Saturday, July 31, 2010

living with pain

Time for a brief foray into something completely new—medicine!—well, sort of, at least. Really what I want to talk about is our society's approach to pain, suffering, and disease.

Whoa, that's a hefty topic! Well, there's a personal experience behind it, one that's affected me significantly over the last few years. Hopefully I can convince you that my story is relevant more generally.

I've suffered from chronic pain for about 7 years now, and I can tell you that every traditional and alternative approach I've tried to make the pain go away has been a complete and typically expensive (sorry mom and dad!) failure. For those who don't know me well, I didn't play the piano or soccer for about 3 years, due to pain in my hands, legs and ankles. I had MRIs, EMGs, cortisone shots, acupuncture, alexander technique, physical therapy, cognitive behavioral therapy, you name it! I even tried some Freudian shit for a while. Luckily my story has a happy ending, but not one that involves any type of cure.

The fact is that we approach medicine as a quest to find what's wrong with us and make it better. Seems pretty obvious, right? We assume that every discomfort is our enemy and every problem has some sort of solution. From a certain perspective, this makes sense. Our bodies are adapted to navigate their environments such that the usual discomforts of life, like hunger, thirst, cold, and pain, are signals from our bodies to our minds that something is wrong and that we should change our behavior accordingly.

On the other hand, the relationship and interaction between our bodies, our minds, and our environments is much more complicated. In particular, the manner and degree to which our psychological state affects our physical state is poorly understood. There's the mysterious placebo effect, by which mere belief in the efficacy of a treatment enhances its effectiveness. This is true not only for merely subjective measures, like pain or mood, but completely objective ones, like the level of cholesterol in one's blood or the maximum amount of oxygen pumped through one's heart. The latter effect is so incredibly awesome in comparison with the former; people can manipulate processes in their own bodies about which they are completely ignorant. That is, most people don't even know what cholesterol is, or how it works, or what it does, but if you tell them a pill will improve their cholesterol, it will! If I'm not mistaken, this is due to some sort of general health boost that people get from placebos. How cool is that?

For another great example of how profound is our misunderstanding of our mind's effects on our physical health, see this recent (and awesome) article in the New Yorker about end-of-life care for terminally patients. The phenomenon the article gets at is our instinctive and never-ending desire to fight our illnesses to the end, and squeeze out as much life as we can. But it turns out that people who accept their fate and stop treatment, opting instead for hospice care at home, outlive the people who try to live as long as possible, treating every new malady as it arises. To most of us, author included, this is a really counter-intuitive effect, but to me, it's no surprise. The patients who opt for home care and less treatment have a much healthier perspective on their condition. They accept that, though they could die at any time, they would lose more, in quality of their existence, in trying to cheat death at every turn.

This perspective pretty much saved my own life. My incessant search for a cure, for a way to get better, was my worst enemy. I've found that, little by little, as I learn to be more open to my physical and mental states, whatever they are, that my pain has become less and less of a burden. It's actually a liberating idea, one that's so obvious, yet so difficult to live by, that has brought me back to life the past couple of years: reject the goal or the aim of eliminating pain, and living with it becomes much easier. Like the terminally ill patients mentioned above, this attitude also results in the most awesome catch-22: my willingness to feel pain and accept it ends up dramatically reducing it. And the same line of reasoning starts to bleed into other areas of life too. In that way, it's become an opportunity more than a curse.

Stepping away from the philosophical and back to the medical, though, what's remarkable is how many people could use a basic dose of the above idea and how much suffering (not to mention money) it could save them. I used to think I was alone with this condition that seemed intractable and untreatable, and that was severely affecting the quality of my life. I thought I was the only one who's body was so messed up it just wouldn't let me live my life. But it turns out, these types of conditions are common, whether they come in the form of pain, or other chronic health problems. Who knows, maybe my situation is really atypical (I'm certainly no doctor!), but it’s hard to know, because mainstream medicine doesn’t track, or treat, people with chronic pain very effectively.

Why is that? One of the problems is lack of negative feedback: though every single doctor I've ever seen about my pain has been no help whatsoever, none of them really knows this, because I would often improve in the short run, but would never go back to them in the long run ('cause they were more or less useless). None of them will ever know that I was a treatment failure, that they diagnosed me all wrong, and that most of what they did for me was unnecessary and wasteful.

Anyone who's interested in what really changed my life should check out these books on mindfulness and meditation...More to follow...


  1. I'm totally with you that purely medical approaches are often a surprisingly bad way to treat (or manage) chronic health problems, particularly pain. But two quick defenses on behalf of medicine -- first, only the most ridiculously out-of-touch doctors would be against the kind of method you're espousing here. In my experience, we are told again and again to encourage (or even to strongly compel) patients to exhaust nonmedical alternatives for chronic diseases before we go in with our blunt, crappy medical instruments. (I have learned more about meditation and its benefits since starting med school than in the five years prior.) The problem is that a LOT of people just don't go in for htis kind of thing, and it's our responsibility to try to help them while "meeting them where they are" (in the parlance of my training). Here's an analogy from type 2 diabetes: by far the best way to manage that disease is to eat a better diet and exercise and lose weight. And a responsible practitioner will strongly urge patients to do this. But the fact is that many, many people are unwilling or unable to do so, so we break out the drugs. To indict doctors for encouraging people to pop pills seems entirely backward to me. I know you're addressing a slightly different issue here (presumed misdiagnoses and lack of followup), but I think there is often an unnecessary line in the sand drawn by proponents of alternative medical practices, causing them to dismiss all of medical science out of hand.

    One more quick comment -- the thing about placebos's measurable physical effects is that they are always, ALWAYS transitory. Fascinating, but not significant in terms of how we should think about pharmacology. (along the lines of, "let's just give everyone placebos and then their high blood pressure will go away forever with no side effects!" or whatever).

  2. well, i'm certainly not trying to undermine standard medicine, or medical science, in general. but i also don't think it's a coincidence that every doctor i saw (including psychiatrists!) failed to see clearly that i had as big, if not bigger, problem with anxiety as i did with pain, back in the day. basically none of them ever told me, or came close to telling me, "i don't know what's going on with your pain, and i can't help you, but here's how you might go about approaching it differently." of course, i realize i may not have been receptive to that at different times, but i basically had to come across it on my own...

    and yes i understand that a placebo is never an effective form of treatment because the effect is temporary. but for me it's still a clear demonstration of how significantly our mental states can affect our physical states, something that is vividly clear to me from my own experience, but perhaps not obvious to everyone.