A Descent into the Abyss of Chronic Pain
After I was suddenly enveloped by chronic pain, my life went dark
Posted June 27, 2021 | Reviewed by Hara Estroff Marano
- There are many possible physical and mental symptoms when you are in sustained flight-or-fight physiology.
- At one point, I was experiencing 17 of them. No one could tell me what was happening.
- The mental pain was the worst part of the ordeal.
- Loss of hope creates an inflammatory response and physically increases pain. It is much different than the gift of acute pain.
I was driving across a bridge late one night, when my heart suddenly began to pound at a furious pace. I couldn’t breathe. I was sweaty, light-headed, and I thought I was dying from a heart attack. I was only 37 years old. This was the first of many panic attacks I would have over the next two years. In one minute, I went from being a fearless spine surgeon to experiencing relentless, progressive anxiety. I wouldn’t emerge from this spiral into hell for 13 years. What happened and why so suddenly?
Chronic pain has multiple manifestations. Each person has a different experience and must find their own way out. But contrary to common perception, chronic pain is a solvable problem. I am one of the success stories.
My first migraine happened on the 4th of July. I was five and excited because the local fireworks were being set off in the town commons, directly across the street from our house. But as the sun set, my head began to throb and by 10 o’clock I felt like I was being hit with a sledgehammer. The fireworks less than 100 yards away weren’t helpful.
This was the first of 17 symptoms of a stressed nervous system I developed over the next 50 years. My suffering included tinnitus, burning feet, prolonged tendonitis, insomnia, anxiety, obsessive compulsive disorder (OCD), major depression, migratory skin rashes, crushing chest pain, sweats, PTSD, back and neck pain, heart palpitations, light-headedness, and tension headaches. At my lowest point, these were all occurring simultaneously.
The “perfect” family
My father was a family doctor in a small, New England town. He was highly respected and appreciated. My mother was active in many local activities. I was the oldest of four children, with two brothers and a sister. People would often comment on our “beautiful family.” We were—from the outside.
Inside our house, my mother was in an intense rage most of the time. She was physically and verbally abusive to me and my three younger siblings. My father wasn’t around much, and he didn’t comprehend the full extent of the situation. Since this was all we knew, we thought this was what life was supposed to be like.
Interestingly, one of the few things that would cut my mother's anger short was one of my migraines. She would instantly become a loving and nurturing mother, placing cold compresses on my forehead and keeping everyone quiet.
My new identity
When I entered high school, I felt a deep shift. I was increasingly aware that my family life was not ideal, and I decided that I had had enough. I “shut the door” on my past
Although I still lived at home, I mentally separated from the chaos. I embarked on a quest to create a new identity. I became an excellent student, trumpet player, hard worker, leader, and athlete. During my junior year in college, I took 18 to 21 hours of credit every quarter, worked construction 10-20 hours a week, played sports, had an active social life, ran for student body president, and pulled off a 4.0 GPA. I was having the time of my life. I wasn’t sleeping much.
I continued to graduate from medical school with honors and was accepted in a competitive orthopedic residency in Hawaii. With a great wife, a home in Hawaii, and a promising career, I thought I had it made. I was unaware that I was keeping busy to outrun my past and I had also become a master at suppressing unpleasant emotions.
I completed two years of internal medicine residency before I entered surgical training in Hawaii. Most orthopedic residents undergo a couple of years of general surgery residency before specializing and are comfortable in the operating room. I had never made a skin incision or even knew how to tie a knot. However, handling stress was such a core part my existence, I did not feel it. I was wrapped up in my identity of being “cool under pressure.”
I noticed that my feet burned while I was jogging, which I thought was due to the warm, Hawaiian pavement. My migraines were more frequent, and I had a reccurrence of warts over both of my hands. One afternoon, while in a weekly orthopedic conference, I noticed some vivid, intrusive thoughts entering my mind. I didn’t think too much about it, but I felt a bit unsettled. Still, I was on top of the world, enjoying my family, learning, and living in a paradise.
