The ultimate sacrifice

His book caught my attention in the first chapter when he related the story of his missionary family moving to a remote area of India where no one had ventured because of a deadly type of malaria. Sure enough, his father died relatively soon from it, but his mother spent the rest of her life there serving the medical needs of these people living in incredibly remote area. He went on to become an orthopedic hand surgeon and spent the first years of his practice in India dealing with patients with leprosy. You may know that they routinely develop severe grotesque deformities of their arms and legs. He would perform corrective surgery and kept meticulous records of his approaches both for learning and teaching.

Leprosy

Since the beginning of time, lepers have been treated as outcasts with their limb and facial deformities being nothing short of hideous. After it was figured out that that the leprosy bacteria was the reason for these problems, they still were not treated that well, but at least it wasn’t some type of evil humor or demon possession. Doctors felt that the bacterium directly attacked the tissues and caused the disfigurement.

Dr. Brand figured out that the deformities were not directly caused from the leprosy bacteria, but because the bacteria destroyed sensory nerves and they had lost protective sensation. Your pain system sends signals to the brain, which interprets them to indicate danger any time the limits of a structure or tissue are being challenged that could result in damage. For example, a morsel of food would fall into the cooking fire and the person would reach right into the coals to lift it out. If there was an injury to an ankle, normally you would rest in order to allow it to heal. These people would just keep walking and eventually the joint would disintegrate. A common descriptive term is, “a bag of bones.”

Diabetes

When he returned to the United States from India in the 60’s, he began to notice similarities between his patients with diabetic foot and leg breakdown and his observations of leprosy. There were poorly healing skin ulcerations, infections that would not heal easily, and joints were severely breaking down. Doctors felt that the elevated blood sugars were the cause of the problem. He quickly noted that it was the same problem that existed in lepers; the sensory nerves were being damaged and that they losing protective sensation. It was his pioneering work that led to more aggressive control of blood sugars, protective footwear, healing casts, and patient education to learn ways to protect themselves. He made a huge difference in many people’s lives.

 Congenital indifference to pain

He also described the problems that are created when people are born without a functioning pain system. It is a rare condition called, “congenital indifference to pain.” They have no way of programming their brain as to what might be dangerous or safe. They routinely exceed the limits of their tissues. They don’t even know how to avoid a hot stove. Their lifespan is only about 10-15 years and they die from repeated infections.

Dr. Brand, as a part of his work and research, was given a large government grant to develop a device that would warn people without protective sensation of danger. He devised a tight fitting body sensor suit that would send unpleasant warning signals to the brain when there was potential tissue damage. For example, if a person was using a wrench to tighten a bolt and was pulling too hard, they would receive an unpleasant electrical jolt. The problem was that the person didn’t want to be bothered and would just remove the glove and proceed to damage his or her joints.

The state of your central nervous system

After multiple attempts, everyone gave up. There has never been a solution for someone not having a protective pain system. The problem is that it is incredibly complex system that exists in a delicate balance. Additionally, the final perception of pain is determined by the state of your central nervous system as well as your prior experiences. For example, one night of poor sleep will significantly increase your pain the next day. (2) Consistent lack of sleep actually causes chronic low back pain. (3) Arguing with your spouse instantly increases pain. (4) Running into the bully at school may cause your stomach to churn. This list is infinite. Why would this be the case? Because pain is only pain because your brain says it is so. Your brain is analyzing about 20 million bits of information per second and is programmed to keep you safe and alive. The species of creatures who did not pay attention to environment cues did not survive. Pain is a major part of all of this and is a gift that allows you to safely navigate this planet.

The curse of chronic pain

Chronic pain is not a gift. For many reasons this intricate and balanced pain system is broken. It continues to fire away even when there is no danger. So, now you have a scenario where you are experiencing a sensation that is intended to be so unpleasant that it compels you to take protective action, but you cannot turn it off. It is like a car alarm that won’t turn off except it is incredibly more disruptive. It may be one of the worst experiences of the human existence.  Research has shown that living in chronic pain has a similar impact on a person’s life as experiencing terminal cancer. (5) The problem is that while suffering from chronic pain, you are not being told the nature of the problem, and where is the endpoint? You could argue that it is worse than having terminal cancer.

Fortunately, chronic pain is solvable by first understanding the nature of the problem and then learning approaches to bring the system back into balance. The DOC Journey represents the sequence of many patients who have broken out of the grip of pain. You first have to understand the nature of a problem before you can solve it.

The Journey also begins by embracing your disbelief. You have already tried everything that has been suggested, why would you try this process? Although a positive vision is necessary to move forward, this Journey is not about positive thinking. It is about becoming connected and engaged to what is right in front of you regardless of how pleasant or unpleasant it may be. Then you can move on.

