The Problem of Pain

February 4, 2014 Insurance Topics, Opinion 1

“Pain,” wrote C.S. Lewis of The Chronicles of Narnia fame, “is God’s megaphone to the world.”

In our bodies, pain is the brain’s megaphone that something is not right. On an immediate level, acute pain tells us to stop whatever it is we are doing.

How to handle the problem of pain as a society and personally are complex challenges. We know that too many people are depending on opiates and other drugs to relieve pain and some doctors are even making a profit directly selling these drugs without enough third party oversight.

We know there is a risk of addiction, which destroys lives and families. The long-term effects on children with alcohol and drug addictions stay with them throughout their lives.

We know that there are too many people in our country on disability related to pain than our joint resources can afford. We have politicians who win votes by providing entitlement benefits when that is not always the best for the morale of the individual.

I know a few things about pain both individually and professionally. By inheriting the back problems of my parents, I suffer from pain. As a writer who has covered health, workers’ compensation and disability, I also know the public policy and administrative efforts being made to deal with the costs and implications of soft tissue injuries and the pain they cause.

We still have a lot to learn about pain. While the medical community and insurers are gradually becoming more open to alternative ways to deal with pain, we know intuitively that pain is deeply individual and difficult to communicate. There is no one-size-fits all answer to addressing pain.

To deal with pain without drugs requires high motivation and an acceptance that pain of all kinds is part of life.

We know that some people can live with more pain than others. For example, living with pain is different for each gender. Recent research contends that women cannot bear pain as well as men and that women are more likely to be seen at pain clinics. We also know that women, in general, see doctors more often. Whether for social or physiological reasons, men tend to avoid doctors more.

As someone who has struggled with pain for years, I also believe there are other factors that affect pain and productivity that employers can do only so much. In medical and workers’ compensation circles, we know that in the Minnesota of Garrison Keillor fame, people are somehow more resilient to the difficulties of life. Coverage costs reflect that reality.

But we do need broad guidelines even though they will never be perfect for each individual situation. Thoughtful determiners of who should be on disability and who should find their way back to work use broad guidelines like the American Medical Association’s Guides to the Evaluation of Permanent Impairment. As with any broad approach, there will always be some that are not well served. 

But there is so much more to these questions of how to deal with pain and help those who suffer from it.

We know that individual values influence motivation to work. That explains why some of us have a very strong work ethic and would be ashamed not to be productive members of society while others just give up.

Some would say this stems from the Protestant work ethic that prevailed in the nation during its early years and that gradually eroded due to political philosophers like Karl Marx.  But Marx, like the apostle Paul, acknowledged that everyone should be productively contributing to society. Marx’s maxim, “People who do not work should not eat,” pretty well sums it up. (As historian Paul Johnson pointed out, it is ironic that Marx was fed by the wealthy Engels family and never did any work that would have made him a “miserable commodity.”)

The belief that work should be required of all, regardless of its source, was supplanted by the idea that all Americans are entitled to not only a job, but a meaningful one. Perhaps it was the post WW II economic boom where jobs were plentiful and opportunity seemed endless.  Perhaps it was political propaganda that made promises for future generations to keep.

What I have never been able to understand is what entitles us to anything. The framers of our constitution assume that through a creator, we have the right to pursue life, liberty and happiness. They did not promise anything, but assumed something greater than us allows us to pursue better lives.

Our individual and collective belief systems greatly affect how we deal with the problem of pain and what we expect from others and ourselves, including employers and the government.

The problem is our collective expectations cannot be met due to how we use our resources. This is the heart of the budget discussions in Congress. Fiscal responsibility is impossible with the plethora of high expectations. If we do not lower our expectations, we will continue to burden younger generations. If Americans began as individuals to be realistic about their own expectations, we would be a financially stronger nation.

We do not have a full handle on why pain is worse for some people than others.

But as with any broad attempt to classify individuals, there will always be some who are on disability unnecessarily and others who really cannot manage working a full-time job.

My Pain Story

An MRI from seven years ago revealed many reasons for my back pain, but the pain specialist who gave me lumbar epidurals and steroidal shots could not tell me specifically why I had pain but only that he could treat it.

If Americans began as individuals to be realistic about their own expectations, we would be a financially stronger nation.

Being busy with work and raising two small children, one having juvenile diabetes, I focused on getting relief. But I knew intuitively that the long-term answer was finding its cause.

So I spent a couple years getting shots and, for some of that time, getting physical therapy. Knowing the shots could cause long-term damage, I elected to get painful trigger point deep messages. Using breathing techniques I learned from intense weight training, I got through them to the surprise of the therapists who told me I could handle pain better than most people.

Massage worked for a while, unless I did too much housework or gardening at once. So I tried to spread these chores out over time to reduce pain. My doctor made sure I always had muscle relaxants for those times when muscle spasms caused me to stop dead in my tracks.

Recently, I got another MRI and a diagnosis for my pain. It turned out I am so hypermobile that I stretched out my ligaments, leaving me little strength to handle the challenges of a good cardio work out or extended day in the yard.

Since then, I have been getting more shots to reduce inflammation and strengthen the ligaments. My use of Ibyroyn has declined, but the issue is not yet resolved. My doctor now wants me to pursue prolotherapy, which is not covered by my health insurance.

My recent physical revealed that I am in excellent health for my age, save for the back problems. I asked my doc for advice on other roads to pursue that are covered by insurance. I got a second opinion from a surgeon, who told me to start swimming. That takes time and money, which are both limited. Recently, an expert told me to try hot yoga, which I will do. I am also trying to determine how much pilates I can do to strengthen my core without pain.

There are also other options to explore, but I know intuitively I need stronger muscles to stabilize me.

Dealing with pain is an individual journey. To deal with pain without drugs requires high motivation and an acceptance that pain of all kinds is part of life. We have high expectations to be pain free, but the reality is that as we age, our bodies are less resilient to pain.

While public policy makers and doctors continue to address pain, I submit that being as productive as possible despite pain is an individual choice. As a society, we cannot afford for people to give in to pain. The social ethos of our society needs to return to the Protestant work ethic because as a nation, it made us strong. Without this strength and determination, our country will become weaker economically and otherwise.