Chronic Pain
yagr
Veteran
I'm sitting here chuckling to myself as I contemplate how to phrase this question to get an answer. You all know that it can be tough to get a straight answer out of you sometimes, right? Just teasing - love you folks...
Anywho, my health went to a hell-realm in a triple basket last year and the truth of the matter is, I'm dealing with chronic pain. Pain is personal and doesn't compare well and so I won't try, but there are a couple of issues here. The pain itself and the complete lack of a break from it which is wearing me down. Each of my doctors have offered pain meds and even expressed concern that I continue to refrain from accepting them. I do know what the Buddha said about intoxicants... and as a result, I've tried to use the pain as a teacher, with some results. The problem is, I'm beginning to belief that I am shortening my life by putting this much stress on my mind and body.
I know the decision is personal, and I've no problem with making a decision - but I would like to make an informed one. Can anyone share any wisdom they have received through dharma talks, writings, or their own practice surrounding this issue?
Oh, and as an aside, most days I can still do sitting meditation (I do know there are other forms but I am much more comfortable with seated meditation). On very bad days I can still pull it off if I can push the pain away for a minute or two - if I can just 'get in front of it'. Other days I simply can't. Thanks.
Comments
@Yagr
Without knowing your medical condition, I thought I'd mention how many folks I've run into who after years of chronic pain, have discovered surprising reductions to their pain with anti depressants.
Is pain medication that has limited affect on the mind an option for you?
I like the phrase you used pain is a teacher. I thought as much when I was suffering sever back pain for 6 months until I got surgery. A thing to remember is that a student that is overwhelmed cannot learn and a student who is not challenged enough will not learn as well. Only you can know how much is too much but it will do you no good if you take it too far.
@how - grateful for the response and suggestion. We've tried the anti-depressant option and apparently I am the worlds greatest lightweight. I sleep eighteen hours a day and drool on myself for the rest - it's not pretty. Too, I hadn't noticed any significant (if any) reduction in pain.
There are a few things going on but what is probably causing me the most problem is my back. I begin the day, with a little help from my wife, a touch over six feet tall. I typically finish the day around 5'10" though I have dipped below 5'9" occasionally. The compression of my spine throughout the day pinches nerves and prevents signals to get to my legs.
@Grayman - grateful...
That's the issue right there for sure - I'm just a little shaky on where the line is, you know? Occasionally I've pushed myself and the results were amazing...other times it's been disastrous. It would be nice to know up front.
The answer I was given was when it affects your relationships, job, general life to an unhealthy degree. For me it was when it ceased to be a struggle within me and began to seep out into the lives of those I love. I think when it gets so far as to affect thier lives with negative energy your containment has observably been overwhelmed.
@Yagr
Taking into account that this info is coming from a plumber....
Some anti depressants have sedative side effects where others can stimulate.
Did you try the stimulant side of the anti depressant spectrum?
Was vertebroplasty or kyphoplasty discussed and discounted?
My solution? Take the frikkin drugs. Unless you dig the pain.
If you think that taking pain meds is somehow breaking the precepts then I don't know what to tell you except you're probably mis-applying them.
Yes.
Buddhism is the relief from stress.
>
Don't give up on recovering or improving. From my own experience with a back injury many years ago, meditation, perseverance, exercise, eating right, and keeping up a healthy lifestyle can help tremendously. It was mainly exercise while controlling the pain without any medication that greatly reduced the pain permanently. I can't say that it will work for everyone though.
personally, I would consider Buddha's other advice that we need to care for our bodies in order to properly be able to practice. Don't assume that any option means mind-numbing narcotics. Pain Management Clinics have A LOT of options, and sometimes include botox shots, cortizone shots, non-narcotic pain meds, and even accupuncture. You never know what works for you, until you take a chance to try it. If you don't like the effects, no one says you have to stay with it.
No and no. I am fairly well versed in medicine (though not my primary job; I was my units medic in the military) I had never heard of anti-depressants that stimulate. I thank you - it will be brought up and discussed with my primary care physician on my next visit.
