They say many psychiatrists choose their profession because they themselves suffer from mental illness. When I started my PhD, studying pain, I never expected to succumb to chronic pain, but things certainly seem to be going that way, so I figure it might be useful to share my insight as both a researcher, and now a sufferer of chronic pain.

My story starts in 2008, when I was diagnosed with ovarian dermoid cysts. In the years since then, I’ve undergone two further surgeries, which have left me in constant abdominal pain which varies in intensity, location, and in the way it feels. I experience two main types: a constant dull ache, similar to period pains, and intense shooting pains, which happen whenever the hell it wants – sitting, standing, walking, lying down – and generally this is most problematic. It’s often briefly excruciating, usually nothing more than annoying and distracting, but there haven’t been a day in over a year that I haven’t experienced pain that has made me catch my breath. It’s exhausting, and I’d be lying if I said it hadn’t affected my lifestyle over the last year in particular.

Despite this, I was very resistant to admitting the possibility that the pain I was experiencing was anything out of the ordinary.  Partly, I suppose, because none of the doctors I have seen suggested it could be the case. I have tried most traditional pain medications with no effect (co-codamol, paracetamol, even tramadol), and ignored the fact that any pain persisting longer than 3months is in the running for the title of “Chronic”. Part of this reluctance was fear, but not of the unknown – I knew too much. Having spent the best part of 5 years focusing my studies on the problems of diagnosing and treating chronic/neuropathic pain conditions, I know only too well how difficult it is to successfully treat pain. It’s a minefield of misdiagnosis and I’ve read more accounts than I care to remember of patients shunted from specialist to specialist with very little improvement or even reassurance. I remember one soundbite I heard in my first year of studies that 30% of the population will experience chronic and particularly neuropathic pain, of which only 30% will experience acceptable pain relief…. so you can understand why I was burying my head in the sand! My main solutions to date have been breathing, swearing,  and stopping whatever I am doing until the pain subsides. When I’m at home I take a bath and hug a hot water bottle. It helps a bit, even if as something to do.

“Neuropathic pain” was the thing that scared me the most – this is pain which is not caused my tissue damage, but by the nervous system itself. It occurs when nerves are damaged, either by ‘foreign bodies’ (drug and viral), or by physical trauma, such as surgery. This damage alters nerve sensitivity, lowering and/or raising thresholds so that what used to be a nice shower temperature becomes way way WAY too hot, a cool breeze switches from refreshing to agonising, and even the touch of clothing against the skin is unbearable. Luckily for me, my experience seems more due to spontaneous activity, which results in shooting pains and other unusual sensations. I like to think of the way nerves function in neuropathies as similar to a faulty fire alarm – over-reacting to steam, failing to detect a fire, and then just going off for no reason whatsoever. Unfortunately, this type of pain has no simple fix, no batteries to change, no refund and replace.

Researchers are still trying to pinpoint exactly what makes one person develop neuropathic pain, and another be totally fine, given the same injury. Part of the reason for this is that pain is a learning tool – it is how our body learns to protect itself from damage, and is shaped by our experiences and attitudes, making every painful moment unique to the individual. Treatment can be complex to say the least.

Of course, it turns out that the last surgery I had (abdominal hernia repair) is one of the top three known to be associated with post-operative pain issues (the other two: mastectomy and thoracotomy)… so if I hadn’t been so busy hoping it’d go away, I probably could have been seen much earlier! Additionally, having underwent three abdominal surgeries, my insides are now riddled with adhesions – these are points where scar tissue has formed along lines of incision, sticking to anything they come into contact with. I have been aware of my own adhesions for a while – for some time they were not painful, just strangely uncomfortable, a feeling of stretching and tension inside me when I moved in certain ways, although since the last surgery I have definitely been more aware of their presence – in the abdomen, they often end up affecting the bowels, and I can definitely confirm that! Eating and needing the bathroom have been noticeably more uncomfortable… further lessons in why taking advice from an ostrich is a bad idea…

So what are my options? Keep on plugging away with co-codamol which does nothing??? Try something else? The last 10 years have seen the addition of drugs established in other areas, such as gabapentin for epilepsy and duloxetine for major depressive disorder to the analgesic arsenal. These tend to be given at much lower doses in pain conditions, and work by altering neurotransmitter levels. Other approaches include TENS, acupuncture, talking therapy, and cognitive behavioural therapy, each having their benefits and drawbacks. My personal opinion is that drugs alone are not enough – the emotional side of pain is not to be underestimated… it’s draining and miserable, but it doesn’t have to be inevitable. How we feel psychologically has such a huge effect on our physical well-being – stress releases hormones which can have a knock-on effect on pain, especially visceral pain, as anyone who suffers from irritable bowel syndrome would confirm, and our attitude and lifestyle can change the course of the disease. Furthermore, there are bidirectional associations between anxiety/depression and chronic pain, and both conditions involve many of the same parts of the brain (e.g. the amygdala), which explains why antidepressants have been used so successfully to treat chronic pain.

So this week, after chatting with some colleagues (if nothing else, my experiences have taught me to make the most of those around me), and reinvigorated with a “New Year Fresh Start Let’s Sort Stuff Out!” vibe, I went to my GP and straight out asked to be put on medication for neuropathic pain. After consulting another doctor, they agreed, and this week I will be starting on amytriptyline, another antidepressant used to treat pain. I’m bizarrely excited – the prospect of being able to go about my daily life undisturbed by pain makes me pretty hopeful. I will also start seeing someone for some talking therapy – I know myself the detrimental effect pain has on my mood, and it’d be foolish to ignore that side of things, pinning all my hopes on pharmaceuticals. These efforts might not fix me completely, and I know that, but I hope they will at least give me the tools to cope better.

I’m only too aware that my experience is very definitely at the small end of the scale when it comes to pain – I can basically function, just not in comfort most of the time – but I have been reminded that the impact of any pain condition is a result of BOTH duration AND intensity. I think most people would prefer a short sharp shock to constant dull pain, and there are studies showing that knowing pain is not going to last forever increases our tolerance as the associated anxiety is much lower.

Anyway, wish me luck, and I’ll be back in a month or so with an update on how this new approach is working…

p.s. if anyone would like references for all the above, or has any questions or points they’d like me to expand on, holla and I’ll write some more!