A Pained Life: Stop Torturing Us

By Carol Levy

For many chronic pain conditions, such as Complex Regional Pain Syndrome, trigeminal neuralgia and Ehlers Danlos Syndrome, a major aspect is the spontaneity of pain attacks. They can come at any time and without warning.

Not being able to anticipate a pain flare may sound familiar to you. It causes psychological stress, keeping you in a constant state of fear and anxiety. The lack of predictability deprives a person of any sense of normalcy or control over their situation, causing helplessness and despair.

That often leads to other health problems and interrupts the sleep cycle, causing fatigue, disorientation and even cognitive decline. 

Where did this description of chronic pain come from?

It is actually a description (with some word modification) of torture and how disruptive it can be to a person. It’s striking how similar chronic pain and torture can be.

Having chronic pain is torture to me in an abstract way: I have pain. I can't find a way to stop it. I suffer as a result.

Like pain, torture is worse when it arrives unexpectedly and you have no way to stop it. You may be feeling okay, when suddenly a blitzkrieg of pain invades. You have no control or defense, and have no choice but to wait it out, cowering under the covers waiting for it to pass.

The Center for Victims of Torture writes this about using unpredictability as a torture technique:

“Randomizing torture makes it even more psychologically damaging and ethically problematic, as it deprives the victim of any control or predictability.”

Too often doctors miss the ethical implications of the effect of the pain on us, much less when one aspect of it is the unpredictability. The need for them to understand it is a necessary component of taking care of us and our needs --- what a physician, in the truest sense of the word, should do.

Too many of them, even those who claim “pain management” as their specialty, seem to get tired of listening as we explain the various ways our pain manifests. Most pain conditions don’t have a nice clean orderly way of detail.

It can be torturous to deal with the medical profession and its reluctance to accept our stories about living with chronic pain. It is harder still when a patient has the additional spontaneity of pain, being repeatedly physically and psychologically bombarded by it, and their defenses on the verge of being destroyed.

Doctors don’t seem to be able to understand this on their own. We may come to them psychologically tattered because of the pain. Those of us with spontaneous pain may come to them appearing very emotionally fragile.

As hard as it is, as difficult our lives already are due to the pain, we may have to be the ones to teach them, to help them to understand why we are so torn and battered. At the end of the day we need to tell them: “Please, listen to me. Understand me. Please, don’t be another level of torture.”

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here. 

Are Chronic Pain Patients Being Tortured?

By Carol Levy, PNN Columnist

“This is how you do torture. Just reduce their tolerance level so low, all you have to do is touch them.”

That’s what an ophthalmologist said to a medical resident as he examined my eye, triggering my trigeminal neuralgia pain.

“They burned my fingers. All they wanted was information. I would have told them anything just to stop the pain.” That’s from an episode of Law & Order.

I haven't tested my theory, but I imagine if you asked a healthy person if chronic pain was akin to torture, the answer would be a resounding, “No. Of course not.”

Torture is defined by Merriam Webster this way: 

“The infliction of intense pain (as from burning, crushing, or wounding) to punish, coerce, or afford sadistic pleasure. Something that causes agony or pain; anguish of body or mind.”

Definitionally, chronic pain patients are not being tortured, because the pain is not being inflicted as punishment, coercion or sadistically. On the other hand, we are definitely being tortured because pain does indeed cause us agony and anguish.

The injunction against torture is spelled out in the Geneva Convention and other international laws when engaging in war, but not when the war is within our own bodies.

The U.S. Congress has twice tried to deal with pain. In 2000, the Pain Relief Promotion Act was introduced. The naming of the bill sounds good, but some of its provisions are Orwellian. It called for a criminal penalties against physicians of up to 20 years in jail and revocation of their DEA license if they knowingly prescribed a controlled substance used in assisted suicide. Some physicians were concerned the bill could lead to charges if they prescribed opioids to patients who overdosed, intentionally or not.

In 2005, the Conquering Pain Act was introduced. It called for federal health officials to develop an “evidence-based practice guidelines for pain treatment” to address “the public health crisis of pain.” 

Neither Act was approved. But many of the things they called for have come to pass.  

Many have posited that under the 1990 Americans with Disabilities Act (ADA), pain patients have a right to opioids and other treatments. That unfortunately is not the case. Under the ADA, disabled people who are prescribed opioids cannot be discriminated against in employment and access to public facilities. However, the ADA does not address the prescribing decisions of doctors.

More recently, the U.S. Supreme Court ruled 9–0 in favor of two doctors who were convicted of acting as drug dealers by “overprescribing” opioids. The decision gives physicians charged with illegally prescribing opioids a fighting chance in court, because it requires prosecutors to prove that they had criminal intent. 

Where does this leave us? Will it change the legal landscape for doctors and patients? Will physicians who prescribe opioids based on their patients’ symptoms, diagnoses and suffering be less fearful? That is yet to be seen. 

Change takes time and one court ruling does not seem like much. But maybe we can look at it as a sliver of light, an opening that we can use to shine a brighter light onto us and our needs. 

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.