As for the procedures you mentioned, I only got health care coverage in mid-January and we are still in the diagnosing stage of things. We had a list of symptoms and such prior to me getting health care but I couldn't afford to take the tests. Now that I can, we are testing the heck out of me... well, we're trying. The reality is, the doctor orders a test, the insurance company refuses to cover it, the doctor orders a cheaper test...it comes back inconclusive and then he orders the original test again and this time they approve it. The process can take a while but we are making progress. It's just a hunch but I'm thinking that the deterioration of the vertebrae's is too much like osteoporosis for such procedures to have much effect - but I will nevertheless bring them up to my doctor and see what he says. I really appreciate the direction.
My aunt has degenerative disc disease, and is quite disabled by it. She cannot work and gets disability. The botox shots help her wonderfully. She can only get them every 3 months (if I remember right) and in the last 2 weeks before the next round, the pain gets difficult to manage. She does so with narcotics during that point, and then goes off them for 10 weeks again when her botox comes around. Her pain in the past had been so bad she considered suicide because she could not manage, like you said it was constant, 24/7 and extreme severity. But when she started the botox, she got her life back. She is 54, and she has young grandkids, and she is able to spend time with them now, she takes them to disney (they live nearby) and so on. Her quality of life has increased dramatically.
I can only tell you what I have/am going through. I live each day constantly in pain. I have headaches that are under control by a medication called Endep and I take 50mg a day (or night as it causes drowsiness). It's also a tricyclic antidepressant, which may be a step towards me being able to cope with my disease http://en.wikipedia.org/wiki/Endep
As my disease progresses, things tend to "break down" a bit more. My latest "issue" is the constant pain in my ankles. Walking is agony. Every step is like fire burning my feet and ankles. I have started to take heavy duty painkillers here and there when it is beyond agonising, but I don't want to become addicted to painkillers either. But painkillers are a better alternative to drinking (I had a very bad period between 19-24 where I drank entirely way too much). But because I work full time, I have to walk some distance daily and I refuse to be a martyr and suffer. When I'm in pain, I'm a grumpy bitch, and that affects my time with my family. I don't want my daughter to think I'm a cow (but she's going through puberty so who know?
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Bottom line - yes pain will affect your life and those around you. Take the pain relief.
Personally I find your efforts, determination, humour, advice etc inspiring.
Quite simple. Alleviate dukkha, start with self. Advice based on experience, 'grumpy bitch' Gold . . . Bravo. Take the pain relief.
Shinzen Young is a meditation teacher who has a book and some audio out there focused upon the mindfulness approach to pain.
I would link you to this or that but I haven't explored his pain relief work. I have done a lot of his guided meditations and personally DIG how he unpacks the practice. I googled him right quick (Shinzen Young pain) and did see a lengthy Youtube video, along with ads to purchase books and audio.
Compassionate treatment of your physical condition(s) seems straight up Buddhadharma, all the way. WHY one takes a potentially mind-altering substance, to me anyway, would indicate breaking the fifth precept or not. No doubt a dose of pain killer might make you woozy along with giving you relief from constant pain, but the mind-altering 'part' of the med effect is actually temporary.
It's temporary nature sheds light on addiction, and how addiction happens. If you consume X amount of a substance twice a day for a month, the first few days, maybe less, will be 'high' days, but then the high goes away. Folks seeking the high double their dose, or whatever. The pain relief remains much as it was from the beginning. There is a slight downward trend for the amount of pain relief, but over a long period of time. It's the intoxicating effect that is quick to diminish and cause people seeking the high to increase their dose.
If you are such a cheap date
perhaps a very low dose, a pediatric dose of a tricyclic antidepressant (as Dhammachick mentions) will cause mild sedation -- but this quickly subsides if you tolerate a few bleezy days. A low dose, long acting narcotic will barely cause any loopiness at all, and if it does, the loopiness subsides quickly while the pain relief continues on.
