September 4, 1998 (Ira Pilgrim)


We must all die. But that I can save him from days of torture, that is what I feel as my great and ever new privilege. Pain is a more terrible lord of mankind than even death himself.

Albert Schweitzer (1875-1965)

I am the world's authority on "pain." I know more about it than anyone else. Whose pain? Why my own, of course. What do I know about your pain or anyone else's pain? Little or nothing. Does that mean that I know more about my own pain than my doctor, or a pain specialist does? Yes! And I learned it by the only method possible: experience. To get an inkling about how much something is hurting me, my doctor may ask me to describe my pain on a scale of one to ten, with ten being the most pain that I have ever experienced. But she can never know how I feel, nor can words even begin to describe the sensation of severe pain.

I am no stranger to pain. In my forties I had an explosion fracture of my left ankle. Seven years ago, I had major surgery. But nothing prepared me for what I experienced this year. It started when I lifted a heavy object and was off balance. I felt a slight twinge on my right side. That evening I was in agony. The medical books refer to it as "writhing pain." The severe pain lasted for more than a month and some pain persisted for two more months. My worse pain, the fracture, became a mere five on the pain scale, as against this pain which was now my reference ten. Perhaps it is that the fracture was just as bad, but I have forgotten it. What made this pain worse than any other pain that I had ever had was that it was there almost all of the time. It didn't, like the spasm of a backache, hit like a sharp spear when I move a certain way. I can control an ordinary backache by lying still. This new pain was there all of the time. It disappeared only when I slept, which wasn't for very long. After an hour or so, I would wake up in agony. The only thing that seemed to help somewhat was concentrating on something such as a computer game, or a self hypnosis technique which focuses my attention on something besides the pain. I felt better sitting up.

Narcotics(opioids) can relieve the acute pain. They take about 45 minutes to kick in, and then there is that feeling of blessed relief, which lasts for a few hours. The pain is still there but it doesn't seem to hurt. Is this what it is like for everyone? I have no idea.

The problem with taking narcotics for a period of time are the side effects. They are constipating. For someone used to defecating once or twice a day, going without a bowel movement for a week is, to say the least, disconcerting.

When you stop taking narcotics, there is the withdrawal. It seems as if the more you take and the longer you take it the worse the withdrawal is. For me, the withdrawal was indescribable agony for days; almost worse than the pain that the narcotic was supposed to relieve. I can't describe it because I don't remember the feeling; just that it was awful. It took a giant effort of will to keep from popping that tiny pill. Is this what it is like for everyone? I have no idea.

Many years ago, they had a narcotics treatment center at a federal prison. They would put the patient (or prisoner) in a cell and let him undergo his private hell, just making sure that he stayed alive. The methods now used are more humane, but the private hell of the addict is still hell. For me, it was hellish enough so that I think that I would not allow myself to get addicted again unless I was fairly sure that I had a very short time to live. That is, that I would die before I had to undergo withdrawal. Still, given the same excruciating pain, I would probably do the same thing. The hell of the pain is so great, that I would do anything to relieve it. I thought, at the time, that death was preferable to the pain and that, had it continued, I would consider suicide.

Next column

Return to the Medicine Home Page

Return to Ira's Home Page