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I started medical school in the late 1990s, when no one had heard of abusing a drug called fentanyl. We learned that pain in any part of the body was largely a signal from the brain, and you could override pain by interrupting communication from central command. If the classroom taught us how essential the mind was to pain, on the wards, we learned mostly about pain medication. We'd start with anti-inflammatories and acetaminophen, but were also told we shouldn't be scared to prescribe opioids. The fears of previous generations were overblown. Opioids were safe. Don't worry too much, and don't let people suffer needlessly.
But like giving parenting advice before having children, I didn't really get it. That all changed this past summer, when my back seized completely. And it happened as soon as I got to the airport for the first month-long vacation of my 10-year career. I spent the 17-hour flight in excruciating pain, distracting myself with movies and hoping that I'd be able to move when we landed. On arrival, I could barely walk or stand. Two months earlier, I had been playing volleyball by the ocean, jumping in the sand; now, I was crawling to the bathroom on the cold, tile floor in someone else's house.
The first night of my back pain, as I lay awake, I tried to put my knowledge into action. I took over-the-counter pain killers. I lay on the hard floor with my legs up. I tried meditation and followed the fireworks in my hip and leg with my attention and curiosity. This allowed me to cope, even to feel a little grateful. When my husband felt me tossing and turning in the middle of the night, he stroked my hair, and the searing calmed slightly. It really was true, I realized: The mind could influence pain. When I had some reprieve, I could wonder if my pain might have a purpose or meaning. But minutes later, I would lose hope. What if my disc ruptures here in this foreign country? What if I can never walk again? Then I would drown in the pain all over again. Yes, I thought, the mind can influence pain.
After two days of constant pain and exhaustion, I felt I might break. Many people in my situation would take an opioid, and that would be totally justified, but I didn't want one. On the third day of pain, I saw a doctor and got an injection of anti-inflammatories. This provided enough relief that I could breathe and think, but if my pain persisted, I would definitely have had to take a prescription opioid. It was only in this current state of true agony that I really began to understand the opioid problem: I had underestimated how painful pain can be.
By midlife, no one seems immune to significant painful events of some kind. There are illnesses, divorces, lost jobs, lost parents. There are cancer diagnoses and sick children. We all come to know pain eventually. But the support of loved ones can buffer the suffering.
Resilience, grit and strength are largely earned through overcoming adversity; yet, there are levels of pain that neither kill you nor make you stronger. Severe emotional pain can start from the time you're born, with neglect or maltreatment. Sometimes, it starts later with trauma, loss or social isolation. And without adequate supports, the snowball can grow, contributing to pain syndromes that are hard to treat. Opioids relieve all the embedded layers of pain. Opioids dampen physical pain, but they can also feel like love, comfort and peace.
With fewer resources, I would have done almost anything just to stop the back pain I had – so how can I possibly think I wouldn't take opioids for longer if my pain came stacked on other, deeper pain? How can I possibly think I would be immune to an offer of comfort and peace, especially if I had to suffer for longer or if I had to suffer alone?
Pain can also be an enormous financial burden. I was lucky to have excellent physiotherapy and a mother-in-law who drove me there. Had I been at home, I would not have been able to work. It's hard to measure the cost of lost income and opportunity. If it were a choice between taking Tylenol 3 or unemployment, odds are pretty stacked for the drug.
The costs of healing from pain can be staggering. Physiotherapy, chiropractors, massage, over-the-counter pain killers and devices: When all is said and done, if recovery takes six months, the cost for rehab may be upward of $3,000. That's not even including lost wages or counselling for the anxiety and depression that commonly accompany chronic pain. I can't even measure the cost of my husband and in-laws' help or how it would be for a single person to go through this, let alone a single parent. But the cost to fill a prescription of codeine or oxycodone or fentanyl in my province of British Columbia? Nothing: It's covered by health care.
I have learned to be more patient and to accept more help. I am thankful to never feel alone in my recovery. But I think of those without access to integrated chronic-pain programs, and those whose underlying pain has never been voiced, much less treated. I also feel for my colleagues, the physicians who have limited time and resources but are implored to make the pain stop.
There are moments these days, in the pool, when my body floats weightless, and for a few minutes I feel absolutely no pain. When I really pay attention, I can actually feel a pleasurable sensation in the exact spot where the pain used to be. I think of it as my body's natural opioids being released, but I don't really know. Right now, nothing feels as good as the absence of pain.
Dr. Ashley Miller lives in Vancouver.