Perhaps a combination approach of several methods will work?
Where I work, we deal with folks and their long term cancer issues, and a common one is back pain, when cancer chews on the vertebrae or tissues around. They wear back braces that redistribute the weight of the upper body or carry it altogether, to prevent spinal compression.
That, and tolerating or getting through a brief period of sedation or loopiness, and a meditative approach together, as an ongoing journey, will give you SOME relief. 30% relief, over all, is SOMETHING.
It doesn't seem morally 'sound' the deny oneself of the available kinds of relief out there, not really.
I've known addicts, currently sober, who needed to take potentially addictive medications. These folks were in AA, fwiw. They would obtain the meds and give them to their spouse or sponsor in AA, who would 'dole them out', which took away a ton of their anxiety about the addiction creeping back in.
Indeed, I would not base health care decisions on breaking precepts. When your intent is to care for your body and follow the advice of your trusted doctor, you are not breaking a precept.
I had severe lower back and knee pain. After visiting physical therapist and doing prescribed stretching, is am pain free now.
@yagr
Oh my goodness! Take the bloody pills already!
Medicine is not considered intoxicants in Buddhism. The suttas even explicitly count not taking medicine in time as a BAD quality in a person who is sick.
It is enumerated right along with Not listening to the advice of the caretaker!!!
/Victor
EDIT: Ok sorry. I can accept it is a personal choice. But you got to understand that it is explicitly againt the instructions in the suttas and thus not a Buddhist choice.
EDIT2: Pain is like pleasure. It is mostly an impediment on the path. You can learn from them but mostly what you learn is how to avoid them.
EDIT3: I was considering if I should say it or no, but I suspect that if you are perfectly honest with yourself this "stoically" enduring the pain thing is just another ego construct. If I may say so a bloating of the Ego. Let it go yagr. Take the medicine so you can get on with the cultivation.
@Yagr there are different types of pain medications but it depends on the source of the chronic pain. You need to talk it over with a pain specialist. For instance if the source of pain is chronic inflammation - anti-inflammatory medications may help (in the UK these drugs are ibuprofen and diclofenac but can cause stomach upsets, also paracetamol (acetaminophen) is a relatively safe and effective drug. If your pain has is chronic and has a neural basis then some drugs which have a 'central' action such as pre-gabalin or gabapentin may help but they are expensive and can take a couple of weeks to take effect (DO NOT be sold on amitriptylline as a cheaper alternative [the tricyclic that Hamsaka suggested above] - it really is an awful drug, with significant side-effects and shouldn't be prescribed these days, it's a sledgehammer to crack a nut)
Opioids I suspect are the drugs you are seeking to avoid, but there are some newer opioids that have less 'intoxicant' effects.
Hope this helps. PM me for more specific targeted advice
If you are able to do it, you may find that consistent (daily if possible) gentle yoga may help. It can make some things worse, so you may want to talk to someone with knowledge of what you are dealing with to ensure you do the right things.
I have had hip and sciatic pain for about 12 years, since I was pregnant with my 11 pound child. I have on and off knee problems from surgery 18 months ago, and lower back/SI pain from being off balance due to the irritable hip and knee. I have done yoga for a while, but it's only been more recently that I added Yin yoga to my practice, and started practicing every day rather than 1-2 times a week. 3 weeks later it has made a huge, huge difference. Even my stride when walking is different as my hips have been able to open up to a normal range. My back pain is mostly gone, my knee feels better than it has in years, and I sleep like a baby. I know your pain is different, but it might be of help. Yin yoga is stretching where you hold the stretch for 3-5 minutes at at time. They can be uncomfortable but it feels amazing, especially afterwards.
I know several people who are doing the same type of program as I am who have MS, and they are doing quite well. They pay close attention to their bodies so they know when to back off or rest or do a more gentle practice but they have found relief and better balance as a result, combined with their doctor's care, of course.