Pain and Depression

   I've just returned home after more than two months at The Comprehensive Pain Program at Johns Hopkins Hospital The program is a holistic cutting-edge pain management program that centers around a simple idea: chronic pain is exacerbated by clinical depression.  The idea seems obvious.  Who wouldn't be depressed knowing that every moment to come would be tainted by pain, every one of them?  So it follows that alleviating this automatic depressing thought in patients will also mitigate that patient's pain. 

I was diagnosed with arachnoiditis three years ago and was told that the nerves in my spine from L-4 to S-1 were damaged beyond repair.  My pain was so high that I couldn't function.  I had struggled through a year of sharply decreasing hours at work finally admitting to my self and my partners that I had to go out on short-term disability.  I found myself suddenly at home with entire days of painful free time and nothing to do.  As the pain in my back and legs progressed, short-term disability became long-term disability and I was powerless to do anything about it.  I wore terminal victim-hood as a badge  I was forty-seven years old and began receiving Social Security benefits.  My kids get checks too.  I was no longer a provider.

I had loved work.  I had fallen into my career by chance, hired as a stockbroker in the first year of the stampeding bull market that stuffed more money into my pockets than I had ever dreamed possible.  By the Crash of '87 I had over 100 million dollars of client assets under my management.  Amazing good fortune drove my career and by the new Millennium I was an executive leading the effort of however many financial advisers I chose to hire. 

In that same stretch of time, I herniated a disk.  This was a disaster.  Most stockbrokers work very long hours in a highly competitive work environment and I feared that even a single sick day would have had disastrous financial consequences for my family. I fought through intense semi-annual bouts of back pain and sciatica, suffering at my desk.  I placed crazy demands on myself.  My expectations were wildly unrealistic; no matter how much money I made or what I'd achieved it wasn't good enough.  I saw myself as a high net worth failure with a bad back.  I was a panic stricken jerk all the way to the bank and my back hurt all of the time. 

Thus the seeds of depression were sown. In the year 2005, the year I was diagnosed with arachnoiditis from L4,5 to S1, an insidious irreversible spinal condition.  I was weakened by this diagnose of ruined nerves in my spine. I saw my life not as one of achievement through adversity, but as one of colossal failure. I had failed to recover from two spinal operations.  I had failed to perform up to my expectations both at work and at home.  I had failed to master pain.  I saw my future as a lifetime of struggle to mitigate minute over minute spikes of nauseating, excruciating neuropathic pain. I was depressed by the thought of no relief, not a day, an hour even a minute from driving pain.  Pain eclipsed everything as the quality of my life diminished.  My family was held hostage by my inability to cope with chronic pain. 

I now understand this digression in my mental state, but understanding and accepting are two very different things.  Cognition doesn't necessitate acceptance.  For example I may know that the onset of severe chronic pain causes depression in people, but can I deny that I am one of those people.  So the trifecta of pain, physical dissipation and denial hit hard and was manifest in me as rage and hurt.  These states were exacerbated by the anxiety  of projecting that each new day would be worse than the previous ones.  This is an obvious fallacy, the past dose not predict the future.

The answer to this cycle of morbid complexity is simple and it begins by accepting simple facts.  I feel pain today.  A shower feels good.  My mind is clear and I'm writing.  It was very cold and windy when I woke-up at six AM.  Now it is warmer and less windy.  All of life, even the most complex scenarios, can be rendered into simple statements of what is true. It is true that it is cold outside. It is true that my feet hurt when I walk this morning.  It is the case that I can walk.  And on and on.  I had concluded that this conception of true statements required specific future responsibilities. 

But It is not imperative from any set of simple truths that a particular action ought to be done.  I knew that an 'ought' doesn't follow from an 'is'.  However, at that time, I was unable to conceive through the fog of pain that this fallacious belief was destroying my life.  I saw my life as a succession of failing to meet obligations.  The horrible lesson I had learned, pain destroys happiness, caused me to remove myself from all joyous events.  I had to.  I'd have destroyed them.  This darkly prophetic view was self-fulfilling.  If I am the agent of destruction of happiness, then I must subtract myself from all of the good things in my life.  What is false, became true, real through my refusal to be in all familial and social occurrences.  A horrid self-loathing took hold.  I was depressed but wouldn't admit it.  This sharply increased the physical pain that was my constant companion.

