My Chronic Pain Life - Opiates, Suicide, and Hiking

My mind likes to wonder, this is especially true when my chronic pain levels go through the roof. This past week would be a perfect example, I think my mind wondered all the way to Jupiter at one point; I’ve struggled with pain this week if you don’t understand my metaphor. To continue with my metaphor, I wish minds could receive credit for steps, I would have blown past the recommended 10,000 steps by breakfast most days these last couple of weeks.

While on these trips through the chronic pain fog in my head, I realized I’m coming up on 20 years of what my doctors describe as moderate to severe chronic pain. Yeah, another anniversary to celebrate (I wonder if Hallmark has a card for this anniversary. This is a throwback to a previous post I wrote if you don’t understand my sarcasm). Side question, why is our culture so willing to turn all history into anniversary celebrations or events (love, homeruns, September 11th)??? Back on topic Alan, I think its time for yet another attempt at pushing the envelope of my own vulnerability in the hopes of giving you a better understanding of my own chronic pain.

One of the hardest questions I get from family, friends, and fellow chronic patients is “what is chronic pain”? Mostly I give some generic answer about it being pain that lasts longer than 3 months that doesn’t have a known cure, my best hope is for pain management.

While trying to write this post last weekend, I stumbled across a definition of chronic pain from the Cleveland Clinics that I wanted to share with you. The clinic defines chronic pain as “pain that lasts for over three months. The pain can be there all the time, or it may come and go. It can happen anywhere in your body. Chronic pain can interfere with your daily activities, such as working, having a social life and taking care of yourself or others. It can lead to depression, anxiety and trouble sleeping, which can make your pain worse. This response creates a cycle that’s difficult to break. (https://my.clevelandclinic.org/health/diseases/4798-chronic-pain)”.

As a chronic pain patient, why do I like the Cleveland Clinics definition you ask? Simply put, it brings in my mental health as a component of the chronic pain. To often people assume to my chronic pain is similar to their paper cut or sprained ankle pain, it is a yes/no proposition. Chronic pain is a cycle in pain, mental health, quality of life, with different time cycles (I’ll explain the time cycles later). Acute Pain can be relatively simple to deal with. More often than not, ice packs, rest, and Advil can and does help. What makes chronic pain hard to deal with is being 20, 30, or 40 something years old realizing that half your life will be spent in various levels of chronic pain with a “good day” being 5 out of 10 on the commonly used pain scale. This is one of the major reasons why to many chronic pain patients turn to suicide.

For any close friends or family that is reading this, I am not suicidal nor am I having any suicide ideation. However, due to the severity of my current flare combined with exhaustion, I do have a better understanding and empathy for those that do have suicide ideation. It is hard to accept that I have might have the mental and physical capability to live the rest of my life at these levels of pain. Not only do I need the capability, I will also have to accept the responsibility of living a life in that much pain. This is a responsibility that isn’t fair or logical, every day I have to accept it though. The amount of energy I would need to live a life, let alone a quality of life that would make my soul happy, in that much pain is simply exhausting. Mind you, I have a certain level of privilege and access to care that many don’t nor will probably ever have.

For the purposes of this post, I don’t want to give my entire chronic pain resume. Please read previous posts if you are curious. I will say I suffer from rheumatoid arthritis, degenerative disk disease, bilateral hip dysplasia, and severe osteoarthritis. My conditions were magnified and accelerated by a rock climbing fall and 6 or 8 car accidents. Due to all of these conditions and events, my medical team and I have decided that if I can live at a 5 out 10 on the pain scale that is my “normal”. Mind you, my 10 out 10 is the night I fell rock climbing and needed 10 screws and a plate to put my left arm back together along with 6 staples in my head. Let me repeat that, my normal or base life is a 5 out of 10.

What would you consider a 5 out of 10 on your own pain scale? Would it be a broken arm? Maybe a full ACL tear? A deep bone bruise? A bad case of COVID-19? In addition, would you immediately go to the ER if you were in a 5 out of 10 on your pain scale? Or would you try to manage the pain at your or significant others house? Do you think you could sleep through the night living in a 5 out of 10? Would you continue to go to work if you lived a chronic pain life in a constant 5 out of 10?

Back to my life and this post. For a multitude of reasons, I’m still able to live what many in the chronic pain community would call a high functioning life. This means I still am able to work full-time at a stressful job while still being able to go for hikes/occasionally ski/bike rides/gym. About 3 weeks ago I went for a hike in the backcountry of Idaho after working all week. I needed an outdoors adventure for my mental and physical health, unfortunately my physical health want more couch time that day. I had to come home after only a couple of miles.

I’m not sure what or why I had a hard time physically that day. The easy answer is “that’s the nature of the beast”. All I know is for the next 2 weeks I experienced a 24/7 lower back spasm. Now, for those of you that have had a lower back spasm you know they are more annoying than painful. Since this spasm was located in my lower back and was essentially 24/7, I would rate it as maybe a 3 to 4 on my pain scale. Like I said, annoying but relatively easy to deal with. However, since my “normal” pain level if a 5 out of 10, that means for a couple of weeks I was living and working in a 8 out of 10 on the pain scale.

