The Seven Capital Sins of Pain
MOACIR SCHNAPP, M.D.
There are many things in life beyond our control or, at least, many more than we’d like to admit. For example, we have no say on which genes we are born with, the DNA that determines our life span, our propensity for cancer and diabetes, or how tall and smart we may become. Nor can we control how well off our parents are, or the country in which we are born, just some of the factors that can determine how cushy a life we may enjoy.
In the great scheme of things there are really very few precious items we can control, and fewer goals still that can be attained to improve the quality of our lives. The avoidance of pain should, of course, be at the top of everybody’s goal list.
Yet, fallible as we are, we frequently steer off course and make dim-witted mistakes that lead to illness and pain, decreasing our chances for happiness and the full enjoyment of life.
Approximately twenty-five percent of the American population smokes, but close to fifty percent of the patients who suffer from chronic pain do. We don’t know whether tobacco is the cause or effect but the relationship between pain and smoking is well established. The link is even more dramatic between tobacco and severe mental illness, with an incidence of close to ninety percent of smokers in that group.
Smoking accelerates the damage and occlusion to the arteries that carry oxygen to the several parts of the body. Pain from clogged arteries can range from angina, to severe abdominal pain, and even inability to walk due to lack of blood to the legs. More severe blood restrictions can cause heart attacks, and even loss of limbs.
This old term refers to the sin of unfulfilled potential, the failure to reach one’s maximum, or laziness. Lack of physical activities or a regimented exercise program is a significant contributor to chronic pain. A fitness program will help maintain the health of the muscles, ligaments and joints, as well being beneficial to the cardiovascular system and to prevent such diseases as diabetes and hypertension. Exercises are a must for the management of most patients who suffer from chronic pain.
While the physical benefits are obvious to most of us, the mental benefits from exercises are not common knowledge. Recent research suggests that a fitness program can increase the production of the brain chemical BDNF, or brain derived neurotrophic factor, which seems to work as a nutrient to the nerve cells, stabilizing the neural circuits involved in mood and well being. It improves energy, increases the ability to focus, and it reduces anxiety and depression. Other neurochemicals released during physical activities, such as endorphins, have also been shown in the past as powerful natural painkillers and mood enhancers.
The great number of overweight people in the U.S. often surprises foreign tourists, for nowhere else in the world is the prevalence of obesity so widespread. Food is plentiful, readily available, and we can use it as a substitute for love, to kill boredom, or even to treat anxiety. Putting on a few pounds is almost inevitable with age, but the rate at which we are gaining weight has accelerated enormously, while children are being affected now earlier and earlier.
Walking on two feet places a substantial burden to the human spine, and the stresses that occur over a lifespan lead to degenerative changes in the discs and joints, especially in the low back. This natural wear and tear grows exponentially as more load is added, and its effect can be felt in virtually all the joints, with hips, knees, and ankles often taking the most pounding in overweight individuals. Pain sets in permanently as the cartilage in the joints wears out and bone rubs against bone.
Now add diabetes and painful neuropathy as among the main cause of chronic leg pain in adults, or sleep apnea, which causes pervasive fatigue and generalized pain, and we get some idea of the misery that obesity can cause.
Life can be difficult and painful, and there are chemicals out there that can help us; the problem is sorting out which ones. Scientists are still learning about the effects of drugs and trying to guide us as to which ones are acceptable and effective. Much of what we learned has been by trial and error, and major blunders have occurred during that process. Many of us don’t realize that at one time heroin was sold as a “non-addicting” substitute to morphine (we know better now), while caffeine barely missed being outlawed.
Alcohol is however a legal drug, the most common way people self-medicate, and its abuse is a major cause of pain and suffering. While most of us can have the occasional drink without problems, some people suffering from chemical imbalance report feeling “normal” for the first time in their life only after experimenting with alcohol. It is easy to see why this could lead to a lifetime consumption of alcohol and even illegal drugs, instead of taking it as a warning and a sign to seek the help of a specialist.
When excessive, alcohol “pickles” the tissues in the body, including the nerves. Alcoholic neuropathy is a common cause of severe intractable pain in the lower extremities, a misery made worse by numbness in the legs and loss of balance.
“I don’t need any help”, or “I can do it alone”, can as easily be applied to the stubbornness of trying to carry a heavy sofa by yourself or the rejection of help when saddled with a heavy emotional burden. Herniated disc, damaged muscle, or a rotator cuff tear in the shoulder are just some of the examples of physical injuries that may occur from overdoing and that can lead to chronic pain. A dose of good sense and a tincture of humbleness can go a long way in preventing injuries that could cause lifelong problems.
As severe as the pain of the flesh is, it can pale when compared to the pain of the soul. Anguish, grief, guilt, are essential emotions that we experience as part of life and help mold us into who we are. When excessive and unrelenting, however, it can destroy some of the basic qualities we see as human, wiping out the laughter and joy that makes life worth living.
Pain and suffering are so intimately related that many times we can’t separate them. Seldom can a person suffering from chronic pain avoid depression, while depression often leads to true physical pain. For example, it is estimated that one out of three women treated for chronic pain have a history of physical or sexual abuse; psychological therapy is an integral part for their successful treatment. Seeking the help of a mental care professional, or from church, or from other sources in your community is not a sign of weakness, but often the first necessary step in healing.
Stress is neither avoidable nor is it necessarily bad for us. In moderate quantities it allows us to survive in a world of dangers and uncertainties, it keeps us alert while driving and tells us to avoid the bad part of town. But when excessive or misdirected, stress becomes a disease in itself that produces toxic quantities of steroids in the body that can lead to cardiovascular and other problems. It progressively impairs the function of the central nervous system, possibly leading to anxiety, depression, and even pain.
Meditation, praying, exercises, fishing, are just some of the ways we can use to deal with excessive stress. The same techniques can be utilized as an aid to combat chronic pain. Give it a try.
In the age of the Internet there is no excuse to remain ignorant about health. There is no better way to stay healthy than to understand how the body works; prevention is the only true way to stay healthy and to avoid pain. For example, the pain from shingles is one of the most severe encountered in medical practice and can lead to permanent suffering. Despite the availability of immunization for the disease, only a small fraction of the population that could benefit from it has. Empower yourself by learning.
© Dr. Moacir Schnapp and Dr. Kit Mays