Strange ly, I knew all of this before I was a patient at Johns Hopkins but I didn't accept that this was true in my life.  My cognition of a problem is not the same as my accepting that a problem is mine.  If I want to alleviate the pain of my ruined nerves, I have to accept my condition every day without wallowing in self-pity.  I no longer have to endure the pain of disassociation from my physical state. 

There is no trophy for me if I endure hellish pain for the sake of running errands.  Today I look at the facts, a winter storm is pounding NY, ice is thick on the ground, driving is treacherous and lunatics are speeding around town in happy idiocy.  They may discover that four wheel drive is no help when trying to stop on ice.  Today they'll find-out without me because I've decided to stay home. I'll give myself a break, and that's okay.  Life as I know it will not cease if wait a day and go to Department of Motor Vehicles.  My pain is bad today, I won't make it worse.

I haven't subtracted myself from the push and pull of life. I cope with the daily pull to do more by just saying no. But it's not enough for me to simply examine and understand what is and isn't important.  I decide what to do.  I set small attainable goals for myself, lots of them.  In the process of meeting my goals I experience the fullness of my life, both pain and pleasure.  In the past few years I hadn't even noticed that I'd lost the ability to feel pleasure. I felt only pain.  This very day is a joy. I still have pain, but I'm living my life away from daily narcotic induced catatonia. The kids will be home soon and I can't wait.  I used to be in bed when they came home from school.

Debilitating illness comes from a sense that everything in my life is tainted by neuropathy.  I cannot afford that sense if I want to experience the fullness of life again.  I've also learned that the usual pharmacological tools to remove pain also remove pleasure.

So I'm home from the hospital and I feel much better.  I'm no longer a catastrophe looking for victims.  It was an excruciatingly painful program.  There were many days that I thought I would drop unmoving onto the floor.  Many fellow patients, some of whom waited over a year before they were admitted, simply quit.  I feel badly for them.  They quit before the miracle.  By the Grace of God, I made it.  And I feel much better.   

Comments

Colin,
Thank you so much for sharing this with us. Everyday every minute is all any of us have and you worked hard to recognize that beautiful but painfully hard-edged truth. As Bob and I are discovering with his newly diagnosed illness (dementia/early onset Alz.) we cannot waste a moment. Take care and as always you and your family are in my prayers.
Breathe in Peace, Kathy

[Leanne Bryan]

Hi Colin, that's a moving account of pain management. I take solace from your blog and others such as the understanding chronic pain blog I came across late last year (http://www.understandingpain.com)

It helps me to know that others are coping.

[jocelyn]

Hey, this is fascinating, it was great to read your report of this program.

I just stumbled across this blog while traipsing through some others, and it's neat to read about your stories. I've never "met" another person who has chronic pain from arachnoiditis before... I guess that's partly out of choice! I started having pain about four years ago, out of the blue. A year of tests, pain, huge amounts of drugs and nausea, and they figured it out - the four major spine surgeries I'd had growing up, from 11 months to 19 years, had encased my spine from T8 to L4 with dense scar tissue, and thus, arachoniditis.

Anyway - just curious whether your program ever suggested that you get an intrathecal pump? After nothing else worked for me, the pump has been amazing.

Great blog!

[PureAgeless]

Hi Colin,
I dropped by to have a good read of your article and a lookover of your site.
For what you have suffered, it has made you a stronger person. I truly believe that we can all move beyond our pain and tragedies to become a different and even better person.
What a commendable journey you have made!
Life always evolves, sometimes into something we never expect.

[ohbrandi]

Hi Colin. I am at the top of the list to enter Dr. Clark's program. I've waited almost a year too. I take some hope from your blog and thank you.

If there is anything you can tell me, anything that might alleviate the anxiety I'm not going thru, I'd be grateful...I have two children and the typically clueless husband who will be without me during this attempt to find sanity in a world filled with pain and thoughts of suicide.

I worry about them. And so not looking forward to being locked away.

Peace.