreated. That kind of physical anguish is bound to cause emotional distress in anyone, certainly in a teenager.
That I can’t find a definition of “chronic pain” less recent that 2005 just about says it all: until now, the two words weren’t even considered to describe a single medical condition. Who knows where our understanding of “chronic pain” will be in another five or ten – or twenty – years. Hopefully, it will be something that has been studied, addressed and treated to a much more satisfying degree than it is today.
To the credit of the medical community, chronic pain is being diagnosed much more often and with increasing accuracy and, as a result, treatment is being given with much more frequency and accuracy.
But I also fault the medical community for too often being hesitant to prescribe strong pain medication because of their concern – and rightly so in too many instances – that in prescribing narcotics, they are creating drug addicts. I am rare in that I simply do not have an addictive personality; that doesn’t make me better than anyone, it’s simply a fact. Of course, doctors don’t believe me when I tell them this which has caused me to become somewhat… unpleasant with some doctors over the years.
The most recent example of my encountering this attitude came in the hospital when I last had surgery (August 2005). I had cervical spinal surgery, my third. Basically, my throat was cut open, my spine was taken apart, bits of it removed – include a bone chip the size of a nickel that was pressing into my spinal cord – a titanium plate was screwed into the bone and then I was put back together again. My own pain doctor was out of town so the doctor supposedly covering for her refused to prescribe me something other than oral Vicodin, which does absolutely nothing for me; I might as well take an M&M for all the good it does. I was refused anything else. Aside from Vicodin not helping me at all, I could barely swallow and I was supposed to choke down a huge pill? Yeah, that was great thinking. They did offer Soma… without checking to see what other medications I’m on; it reacts very poorly with some of them and, luckily, my father caught that before I took any.
It took several days after I’d come home from the hospital to obtain a prescription for Percocet – which my father had to drive 80 miles each way to collect as it’s a triplicate prescription and has to be handed over, not FAXed or mailed or phoned in. Now, just over two years after surgery, I have over half that prescription left. I’m a real drug addict. Right.
Again, if I sound cynical it’s for a good reason. I wish there was a machine that could transfer a doctor into my life for a day, an hour, and see how they’d handle what I feel every minute of every day. Then see how quickly they’d prescribe pain medication.
My personal definition of chronic pain is perhaps more poetic than a dictionary or medical journal but it’s a definition that has come from long years of trying to explain, describe, define something that can’t be seen, smelled, tasted, touched or heard. And when all five senses fail you, you have to rely on the sixth sense, which is what I call “creativity”. In other words, when it comes down to communicating the essence of being in constant, unrelenting, gnawing pain, you have to, as they say, fake it till you make it!
Chronic pain is dark as night. It is impenetrable. It is an absence of peace. It is being at the center of a war taking place within your own body. There is no escaping it. No R&R. No taking leave to go home to visit the family. It is a battle waged in a space that has no form, no substance or dimension. It is your own thoughts beating at you with razor blade wings that rip you apart from the inside but never, ever make it through to the outside; never, ever cease their ripping.
Chronic pain is like living in the Hieronymus Bosch painting, The Garden of Earthly Delights, specifically, the left wing of the triptych If you’ve never seen it, go look it up. It’s his version of hell.
While sitting in my pain doctor’s office one day several years ago, I spied a small pamphlet advertising something called the Chronic Pain Visual Art Project. (http://pain-topics.org/gallery.php) A gentleman by the name of Mark Cohen was putting together various artists’ depictions of chronic pain, a visual gathering of art showing each artist’s inner turmoil over their pain. I am lucky enough to have had one of my self-portraits accepted to the project and I thank Mark not only for organizing the project in the first place but for giving me and others the opportunity to be acknowledged, to have our pain acknowledged. It’s a rare experience to have this kind of validation.
I have been painting in oils for most of my life. It was a compulsion for me early on, something I didn’t necessarily want to do (though there are certainly times when I do want to) but something I absolutely had to do. In retrospect I now understand that I was using this form of expression to externalize that which was tearing me apart internally. It never solved anything, certainly didn’t reduce the pain I was dealing with, but it was a release valve of sorts. It remains such a compulsion for me today that I taught myself to paint left-handed because I can no longer use my right arm and hand very well. It’s awkward, it takes much more concentration, the paintings definitely look different, but I don’t know what I’d do if I could no longer paint. It’s both a coping mechanism and a talent with which I was born (with all due modesty; I’m not claiming to be a great artist…).
People looking at my paintings – especially my early ones – often comment that they’re very dark, twisted, distorted in some way. To which I will reply: “Well… duh!” Not eloquent but concise.
I suppose, in the end, we each have to define chronic pain for ourselves but defining it for others – doctors, family – is extremely difficult. Just know that you’re not alone in that struggle.
Maybe there are words in Vulcan. I’ll have to look it up…
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