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I hear you!

Pain is good, in fact pain is important. But it is uncomfortable, in fact it’s relentless in humbling us. Pain stops us from our day to day activities, and even at times leaves us lying on the cold hard floor without a solution. We use many adjectives to talk about it; she was writhing pain, I have excruciating pain, sometimes, we even ask is this how it feels to die, because I can’t imagine anything worse than this.

Nothing beats the disappointment that comes from the accusation that you are lying about your pain. Especially when it comes from a trained health practitioner. They look at you and you are sure they don’t believe you. And so, you change physicians, you change medical models, you even turn to spirituality. You are desperate for someone to believe you.

Well, it is true. Your pain is real to you. Your pain does exist. The biomedical model may not agree with you, but you know it’s there. Plus, what is pain really? Pain is whatever one feels pain is. It’s certain and it is there. The biomedical model is the basis of health care. It is the core of what is now conventional medicine. Something is wrong with this tissue, the symptoms imply this diagnosis, we verify the truth in that through tests and measures and arrive at a conclusion. Then we fix it with medications, physical therapy, surgery or make you comfortable. Pretty straight forward isn’t it?

We tend to classify pain as a symptom by its own because it fits in the paradigm. Recent research however shows that there is more to the story of a patient who comes in with pain. In conversations with people living with chronic pain, it is found that pain has its own mind. The amount of pain that one experiences does not always equal the amount of tissue damage. In fact, one can be in pain and have zero to minimal tissue damage or have massive tissue damage and little to no pain.

I want to tell you a story about Jane (not her real name). Jane came to us because she had moved cities. Her daughter called in to confirm if we had the specific service that her doctor had recommended. After much convincing, they agreed to try with us. Jane comes in and her husband tells me a story about her pain. She says that it started years ago, and now she can’t sleep through the night. We do a back and forth but he still speaks for her. He is clearly worried about his dear wife. She is quiet all through. I start her on a five sessions therapy plan.

Finally, it’s the first session and I am glad that finally I get to hear from the horse’s mouth. I quickly find out that my lady is not shy as I thought. She clearly has a say in her family and in her life. So, I wonder why she has been quiet about her pain. She tells me that her doctor instructed her to rest and not push herself so much. With this in mind she feels that her life now is all about “the pain”.

“Sometimes, I am afraid to tell my family that I am in pain. I don’t want to bother anyone. Do you know I never wanted my kids to live the life I lived? So, I worked myself to the bone to make sure they had a good life and now they are worried about me. Everyone is.” She feels a sense of accomplishment that they are out there living their lives. Her issue with her back is quite “bothersome” and that’s why she keeps it to herself. “uchungu ni wangu- (the pain is mine)” she keeps on telling me.

I use my clinical skills based on the biomedical model to treat her. I engage her in exercises and physical therapy manipulations and I get good feedback. She is improving, able to sleep through the night. But I also engage her in talking about her pain, I let her know about the tissue changes that occur with age, and how triggers in everyday life can activate/trigger her pain. I let her know that the goals of managing chronic pain are not to get rid of the pain entirely, but to lead meaningful functional lives while managing the pain. I let her know its okay to participate in her life, to do the things that she wants to do.

Why is this important? Chronic pain can have a shame-based quality to it. It can become very lonely. When we refuse to acknowledge it, we hold ourselves to an impossible standard that no human can uphold. Acceptance doesn’t mean resignation; it means understanding that something is what it is and that there’s got to be a way through it.

At the end of our sessions, “mama” as I call her tells me she is watering her seedlings, she also tells me she knows where to ask for help. She has mastered her exercise program and she goes home knowing that she is not dependent or disabled. She is empowered to live her life. That’s what we do here. We help you understand that its not all in your brain neither is it all in your body. It is everything and there are ways to mitigate it.

In conclusion, pain is still a mystery. Pain is not clear, but it does not mean we can’t have a life in spite of the pain. It means that we can expand our lives to be bigger than the pain. That we can change the language and the perception we have about it and more often than not, we can still lead meaningful lives without it being the very center. We can engage it, and demystify it. We can get the help we need. We can conquer it. We can choose to be warriors and fight for better days. So, let’s talk about it, let’s work with it, let’s change our thoughts about it!!!

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