Who was I?

One of the patient participants I’ve had the pleasure of meeting as part of my PhD project was telling me about her life, and how chronic pain had impacted it. She never wanted to take time off work and refused sick-leave on multiple occasions, but eventually the constant pain she was faced with became unbearable and she spiralled into a burnout with depression and was away from work for years. She found it hard to believe that her younger self couldn’t come to terms with a few weeks of sick-leave during bad periods. Indeed, she now believed that she probably could’ve prevented the burnout had she been more accepting of the signals her body was giving her. Eventually, she would bounce back and be able to finish her career at the work place.

“I gave them my all, and while I was still working people turned to me for help and advice. Then I got retired. Now that person is unknown to everyone and frankly, also to me. Who was I? Indeed, that is a good question. And if I was someone back then, then who am I now?”

This conversation gave me much food for thought. We experience our lives differently depending on circumstance, of course, and sometimes we cannot properly assess the impact one decision might have on our trajectory. The patient quite often comes to the doctor with longstanding problems to which he/she wants a quick solution. The solutions they themselves have in mind are often of the short-term character, and I think it is the job of the doctor not to be allured by short-term gains that cannibalise on long-term outcomes. We need to be able to zoom out to see the whole picture, and give the patient the tools needed for them to see that as well. Only then can we truly help our patients.

Chronic pain is a relentless companion. It pokes at your attention all the time, and the warning system that acute pain comprises becomes difficult to interpret when you suffer from chronic pain. Oftentimes, it is also accompanied by sleep problems and fatigue, making everyday life even more complicated. If abuse of alcohol, drugs or narcotics is present, we are in a very tricky position. Then, the only path forward is to break down each symptom, consider its impact on daily life and stay aligned with the aims the patient sets up for him- or herself regarding their recovery or, at the very least, functional improvement.

Not only does pain complicate our everyday life, it also shifts the immune tonus of the central nervous system into a mode that seems to be more about symptom relief and learning about the symptoms, rather than contributing to an increased symptomatology.

This predicament, and the fact that chronic pain afflicts as many as 20-30% of the population, led me to pain medicine. Trying to understand the physiological mechanisms linking immune system alterations, neurobiology and experienced symptoms is what made me stay.