Pain Management & Depression

He’s in obvious pain just walking the 40 feet to my office. I annoy him by asking how he’s feeling. He speaks of the weather with contempt – his arthritis goes up and down with the barometer. It’s something he can’t control and therefore he hates it. Rather than cope with the powerlessness he channels it into being a sarcastic curmudgeon. It’s endearing to others but limiting to himself. He tells me there’s nothing he can do about it. I believe he’s wrong.

I tell him he can’t change something if he’s unwilling to first accept what it is. He’s stuck in the injustice of it all. It’s certainly not his fault he developed a brain tumor. It’s not his fault that his doctor fears being red flagged by the D.E.A. for prescribing pain meds. It’s not his fault that his insurance doesn’t want to pay for alternative treatments that might alleviate some of his pain. He’s still the guy who gets to choose how he will manage his life given the parameters of what he cannot change.

Pain management is something we associate with opiates and physical rehabilitation. It’s not something we think about as being intimately attached to depression, high levels of stress, or anxiety. This is a bit mystifying given that we know that how a person feels emotionally and physically are intimately connected.

It’s a two way street but both sides are a dead end for him. My client is minimizing his emotional pain in exactly the way that he minimizes reports to his doctor about his physical pain. There are few things more arbitrary than a 1-10 pain scale. What he calls a 3-4 most folks would call a 7-8. Having a high pain tolerance may be a strength but it does not dictate that simply because we can tolerate it that we should passively acquiesce. There are a lot of issues that aren’t getting dealt with here and his fear of pain medication is one of them.

There are a lot of good reasons to be opposed to pain meds. Folks fear dependence, addiction, side effects, being judged by others, theft, and a loss of quality of life. I’ve served dozens of folks who have these fears. Sadly, they also have minimal expectations of their doctors, fear the appearance of being med seeking, or are simply uncomfortable asking for help. These folks tend to be very passive in treatment and under report their symptoms.

When we minimize we seek to reduce the significance of how we’re impacted. We turn the proverbial mountain into a mole hill. We act like things aren’t important – but only when we’re the one getting hurt. We’d find it cruel to do this to others.

Saying that it doesn’t matter is akin to saying that we– our needs, our feelings, our pain – don’t matter. This is beyond self limiting – it’s depressing.

We’ve all seen Cymbalta’s commercials and heard their tag line, “Depression hurts.” In the case of chronic pain it compounds an existing problem. Ultimately this creates a downward spiral and the truth is that once you’re in that spiral it’s very difficult to get out. They don’t make meds for having a lousy life and there’s no pill that makes it easy to break out of unhealthy patterns and coping.

Getting into the Solution

The solution is making every possible investment into our quality of life and advocating for the best possible treatments. Explore options and keep separating what you can change from what you can’t.

Western medicine has its limits. I encourage my clients to look into acupuncture, chiropractic, Reiki, Qigong, massage therapy, and other long standing forms of relief and treatment.

Then I encourage them to read Norman Cousins’ book The Anatomy of an Illness, Gilda Radner’s book, “It’s Always Something” and to watch Robin William’s movie, Patch Adams. Laughter really is good medicine.  It makes us feel alive and it provides release.

Spirituality is always key to me and I advocate it to others. I have found that pain and suffering are most often the catalysts for my growth. They lead me to greater awareness of what I choose to call God. They foster my choice of increasing connection to others and they can increase my empathy for others a hundred fold.  I give of myself and love more fully because I have know(n) pain and I wish to help provide relief to others. We who best give of ourselves are wounded healers.

I don’t ever want to invalidate. I’m never going to tell folks that I know how they feel because I don’t. I simply ask, given what you cannot change, what do you choose to invest your time and energy into today?  

Jim LaPierre

About Jim LaPierre

Jim LaPierre LCSW CCS is a Recovery Ally, mental health therapist and addictions counselor. He specializes in assisting people in recovery (whether from drugs, alcohol, trauma, depression, anxiety, or past abuse) overcome obstacles and improve their quality of life.