I was going to start this article with some stats that would show you just how bad chronic pain and the opioid epidemic has gotten. Stats like one hundred million Americans and 1.5 billion in the world at-large suffer from chronic pain. Or in 2016, 11.5 million people in the U.S. misused prescription opioids and over 42,000 died of an overdose (see what I did there?).
But our brains struggle to make much meaning out of such large numbers. So I’ll tell a brief story about one of my clients. Mr. R has had unrelenting back pain for 18 years since he was involved in a car accident. Multiple surgeries, implanted neural stimulation devices, and numerous physical therapists and chiropractors haven’t fixed his pain. In fact, he feels it has gotten worse.
So he started using pain medication, OxyContin, upon the insistence of his physician. [So ingrained are the use of opioids in our culture that when I typed oxycontin into Word, spell-check changed it to the brand-name spelling!] Within one year of taking this medication he was out of work, feels disconnected from his young children, and struggles to juggle his responsibilities because he has trouble remembering what he’s supposed to be doing. He doesn’t know where his body is in space, feels unable to relax. And his pain? It continued to worsen.
Most people, like Mr. R., are taking these potent medications with the hopes that it will reduce their pain and make life more livable. But I think that our society’s predilection for prescribing, and taking, opioids speaks to a deeper truth: the pain of unmet needs.
Pain is about the body-brain’s perception of danger — the threat of damage. Literature is showing unequivocally that pain is not an accurate indicator of tissue damage or severity. Defined as an unpleasant conscious experience that has evolved to evoke a protective response, pain is more an indicator of threat than it is of damage. We protect that which is in danger, and pain is a particularly strong signal that grabs our attention and encourages protection. The longer pain persists, the less likely it is that the pain is related to any problem in the tissue.
Taking opioids may temporarily reduce the perception of pain, but like all quick fixes, the price of maintaining their benefits goes up. The brain becomes more sensitive to danger signals because of its plastic nature, requiring more drugs to fulfill the same painkilling function (opioid-induced hyperalgesia or OIH).
If there is actual tissue damage, opioids and other pain medications do not address the damage, only deaden our perception of it. And often, the undesirable side effects only create more discomfort like constipation — for which pharmaceutical companies are now marketing a separate class of drugs (opioid-induced constipation). So opioids will never make pain “go away” and very often they just make it worse.
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So all this begets the question: if more people than ever have chronic pain and more people than ever are taking prescription pain medication, why aren’t people getting better?
To answer this, we must come back to why pain is produced in the first place: the perception of threat. Perhaps I’ve been remiss in not describing accurately what a threat is. A threat is something — a person, physical, or mental event — likely to cause damage or danger. Notice I said likely not guaranteed. Certainly the threat of danger to the body, such as infection, muscle or joint damage could elicit pain in a person.
However, that is much less common than you may think:
For example, two-thirds of the population has structural abnormalities in their knees and no pain (Beattie et al. 2005); 52% of people with no low back pain have at least 1 bulging disc on MRI (Jensen et al. 1994); and over 90% of people have “degenerative changes” in their neck and experience no pain.
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But what about basic human needs that are not being met? Is their absence not also a threat to the self and therefore pain-inducing? If a basic human need is unmet, we feel threatened.
And there is a multiplicity of needs missing in modern life: the need to love and be loved; the need for parental attunement during infancy and childhood; genuine human connection without judgment. The need to feel safe in one’s own body; a connection to one’s own intuition; a deep relationship with nature; doing meaningful work (is it any wonder that a strong predictor of the development of chronic back pain is whether someone likes his or her job?). The need to do nothing and just be and it’s corollary: the need for deep relaxation. The need to express one’s talents and gifts. The need to move, create, play, and explore.
The presence of these factors in one’s life creates a sense of true security, which is the antidote to the chronic pain from which our society suffers.
The body is a portal thru which we experience the world, if a need is unmet whether physical, social, or emotional, why wouldn’t the body-brain alert us by means of pain? In other words not meeting your basic needs hurts, quite literally.
Conventional medicine propagates the belief that pain can be fixed by external means, and perhaps it can in a few instances (I think of the instance where removing a painful tumor can eliminate the irritant. Of course, I then wonder why the tumor grew in the first place). But opioids and other pain medications will never meet the underlying need for security. Instead of looking outwards for another fix for the pain and dis-ease of modern life, pain is a clarion call for internal attention. Meeting a need feels good, providing for the basic security we all crave but rarely receive.
So perhaps the opioid epidemic is truly just an epidemic of unmet needs.
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Thru this view of threat, insecurity, and unmet needs we see just how archaic are our methods of “treating” pain and the resultant opioid epidemic. In fact, how chronic pain is treated speaks to the collective desire we have to “make” discomfort to go away at the expense of understanding how we can meet our own needs. In the haste to eliminate pain, physicians, healthcare providers, and society at large have betrayed our ability to restore security. And in doing so, we prolong our pain. I have had more patients eliminate pain, get off medications, and restore goodness in their life by helping them to attune to themselves and their needs than by any combination of medication, surgery, or singular exercise technique.
Hopefully it’s becoming clear that the use of opioids will never fix pain, and while they may subdue it, this comes at the cost of our awareness and attunement.
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So how do we get thru this? Well, truly, this epidemic calls for a seismic shift in how society handles such situations. The epidemic, under the guise of opioids, is really an epidemic of trauma and unmet human needs.
Do we really need a research study to tell us that real, human connection is a good thing? Or that developmental trauma can set you up for a lifetime of hypersensitivity and insecurity — the two fundamental precursors to chronic pain? [I look forward to the day when those prescribing opioids hand out an Adverse Childhood Experiences survey first]
Will more advanced medical imaging and surgical procedures reduce threat or just serve to distance you further from your body? Will putting people in jail or using force thru methods of judgment, labeling, and ostracizing really “fix” the problem? Thru the lens of insecurity, it becomes clear these actually deepen the threats and prolong pain and suffering.
What if, in order for someone to heal from feeling chronically threatened and painful, they learned the fundamental capacity to feel safe and comfortable in their own body? If we do not understand and become aware of our individual needs, we will replace one addiction with another and the pain will spread.
We must learn to tune in to sensations, the “good” and the “bad”, and allow ourselves to experience pain for the meanings it provides. We need to understand our intuitions and meet our needs, thru the process of self-regulation and awareness.
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So what did Mr. R and I do in our work together? He learned how to feel safe and relaxed in his body which allowed him to rediscover his own intuition and his bodily sense of connection to the world. This enabled him to restore and expand his awareness to his needs, which largely centered around movement and connecting with his kids. The OxyContin was no longer necessary.
Only by attuning deeply into our own needs and learning how to quiet the body and mind, can we solve the chronic pain and opioid epidemic.