I have been told advanced osteoarthritis and especially osteoarthritis of the hip is one of the most painful conditions you can have. It is both relentless and acute. Those of you in the throes of the experience know what I mean. I had access to the full range prescription drugs including opiates as my doctors felt quite free to distribute controlled substances based on my x-rays. Living on drugs did not match my way of going through life so I had to find another way. In the end I took no drugs at all before my hip replacement operation, not even an aspirin.
My Pain Landscape
Before I talk about how I managed this first let me describe my osteoarthritic pain landscape in the present tense. Pain is a fundamental part of my moment to moment experience. It comes in waves, peaks and troughs. There are times when I feel the immense pain that is inside of me, in my hips. It can feel huge, overwhelming and inescapable. I can see how people would do anything to get away from it. In the daytime there are breathtaking sharp pains from required activities like putting on my socks. There are the unexpected zingers from missteps. Challenging tasks like a short walk or scaling a flight of stairs ratchet the pain up one level to the next. When I’m at the top of those stairs having made the climb, the acute moment is past but the baseline pain is up a couple of levels. It can take minutes or an hour to return to baseline. There is positional pain from not moving that has me squirming in my chair like an unruly kid. When standing, it takes seconds for the pain level to go up so I’m constantly leaning on things and shifting. The relief from moving is going from high pain to lower pain, not pain to full relief. That temporary relief is overwhelmed in minutes as the pain level has crept up to the point where there will be some other position of lower pain to shift into. If I’m doing the same thing for a while the baseline gets too high and I have to find another activity entirely.
I fall asleep in pain every night. Going to bed I slow down enough for pain to be there front and center instead of being obscured by activities and thoughts. Once asleep the fact there is no long-term comfortable position forces me to move at night asleep or wake up to move. Once I wake up in the morning pain is fully there again.
Drug-free Pain Control
So if that is my pain landscape how do I get through it without drugs?
First of all I wanted to go without drugs. I was willing to deal with the pain [which my mother told me was unnecessary – just take the drugs already]. Second of all I fully believed it was possible to find a path through the pain. You could say I had faith and desire.
One mechanism I used to go down this path was to understand the boundary between pain and hurt. Pain is those nerves firing and sending the signal to my brain. Basically inescapable, the body acting like a machine delivering information. Hurt in the internal experience, the suffering. This is the mind’s interpretation of the information provided by the nerves and the brain. That mental experience is what you have a level of control over, with sufficient perspective the suffering is optional.
The easiest way to see this for yourself is through distraction. Move your mind’s focus elsewhere and pain will recede or disappear. You can experience this, even if momentarily, responding to an unexpected sound. What that tells you is that the pain signals do not have to constantly generate suffering. This gives you a first inkling of control.
For those of you who can’t concentrate, distraction is a great pain reliever. Do something else intently – even watching TV – and you enter a pain free world. That is a fine but ultimately temporary solution. Still it reinforces the concept that suffering due to pain is not a given, there is a mental locus of control.
Another mechanism is to use the mind’s impetus not to waste energy. One of the deals I made with my body was that I would pay attention to the situational acute pain (those missteps) provided my body chilled out on the useless chronic pain signals. I believe this worked to some extent in cooling out the intensity of the mental experience of the background signal. The body doesn’t want to waste energy on useless responses to neurological signals.
I also began to make the distinction between pain and degenerative weirdness. Again this might be hard to imagine for the uninitiated but no cartilage means bones grinding together. Well for the most part those bones have no nerves. You can feel them moving the muscles around your hips and even hear them grinding but there isn’t any pain. You think there should be and even react like there is but a bit of awareness lets you know you’re feeling fear, not pain.
More important, however, was changing the way I interpreted pain. Ultimately this involved feeling pain without being overwhelmed. I am not talking about sucking it up, gritting your teeth and bearing it. That’s no way to live and willpower runs out eventually. I’m talking about true pain relief. If there is anything useful I can impart here it is that such a thing is possible. In the absence of proof, and most people have no experience of this, the way to start the process is to adopt a stance of open mindedness. Allow for the possibility of drug free pain control.
Paradoxically the first stage in this process is to fully face the pain while at the same time relaxing into it. Sound impossible? Try it, feel the pain and feel relaxation at the same time. Pain isn’t a constant, intensity changes. Relaxation, as we all know, goes on and on until you’re fast asleep. Relaxation is more reliable and ultimately more powerful than pain.
The real trick is to get that relaxation to bleed over into the pain. Instead of the sensations running in parallel combine them. Once you lose that edge of tension and experience a variable response to your constant pain you begin to develop some measure of control. Success builds confidence. Relaxation eventually begins to feel good and the pain drops far into the background. It is still there but the moment to moment experience is information without victimhood.
Another way of deconstructing the power of pain is to look directly at it and try to go inside to its essence. The deeper I went into facing my pain the more I felt a thinness to it. It is like the pain was a veneer on top of a very few nerve impulses. Essentially [as some might say about the whole universe] pain is founded on emptiness. Bring that emptiness to the forefront and the suffering diminishes immensely.
Sometimes instead of looking at the totally empty glass I looked at the absolutely full one. Physical pain does not go as deep as the joy of living. Keeping things in context was helpful. I was always clear it was it better to be alive and in pain than neither. I counted my blessings.
On a more mundane level you can also just wish pain away. Sound farfetched? Well here is a journal entry:
Last nite I went to bed in a fair amount of pain. I had ridden my bike a bit hard uphill and my hips ached. I got woken up by the pain in the middle of the night even – something unusual these days. After I went back to sleep I dreamt I was at my sister’s house looking in her medicine cabinet. I took this non-steroidal pain killer (just the kind of thing I never take in waking life), then I went back and took another one. When I woke up the pain was all gone and today was a very low pain day. Amazing what your dreams can do for you.
I found my psychological pain management worked most effectively in the face of constant pain. Sharp pain was always startling – a jolt is a jolt. What was gratifying was just how fast the breathtaking intensity of a misjudged a step faded back into the habitual fuzzy background; that is the control part.
What I have been able to accomplish with my pain control is to shrink this potentially huge part of my perceptual landscape to a manageable size which left plenty of space to relax, smile and NOT have a bad day. Pain did not rule my life.
While my internal experience was generally pretty good I did not achieve some kind of pain free Nirvana. I had a subtle look, a substrate of pain on my face that dropped after the operation according to my friends. I thought I was doing great, smiling and laughing through my years of disintegration but now I’m told people knew I was in trouble.
My drug free pain control had a practical side, clear mindedness and the continued ability to operate heavy machinery safely. It also was a bit of an ego trip in that I had a certain amount of pride in being drug free and highly functioning. You might even get a bit more sympathy without pain killers. Those are things to keep an eye on as they can be difficult to unwind after the pain has been take care of permanently.
Post-Op Pain
Everybody will tell you that once you have the operation the pain is gone. Very true, all the rotten parts have been removed. If something feels weird, it is not my vanished bones but the remaining supporting tissue. One very quickly adapts changing back to living in a pain free body.
I talk about post-op pain and how I got to love those drugs in the “drugs” and “recovery” sections
