Pain perception

felix's picture

"a long period of chronic pain is is preferred to a significantly shorter period of mild discomfort with peaks of acute pain." 'Thinking, Fast and Slow' Daniel Kahneman, 2011 978 1 84614 055 6

What shorter string of words can sum up the behaviour of the heroin addict? TO go to work knowing each cent you earn will be spent not on accommodation, not on food, not on health, but on a temporal pushing back of the wall of pain that is withdrawal. I detoxed in 1993, and again in late 1994. Both times in clinical settings with minimal chemical intervention, that being the prevailing attitude of the times. The first time I had Lomotil for nausea, kaleen for diarrohea, clonidine (a blood pressure tablet) for anxiety and quinine for the twitching legs and arms.

I think the second time around I was granted a few mg of valium each day, nowhere near a dosage enough to alleviate even the thought of the pain.

These two events and the imprints they left on my young memory have led me to the following nearly twenty years of prolonged but milder pain that is heroin addiction. I stay in poverty and on the edge of the health/illness barrier in order to be able to purchase enough opiates to avoid a repeat of those two events.

Of course, a rational person at the outset of such an experience would always take the acute pain for a week over two decades of milder suffering. But this is not the human way. All we can do is to inhabit the very moment we inhabit, it is the only concrete point in life. Future is just speculation, and acute pain banishes speculation. How many have been mercy-killed on the battlefield by a comrade although their injuries are treatable? To sacrifice your entire future to avoid a few relative moments of pain seems obviously irrational, yet it is a choice made again and again.


sayarsan's picture

As a schoolboy I occasionally had a conversation debating the relative pros and cons re the cane vs. detention. Invariably the cane won unanimously, at least in high school. The stated reason was always; "the cane is quicker" often with the appendix; "and it doesn't really hurt”. When I went to school caning was always done on the finger tips, I was caned on the backside 1 x 6 and it was worse but still not a deterrent. In primary school especially it was often the routine of humiliation that was the punishment because you can tell when someone is putting their heart into punishing you and thankfully those primary school teachers who did were extremely rare by the '60's. The length of the sentence, the relative pain of the punishment, and the attendant humiliation. This is why primary teachers didn't need to inflict much pain because youngsters are not yet inoculated to pain and are much easier to humiliate.

Whatever the intensity pain can be tolerated and some can tolerate fantastic levels of what should be intolerable pain, and when it is too much I know of an analgesic that will make it bearable and the mind notices this immediately it is exposed to a sufficient dose. How often do we hear “you never know, until you try it, whether or not we will become addicted” I first heard it from my Mother and I believed it but not as much as I do now. Someone who fancies themselves as immune to pain has no need of an opiate and however much I liked heroin I was never drawn to it until I needed it. Opium,morphine and heroin several times were quite a casual affair until I was exposed to pain that I couldn't deal with and I was hooked. I could almost hear it happening in my head at the time -“shoot up!” Worked like a charm and probably averted an untimely death from misadventure but that is not an end to it. Elizabeth Kubler-Ross was the author of the book we used in nursing while learning about coping with pain, death, and loss in general. If you don't hit all the bases you never get off the field.

There is a saying I have heard it attributed to Alexander the Great and to Plato that “Opium can sooth the greatest grief and quench the greatest anger” and this is very appropriate to the source of a habit on opiates. With a distressed mind, especially one that is very angry it becomes almost inevitable that the person will get stuck in a process of resolution and never make it out. Like a scratched record, the person is playing along but as soon as they are dealt a blow of a particular nature or intensity and kathuk they revert straight back to “shoot up!” It happened to me that the death of a close friend triggered the reflex for a habit and quite possibly I would have grown out of it in time but a more acute dose of the same pain confirmed the behaviour. Unusual pain that i hadn't been exposed to before and i was not equipped. A few more over time and one has a tendency to give up and live with it by taking an opiate and before long the habit is quite self sustaining as one of the peaks of consumer existence. This can be tragic but not necessarily. The possibility of tragedy lies more in what the mind might decide as a better contingency than an indefinite period of addiction, deferred pain, followed by death. I still have a similar response when someone really close dies I find myself dealing with the familiar scenario from years ago. I no longer race off to score as much because of the methadone but at least I can approach the whole affair without abandoning all dignity.

While acute pain banishes speculation and problem solving in particular the relief afforded by an opiate is not a solution. Pain is the bodies signal to say “stop!” and we ignore it at our peril always. With a sufficient dose of opiates you can get very close to the pain but you can't solve the problem and left to it's own dynamic an opiate habit can unleash the most fabulous pieces of logic that can be truly dangerous. Once you have convinced yourself that opiates may have saved your life you are in deep shit. Trusting Jonesy is a no-no. He is never your friend and just because he alleviates the misery of ones worst moments doesn't make him a solution.

felix's picture

for many years I had myself convinced that opiates had saved my life, it's a damn fine justification for continued use, so it's good to read that it's a thought that crosses others' minds. It's wrong to use insidious when describing something that is purely chemical - surely the insidiousness exists in our reaction to the chemical - but Whether it is insidious, or the way we have evolved to co-exist with opiates, either way the rsulting relationship is insidious.
I will try to abandon my thoughts of seeing opiates as some saviour of my youth and see where that gets me.

sayarsan's picture

In this respect the popular wisdom that opiates are a bane for our youth, and our parents isn't so true. The detachment they afford allows a more dispassionate view of affairs and rash behaviour can be averted. Many parents of drug users, heroin at least are aware that an opiated version of their dissatisfied youngster is a more manageable, perhaps less reckless version of the unopiated version, far more so than a drunk one. The other thing is heroin can preserve youth by interfering with an ability to change, adapt and mature. The bigger the habit the truer this is. A rut that tolerates little deviation from the scoring routine is the happy fate of many heroin addicts who fail to negotiate this carefully. Historically, in the english speaking world at any rate, a lot of junkies got there through the medical profession where supply was safe and secure as was administration. One case was still practising in his 80's which can be taken to mean there was more than one who got through life without making waves. They would be in a nightmare if they woke up this morning. The hysteria which is heaped upon its use is terribly counterproductive, the laws amount to persecution, to wage war on it is quite mad.