Don’t let the gift of pain that has spun out of control take way from your gift of life. Treat yourself this Holiday by taking  your life back.

1. Yancey, P and Paul Brand. Pain: The Gift Nobody Wants. DIANE Publishing Company (1999).
2. Kahol K, et al. “Effect of fatigue on psychomotor and cognitive skills.” Am Jrn Surg (2008); 195: 195-204.
3. Agmon M and Galit Armon. “Increased insomnia symptoms predict the onset of back pain among employed adults.” PLOS One (2014); 9: 1-7.
4. Burns, JW, et al. Temporal associations between spouse criticism/ hostility and pain among patients with chronic pain: A within-couple daily diary study. Pain (2103); 154: 2715-2721.

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A functional pain system is critical to your health and even survival. He presented several stories of children born without a pain system. Their body quickly becomes deformed from over-stressing their joints and skin breakdown. The average lifespan of these children was only 15 years. I knew him when he moved to Seattle to be close to his family. He was over 90 years-old and still writing and lecturing all over the world. He was one of my true inspirations.

My Gift

I have slowly realized that I have been granted a similar gift that I did not want, nor would I accept it again if it were offered to me. It is the gift of prolonged severe suffering in the form of both physical and mental pain. I slipped into an anxiety-driven depression/ burnout in 1988, and developed symptom after symptom of the Neurophysiologic Disorder (NPD). At one point I was experiencing 16 of the over 30 symptoms outlined by Dr. Schubiner in his book, Unlearn Your Pain.

OCD

The worst part of the descent into oblivion began in 1995 when I developed a full-blown Obsessive Compulsive Disorder (OCD). I had always thought it was a loose term for some compulsive habits and felt it was some type of TV joke. It is the ultimate anxiety disorder manifested by intense, repetitive intrusive thoughts. They never stopped and became increasingly intense. By 2002 I was done and ready to check out. I will never completely understand why I survived. I have 18 medical colleagues that have committed suicide. Most recently it was one of my best friends in the spine surgery world and the other was an orthopedic surgeon acquaintance that I did some business with. Both had everything life that one could ask for.

While I was living in Sun Valley, six men between the ages of 45 – 60 committed suicide over a span of 18 months. All were extremely successful and prominent in the community. Why?

Anxiety

Raw anxiety is intolerable. It mental pain that I couldn’t escape. I cannot describe my suffering in words. My best metaphor is a “branding iron on my brain.”

I got extremely lucky in pulling out of it. In 2002 I began to heal and by 2004 began to thrive. The last five years have been the richest I could ever imagine. All of my NPD symptoms resolved, and flare only if I quit practicing the principles I have outlined in my book. So what are my gifts? This does not sound that convincing yet. They are many:

My Gifts

• Every day I am alive I can appreciate it at a depth I could not have imagined. It is a marked contrast to extreme suffering.

• I can look any patient in the eye and let them know that I understand your suffering. “You may be suffering as much as I suffered but not more.” I know where they might be going and where they are at as the come out of “The Abyss.”

• I understand the endless quest to find the one answer to the pain.
• I know loneliness.
• I did not have a shred of hope. NONE. Having the physical surroundings of success made it even worse in that I had worked so hard to attain them and I was still miserable. My efforts to find happiness had not worked. That included friends, family, and incredible experiences. I could not run from my mind. If none of that worked I developed a deep feeling of desperation of,  “What do I do next?”

• As I have learned to accept myself (the medical world is not an accepting culture), I can accept my patients wherever they are at. I know them better and it is one of the most enjoyable aspects of my practice.
• I have learned when I can help and when I cannot.

• I no longer let patients make surgical decisions when they are under extreme personal stress. In the past I never really was aware of the degree of their personal suffering in addition to the pain. The lines between mental and physical pain overlap.

• I saw patient a few months ago who came to me for a second opinion. She had seen a surgeon for correction of a spinal deformity. She did have the deformity and surgery would have been helpful. The problem was that she was scheduled for a 10-hour procedure just a week after meeting the surgeon for the first time. A month earlier her 34 year-old daughter had died of cancer.

Gratitude

The greatest gift has been gratitude. That was not a familiar word for me until a few years ago. I was charging full steam ahead just doing the best job I could. I am grateful that I am able to share the tools I learned coming out of my burnout and witnessing so many patients experiencing the same success.

I am a surgeon and do not understand all of the reasons why the dramatic turnarounds occur with such regularity. I am not a neuroscientist. But it is a completely unexpected phase of my career and is incredibly rewarding.

The post The Gift of Pain – Thanksgiving 2013 first appeared on Back in Control.

The post The Gift of Pain – Thanksgiving 2013 appeared first on Back in Control.