Lets discuss my pain med situation for a minute. Although I don’t sleep this much, I like to be in bed by 10pm every night and I usually get up around 5am. That means that in a 24-hour time span, I am awake for roughly 17 hours a day. Depending on which medical journal you want to use, my Oxycodone starts to wear off at the 3 to 4 hour mark. Right now I’m allowed to take up to 4 per day as needed. If you do the math, 4 pills a day multiplied by 4 hours equals a potential of 16 hours of pain relief a day. Beginning to see the problem, if I’m a wake 17 hours a day, like I said I don’t actually sleep 7 hours a night, that means I have 1 hour a day without pain coverage. One hour a day might not seem like a problem unless you put it on the same scale as my life. 1 hour a day multiplied by 20 years of chronic pain equals 7,300 hours of no pain medicine coverage. To put it another way, I’m 7,300 hours behind in my pain management, or my pain has a 7,300 hour head start.

For the time being I am going to skip the mostly right-wing demonization of opiates and the people like me who use them for our pain management. I will (this is my post so I can do whatever I like) take this opportunity to point out that opiates, like Oxycodone, do not heal or cure my pain. Basically my Oxycodone tricks my brain into not caring that I am in chronic pain. The damage or wrong is still happening, the hope is the medication provides enough not caring so I can still go for hikes or take my camera out for some nature photography after putting in a full week of work. To put it another way, they are designed to keep my quality of life at a level (even if that level is not truly accurate) for which I won’t consider suicide as a treatment option.

Tangent time. Although there are no absolutes when it comes to mental health and chronic pain, based on my own patient story, I’m willing to bet the amount of preventable suicides would surprise us all if we started to look at suicide from a patients perspective. Suicide, from a chronic pain patient’s perspective, is not always a loss of will to live as many might think. Suicide becomes a viable treatment option because a chronic pain patient is 10,000 or 15,000 hours behind in their own pain management. Think of it this way, someone offers to take you on a 5-mile hike but a quarter of they way in they tell you that you actually have to scale Mount Everest. Prepping for a 5-mile hike is one thing, prepping for Everest is a whole different beast.  

So how might we prevent suicide from becoming a viable treatment option for chronic pain patients? First, the narrative around opiates needs to change, and quickly. Yes, there is an addiction and overdose problem in our country. I’m not arguing against that at all. People with addiction issues need our help. We need to remember that chronic patients, like me, use opiates as medication. In our eyes, these meds are no different than a cancer patient who uses chemo or someone with the flu using cough syrup. These are meds that if used correctly will help us all obtain a higher quality of life.

Next, most chronic pain patients do not distinguish between traditional and so called alternative pain management treatment options. For us, it’s all just pain management. Most of us are open to things like physical and occupational therapy, diet, exercise, and even counseling (although if you come to me with pain acceptance therapy I will punch you in the nose. Accepting chronic pain into our lives is not the problem; it’s accepting that there are no other treatment options are where I have a problem). 

Yes, by most definitions I am addicted to opiates. But here is the deal, I don’t care nor will I let you take them away from me without a huge ass fight. You want to make opiates obsolete then offer unlimited or maintenance based physical and occupational therapy. Have my health insurance pay for float therapy (https://www.healthline.com/health/sensory-deprivation-tank). Speaking of health insurance, have it pay for my grocery bill at the Boise Coop or Whole Foods along with my YMCA gym membership. Allow me to work 30 hours a week and have my health insurance (or some other payer) pick up the other 10 so I can still live in my current house and maintain my current standard of living. Make it easier for chronic pain patients to go on disability. I will fight like hell to experience and live life to the fullest but my chronic pain dictates that I will need help at some point. Right now opiates help.

Work. I’m ok with working but at a certain point I’m not going to be able compete at my current level. Not only is chronic pain distracting but it is also exhausting, to ingredients that make for easy and embarrassing mistakes, 2 things bosses tend not to like. Not to mention when I’m trying to still work through an 8 out of 10 I’m not exactly producing a quality product in a reasonable amount of time. Even a simple email can take and extra 5 or 10 minutes due to having to proofreading it for grammar, spelling, and brain fog mistakes.

Despite the last few weeks being rough, I still believe that I have a good life. I’m still believe in the mantra of “its just a bad day, not a bad life.” However, both the number and strength of my bad days continue to rise. At some point, probably sooner than later, I will need help from family, friends, hopefully a love one, and society. However, our culture only celebrates those that ask for help in blog posts and maybe Hallmark movies. Those individuals that can “pull themselves up by their own bootstraps” still get the rewards, girls, and the songs written about their lives. I’m already buying boots without laces because tying my own shoes is painful, it won’t be much longer before I can’t pull those boots on. At some point I’m going to need help putting on those boots and more than a blog post celebrating my life.

P.S. I purposely did not proofread this point for grammar life I normally would. I’m an intelligent individual with two degrees, I’m hoping by not proofreading my post you can get a better idea of my brain fog.