I first met Renée, a forty-seven-year-old secretary almost eight years after her injury. The accident itself was nothing dramatic—she had fallen about two feet off a small ladder and hurt her left knee. It was twisted and strained, and she had torn the knee cartilage, so she required surgery. She took care of that in short order, and her surgeon declared the procedure a success.
Months after the surgery, however, Renée was still experiencing pain. In fact, contrary to her expectations, the pain was getting worse. At this point in her supposed recovery process, Renée reluctantly agreed to attend a multidisciplinary pain management program, but it proved too difficult for her to maintain. She described the program as being “too heavy” for her, which led her to walk out after only two weeks. Later on, she realized her early departure from the program had been a mistake.
She still had horrible pain months later, which was why she was talking to me.
She wasn’t particularly pleased with my line of questioning at first, though. In fact, she became quite agitated when I asked about depression symptoms. Below is my recollection more or less of our dialogue:
“Forget depression,” she replied. “How about extremely angry, as in ripping someone’s head off!”
I had heard similar responses before, so I was ready with my next question.
“What has made you most angry?” I asked.
She looked up at me. “You got a couple of hours, Doc?”
“Let’s at least make a start,” I suggested.
“I’m angry because every second doc tells me that the pain is in my head when I only ever feel it in my knee,” she explained. “And then they go on and on about how I must educate myself and change.” Her face flushed. “Well, I’ve done that already; I’ve gone from terrible to way worse!”
She could no longer hold the tears back.
“What have you learned, Renée?”
She shrugged. “Not a lot. I end up going back online, but it’s depressing.”
“Have you read any books or manuals?”
“Quite a few, actually—at least I tried to.”
“How did that work for you?”
She sighed. “The advice is always a pile of stuff that you have to do every day, like an extra job. No, two jobs! Don’t they realize that I have zero energy, that I barely sleep at night, that my life is wrecked, and that, yes, I am depressed?” Again, she wiped her cheek. “All those to-do lists, brain chemicals, scales, and diaries. Forget it!”
I have heard stories like Renée’s too many times. People in chronic pain are doing their best just to get through the day. They need help, not more to-do lists crammed with seemingly random tasks. That’s why I wrote this book—to give people in chronic pain something simple that they can use to get better.
WHO IS THIS BOOK FOR?
Are you, like Renée, looking for a way to reduce chronic pain that isn’t heavily focused on drugs or expensive pain management programs? If you have chronic noncancer pain and are concerned about the potential drawbacks of those approaches, including addiction, unpleasant side effects, or lack of long-term success, this book is for you. It’s time to learn a new approach that reduces your pain both now and over the long term. My approach facilitates recovery by targeting the specific generators of chronic pain (mostly behaviors, beliefs, and attitudes) that trigger certain centers in the brain to believe that you are under constant threat, setting off the “alarm signal” in the form of ongoing pain.
The Language of Pain is not like other books that may overwhelm readers with endless details of anatomy and physiology. Those details can be fascinating, and we’ll certainly address the ways the body deals with pain in these pages, but as a physician with years of experience working with chronic pain patients, I realize that learning what often seems like trivia to someone in distress—neurotransmitters and which parts of the brain “light up” on an imaging, for instance—has limited usefulness in a person’s everyday life, even though we know that these important areas of research will certainly yield more major insights and breakthroughs in the future. If neuroimaging, the study of neurotransmitters, and elaborate chemical interventions are your thing, then this book is not for you. If you want to discover practical tools for reclaiming your life, read on.
Instead of filling these pages with scientific jargon, I will offer images and stories to illustrate where the real problems lie and identify where you should focus your efforts. Then I will help you build a foundation that you can take forward into your own pain management program—clear, simple recommendations for actions you can take. I will never push you to strive for perfection by requiring you to do everything under the sun to alleviate your chronic pain. Instead, I will show you how to get “more bang for your buck” by completing the most helpful 20 percent of tasks while receiving 80 percent of the benefit.
The 80/20 rule, first described by Vilfredo Pareto, an Italian economist who was studying land ownership in his native country a century ago, applies to many types of activity and endeavor, where 20 percent of the efforts curiously account for 80 percent of the results or success. For example, in a company sales team, often about one-fifth of the sales force will bring in approximately four-fifths of the sales. Similarly, a small group of customers frequenting a supermarket will account for a much higher percentage of the complaints made to customer service. (It is important to realize that these proportions are approximations and need not be exactly 80/20.)
Using the Pareto principle helps us keep it simple so that after a couple of months, the insights in this book will live in your head, and you won’t have to drag a pain manual around with you all the time.
WHY SHOULD YOU LISTEN TO ME?
If you have chronic non-cancer pain and are underwhelmed with your progress over the years, this book could well be for you. Although the concepts presented are intended to reach everyday readers, they are based on solid science and extensive professional experience as a clinician. I have worked in the trenches with chronic pain patients in both multidisciplinary pain management programs and programs that help chronic pain patients reduce and eliminate their opioid use. I have also consulted the robust scientific literature available on various aspects of chronic pain and will share many of those findings here. A bibliography of scientific studies, medical journal editorials, and other documentation is provided at the end of the book. Additionally, I have been a family physician over the past thirty-seven years and have had a lifelong interest in various types of counseling, the power of thought, and daily due diligence in the prevention and treatment of chronic disease.
My training in South Africa taught me that not every country has a pain-related opioid prescription crisis and that there are other, more successful approaches to treating chronic pain. I became more involved in chronic pain while in North America and was a medical director for a well-known pain management provider in western Canada. For the last six years, I have worked in the field of disability medicine and have, together with a team, helped bring hundreds of patients with chronic pain and high-dose opioids to a safer place.
I know that I can help you, too.