Origin Stories

Post #2 in the series "Reprocessing Chronic Pain"

To figure out where you need to go, it can be helpful to understand where you've been. So, my efforts to end chronic pain now -- 32 years after its origin -- rightly begin with the story of how it all got started. The through-line, which should emerge here, is stress and distress becoming associated with (and forming a feedback loop with) pain. For me and for millions of other chronic pain sufferers, the pain has an exogenous initial trigger. But once the body heals from that trigger (an injury, an infection, a medical procedure) chronic pain is fueled and perpetuated by the body's stress response. The stress response is a set of physical/biochemical reactions that take place immediately and automatically where there is an experience, a sensation, a thought, or a feeling that the brain interprets as threat. (My favorite book on the biology of the stress response is Robert Sapolsky's Why Zebras Don't Get Ulcers).

I'm going to pause here for a hugely important message, one which I will continue to repeat. Pain is NOT, ever, "all in your head." All pain is a real physiological phenomenon that can be documented by brain scans. Historically, the term "psychosomatic" has been used to dismiss pain patients as liars, fakers, attention seekers, or "just" anxious, depressed, or stressed. We don't "bring this on" ourselves. But -- and -- pain IS a complex and subtle dance between brain and body. It's frequency and intensity are influenced by thoughts and emotions. The term being used in neuroscience now is psychophysiological (which actually means literally the same thing as psychosomatic, "soma" being the Greek word for body). But it lacks the stigma and connotation. Words matter, even when they are synonymous.

My pain experience actually had two different "starts." The first was a minor car accident when I was 19. My boyfriend and I were on an icy highway in an old car with lap-belts but no shoulder belts (if my memory serves it was a late 70s-era Dodge Dart that looked something like this). We skidded on the ice and rear-ended a truck. I was thrown forward from the waist. Luckily (it seemed) neither of us was injured. But the accident totaled the Dart, cancelled our romantic getaway, and abruptly -- jarringly -- ended the relationship. That's a longer story, but it was a fraught and painful experience that I never really got to process. It's likely that the trauma of the accident and subsequent pain, and the trauma of the lost relationship, were linked in my subconscious.

Several days later I developed stabbing pain in my lower back. Some rest and a round of physical therapy resolved the pain and I went back to living my life. I finished college and moved to Washington DC to start a job. I was active and athletic. After a year and a half in DC, I decided to go to grad school for a PhD in history. It was a dream, a calling. (I'd toyed with the more practical and conventional move of going to law school. I even worked in a law firm for a spell. But I hated it). I loved nothing more than to read and write and talk about big ideas. Penn granted me a full-tuition scholarship plus a stipend for living expenses. I moved to Philadelphia full of hope and excitement.

I loved school, loved the people, the work, the whole thing. I was totally in my element. I felt like I had finally found my people. On the other hand, I was living alone for the first time, in a strange city, in a horrible apartment. (My mother later told me that she cried the whole way home after dropping me off there). There was 24-hour noise from a fraternity house next door and a threatening neighbor upstairs with big dogs and an even bigger sub-woofer. I was unable to sleep for months. There was a seriou