Pain Principle

is a professor at Harvard Law School. He is currently writing a book about pain. The date was December 31, 1999--my personal y2k. I was driving my family home from a vacation and got a flat tire. I pulled the car over and started to change it. (Dumb move: I'm more the kind of person who breaks things than the kind who fixes them.) Something nasty happened at the base of my back. Ever since, my lower back and right leg have hurt, usually a lot.Doctors sometimes call it Failed Back Syndrome. It's a great phrase: My back may be a failure, but I've got a syndrome, which sounds like a badge of honor in our therapeutic culture. Unfortunately, it's also a synonym for "thing nobody understands." Whatever my syndrome is, it doesn't show up on a CT-scan. And it doesn't seem amenable to surgical fixes. I've had three fusions (the surgeon typically removes a lumbar disk and locks the adjacent vertebrae together with bone grafts and metal screws): one when I was a teenager in the mid-'70s, the other two since my car suffered from Failed Tire Syndrome. The first fusion worked--I felt pretty much normal until middle age. The second and third, not so much. So I wander from specialist to specialist, looking for ways to get my pain down to a manageable level without making me too foggy-headed to work. The specialists, most of them anyway, don't know what to do with me. Medical practice is all about snapshots: Measure the patient's condition, prescribe the treatment, then measure again. That approach works for static, on-off problems with easy fixes. But pain isn't static, it isn't on-off, and there are no easy fixes. Chronic pain is like a living, breathing thing with a mind and will of its own; it grows and moves and adapts. The snapshots--and most of the specialists--miss that. So each doctor clicks the shutter and applies the relevant specialty's preferred fix: this drug, that surgery, some new exercise program. Afterward, when I still hurt, they tend to get frustrated. That's usually when I'm diagnosed with Failed Patient Syndrome. Iused to think the "chronic" part of chronic pain was the really bad part. Now I'm not so sure. Neverending pain wears you down; it's exhausting. But, on the whole, I think I'd rather have constant pain than the variable kind. If that sounds bizarre, bear with me. Pain is largely about the gap between expectation and reality: the distance between what you feel now and what your mind tells you you're supposed to feel. As reality slides downhill, expectations slide, too. Which makes reality feel less awful. Several times during the past half-dozen years, my baseline pain level has kicked up--say, from a 3 on a 0-10 scale to a 7. (Doctors love that pain scale, which is one more example of the snapshot problem.) At first, it feels horrible: 7 is bad news; walking around feeling that kind of pain all the time can be sheer hell. But, after a while, you get better at dealing with it. The bigger pain starts to feel smaller; 7 becomes what 4 once was. And 4 starts to feel like 1; it's just background noise--the pain equivalent of elevator music. I don't remember what it feels like to get out of bed in the morning, stretch, walk to the bathroom, and feel no pain in my back. For me, that older and happier baseline has disappeared. That sounds sad, but it isn't. Forgetting the world of easy stretching and long, pain-free walks has been a great mercy. My mind doesn't tell me I'm supposed to be pain-free. Instead, it tells me to expect bad times. Which means I'm no longer quite so disappointed when bad times come. Something very important follows from this. Hope hurts; optimism amplifies suffering. The pain-free, healthy world is gone; this is my world now. If I can make those long-ago sensations vanish, a portion of my pain vanishes with them. One cannot feel the absence of a nonexistent thing. Let the thing become real again, and its absence stings. Norman Vincent Peale, apostle of the theology of positive thinking, got it wrong: Pessimism is power. Hopelessness turns out to be surprisingly good medicine. Sometimes the pain itself seems to have medicinal value; it brings strange pleasures in its wake. Good food tastes better than it did before. I've always loved looking at water: the ocean, rivers, the Chesapeake Bay that was a block away from our living room when I was a kid. I love it more now. Great music sounds better. (Bad music sounds worse: I'm glad my children are finally too old for middle-school orchestras.) All good sensations feel better. Work feels more satisfying, even though it's much harder to do. I was never much of an athlete, but I imagine it's similar to the sense a distance runner gets when finishing a marathon. Especially the first marathon: You've reached the edges of your capacity, pushed the envelope farther than you thought it could go. The feeling of accomplishment is indescribably powerful. I didn't realize it, but, before my back took its turn toward hell, I never used all my capacities. Now, most things I do take every ounce of me. Athletes have a terrific expression for this phenomenon: They say, "He left it all on the field, " meaning there was nothing held back; the reserves were all spent. These days, I leave it all on the field--because there isn't any good alternative. For the first time, I know the satisfaction of doing the very best I can do. Pain gave me that. And pain gave me one more good thing: It taught me to live in the present, not the past and future. Before my back went south, my mind was so full of past regrets and future wants that the present could hardly find a home. Now, I have to concentrate harder to do anything, so I'm more focused on what I'm doing-- not on what it might get me or what I should have done differently. Today, the part of my mind that deals with everything other than my back is occupied with living. Before, it focused more on satisfying my many wants and regretting my many mistakes. Wanting and regretting take a lot of energy, and I don't have much energy to spare. So I do less of both than in my earlier, healthier life. Maybe that's why life's pleasures please me more than they did before that sad New Year's Eve in what seems, and was, another century. It's a nice irony: When chronic pain arrives and then announces that it's here to stay, you would give anything for numbness. Please, God, just dull the sensations; let me feel as little as possible. Instead, pain gives you the opposite: You feel everything, and you feel it all intensely. Needless to say, the feeling isn't all good. But it isn't all bad either.

By william j. stuntz

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