The wheels started to come off during my post-residency spine fellowship at one of the top programs in the world. It was not as physically demanding as the rest of my residency, but the expectations were extremely high. My migraines were occurring every other week, my ears started to ring, while my feet continued to burn. I pushed through it all.
My iron-man identity continued to evolve. It seemed that I could handle an unlimited amount of stress. It was my badge of honor. The obstacles I encountered in private practice dwarfed any prior challenges in my training. I recall sitting at my desk one night after working yet another 14-hour day. A patient had developed a serious postoperative wound infection. Another one had gotten into a fight with a security guard. I discovered I wasn’t getting a paycheck that month because of the high office overhead. My mindset was "Bring it on.”
A few weeks later, I crashed with the panic attack.
It was only the beginning
Little did I know how severe these symptoms would become and how many more would occur. Skin rashes popped up and disappeared all over my body, my scalp itched, my nightmares became more intense, I had deep aching pains in my upper back, and intermittent crushing chest pain.
There were other terrible aspects of my ordeal. I am a social person and since I didn’t feel great, I quit spending as much time with my friends. The loneliness was crushing. No marriage could have survived all these untreated symptoms because I was often not in a great mood. I worked at hiding it from almost everyone.
As my family disintegrated, I descended into a full-blown obsessive-compulsive disorder (OCD). I had the internal version, which is experiencing vivid intrusive thoughts, which I would then try to counter with “good” thoughts. I was in an endless, unwinnable battle and my thoughts progressed to disturbing impulses. There were many other symptoms, and I was in bad shape.
I then made the mistake of reviewing some articles on OCD and discovered that the prognosis was (and still is) poor. The best outcome would be to somehow manage or diminish the symptoms with medications or behavioral therapy. I became totally despondent. There was no escape, and I sunk into a major suicidal depression. Still, no one could explain to me what was going on or how to solve it
Penetrating the facade
I now understand that major life changes, especially around family dynamics, create more stress and symptoms. The stresses can be positive or negative. The problem with major family events is that they penetrate the façade, and I had been working on mine for decades. A major shift in my symptoms occurred with the birth of my son. My divorce was disastrous. The burning in my feet increased to the point where they felt like they were in a toaster oven. The pain was intolerable, I couldn’t sleep, all my other symptoms worsened, and the unrelenting anxiety continued to be one of the worst parts of my ordeal.
I pursued many self-help books, took medications, saw other physicians, underwent multiple diagnostic tests, and aggressively pursued psychotherapy and counseling. I was both open to anything and desperate.
I would have thought that meeting my current wife would have been the answer to my suffering. We had an instant connection and I fell in love—except it felt like I was falling off a cliff. I lost more control. When I mustered up the courage to tell her that I was in love with her, she thought I was going to tell her that I had terminal cancer. My suffering dramatically worsened, and I was beginning to seriously give up. No avenue of treatment was working. I had no hope.
During my prolonged suffering, almost everything I tried failed, and when I experienced the faintest glimpse of a way out, I kept building on it, step-by-step. Not only I am I doing well, but I am thriving. It is my privilege to share my collected strategies with you and be a witness to your healing journey.
The physical and mental symptoms of the chronic pain experience are bad enough, but repeated disappointments drive them deeper. Research shows that loss of hope is inflammatory—and physically increases pain.1 Nevertheless, chronic pain is a solvable problem.
Questions to consider
1. Dr. Howard Schubiner2 has compiled a list of 33 symptoms. How many of them have you had or are currently experiencing?
2. It is critical to understand that stress is a physiological issue creating many mental and physical reactions in your body.
3. Most people who are interested in the course I developed out of my own professional and personal experience (Back in Control) have essentially given up. Allow yourself to be with this feeling for a while. You don’t have to generate hope. It will emerge as you can allow it to.
1. Dantzer R, et a. Resilience and immunity. Brain Behav Immun (2018); 74:28-42. doi: 10.1016/j.bbi.2018.08.010.
2. Schubiner H, and Michael Betzold. Unlearn Your Pain, 3rd edition. Mind Body Publishing, Pleasant Ridge, MI, 2016.