What is pain?

Given the title of this here blog, I reckon I've been remiss in failing to explore this topic in much detail. The reason, I suppose, is that by the time I created this blog I had been in more or less constant pain for 13 years. Constant pain, in my experience at least, entails a complete alteration of reality, to the point where pain becomes something like a fifth limb: it's always there, you can't do anything about it, and if it weren't there you don't know exactly what you'd do.

That's right -- I honestly don't know what I'd do with myself if I woke up one day without pain. One possibility is I would assume I was dead and had gone to heaven, or whatever place you go when you die. Or I'd gone to hell, and this was some dirty trick, and the pain would return at any time. But the hope that I will ever be without pain again has long since passed. I've tried every drug there is, several times in fact. My first encounter with serious opiates began about 12 years ago, under what turned out to be the reckless auspices of a Dr. Stein.

He started me out on Oxycontin, a drug I'd never heard of at the time (this was 2001), but which would soon become vilified in the press as "hillbilly heroin" after a number of Appalachian addicts overdosed on the stuff. To that he added Dilaudid, a short-acting form of morphine. This combination proved only moderately effective, and had several decidedly unpleasant side effects. One, which is universal among opiate users, is constipation. This may strike the reader as a minor, even amusing, inconvenience; let me assure you that when you haven't moved your bowels in a week, all humor gives way to discomfort, then concern, and finally outright desperation. The other side effect was far worse, however. I awoke in the middle of the night gasping for air. It's impossible to know for certain, but I believe I had been in respiratory arrest for a significant duration. (This is another classic effect of narcotic use, and in fact respiratory arrest is the definition of overdosing.) It took me a long while to fully catch my breath and walk around rubber-legged. I was afraid to fall back asleep for fear of ever waking up again.

Not long after this episode I resolved to tell Dr. Stein that I wanted off the narcotics altogether. At one point I was taking 240mg of Oxycontin and 48mg Dilaudid per day, and the pain still was winning. Worse, the side effects were not only affecting my life, they were threatening to end it. My wife, curiously, was adamantly opposed. She said that I was a mean bastard before I went on the pain meds. On them, I was at least under control. I could see her point -- my behavior following the accident was nothing to be proud of -- but I couldn't see living the rest of my life under these conditions. So we all (including my wife and two daughters) went in to see Dr. Stein. He informed us that he had become involved in a federal investigation involving Oxycontin and was closing his practice. So my decision was moot, I was off the narcotics whether I liked it or not. Six months later Dr. Stein was on the front page of the Washington Post. Several former clients had died from Oxycontin use, among other lurid charges. He was a nice guy to me, but you never know about people.

Because of my association with Stein, I would be many years before a doctor would prescribe anything stronger than Percoset for me. But that's another story for another day, because I'm getting tired now.