I ache. I\u2019m sore, nearly all the time. I\u2019m one of the estimated 900,000 New Zealanders who suffer from chronic pain.<\/p>\n
Chronic or neuropathic pain is usually defined as pain that\u2019s lasted for more than three months. I\u2019m lucky; I\u2019ve had it for only five years or so. Multiple thousands of Kiwis have suffered for decades, or their entire life.<\/p>\n
More statistics. Over 40% of people in the UK are thought to suffer, at various times and to various degrees. (The US estimates almost 50%.) For over-75s in Britain, the figure lifts to 65%. About 80% of this is back and neck pain.<\/p>\n
In Aotearoa, a 2018 report from research group Sapere suggested that chronic pain costs our health system some $2 billion annually, plus another $15 billion in lost production and benefit costs. Utterly predictably (think housing, working conditions, $60 for a GP visit, $75 for a physio session), it affects lower socio-economic groups more. Oh, and (think trad Kiwi male stereotypes this time), women are more likely to report it than men.<\/p>\n
In my case, it\u2019s cervical spondylosis with foraminal narrowing and radiculopathy. I like to roll out the phrase so I can watch listeners\u2019 eyes cross as they wonder how much time I\u2019ve got left.\u00a0<\/p>\n
English translation: my neck is stuffed. Age, plus bad posture at the keyboard, means the cushioning discs between cervical vertebrae have worn thin. Bone spurs have formed. My mobility is limited; I get deep pain in the neck and between shoulder blades, plus intermittent giddiness.\u00a0<\/p>\n
I\u2019ve gone into detail because, like most sufferers \u2013 and I dislike that word \u2013 I usually don\u2019t say much about it. People with chronic pain get little sympathy. Who wants to hear about an ailment that goes on and on, especially when it usually comes with no bandages, slings, plaster, other visible signs of affliction?\u00a0<\/p>\n
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Like Chronic Fatigue Syndrome and Long Covid, it\u2019s easily seen, even by some health professionals, as self-pitying, even malingering. \u201dWhatever happened to \u2018pull yourself together\u2019?\u201d I heard one sceptic sniff, after an acquaintance had vented over his months of continuing hip and leg discomfort. It\u2019s the least telegenic of ailments; if we do appear on screen, we\u2019re usually caricatured as boring old whingers who need to snap out of it.\u00a0<\/p>\n
\u201dIt\u2019s all in your head,\u201d is another common dismissal. True. Also stupid. Of course it\u2019s in the head, because that\u2019s where the brain\u2019s pain receptors are. We don\u2019t register any injury or discomfort till those receptors fire.\u00a0<\/p>\n
Trouble is, if the pain continues for more than a few hours, your pre-frontal cortex starts assessing the sensation in terms of what it may mean long-term, and begins reinforcing the synapses associated with stress and discomfort. The brain\u2019s \u201dpain switch\u201d gets stuck in the ON position, and your body becomes convinced of its distress.\u00a0<\/p>\n
Neurologist William Davies notes that \u201dpain carves a path directly between the realms of mind and body\u201d. It\u2019s called Control Sensitisation: just as Pavlov\u2019s dogs slobbered when a bell rang, almost any tug or tension for a chronic pain sufferer sends those brain receptors into power drive. It means that pain can become a habit, and like many unpleasant habits, it\u2019s hard to get rid of.\u00a0<\/p>\n
A cycle of discomfort \u2013 sleep deprivation \u2013 stress \u2013 more discomfort and more stress can become established. Withdrawal and depression may follow, with the symbolic Black Dog liable to squat and crap on any of your days. So yes, it is\u00a0all in the head, and it\u2019s utterly genuine.\u00a0<\/p>\n
There have been some curious associated discoveries. Women\u2019s limbic system responds to pain more than men\u2019s, so women often experience greater emotional distress, while the fact that men\u2019s pre-frontal cortex is more affected means they may see the issue primarily as a problem to be analysed.<\/p>\n
And chronic pain may be exacerbated by apparently unassociated events; Brexit, the Covid pandemic, even the Trump presidency saw a rise in reported cases. You\u2019re right: the Orange Roughy can indeed become a pain in the arse. Bad news for the next few years.<\/p>\n
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Chronic pain victims make unrewarding patients, even to sympathetic doctors \u2013 and not all are. Symptoms are frequently vague and diverse. We\u2019re the unwell who can sometimes seem well.\u00a0<\/p>\n
Our GPs ask questions, refer us to specialists who ask more questions, at $2 per syllable, rule out nastier possibilities if you\u2019re lucky (and that is indeed a help), and usually intone variations on the theme of \u201dyou\u2019ll have to live with it\u201d. I sympathise with them, actually: as with Chronic Fatigue or Long Covid, we seldom give them the satisfaction of finding a specific cause.\u00a0<\/p>\n
So chronic pain is a formless and often unresponsive condition. It can take a long time to get a diagnosis, and it seldom comes with any clear path of action. It can be treated, but seldom cured \u2013 whatever that last word may mean.<\/p>\n
What are the treatments? Painkillers, anti-inflammatories of course, though all of them, except perhaps paracetamol, come with potential side effects. A TROUP (Trends and Risks of Opioid Use for Pain) study in the US found that 22-26% of people prescribed opioids for non-malignant chronic pain ended up misusing their drugs.\u00a0<\/p>\n