Wednesday, June 19, 2013

Afflixerim Ergo Sum: Pain and Perception

"Cogito ergo sum: I think, therefore I am."

Descartes used this phrase when discussing his epistemology. Simply put, epistemology is the study of knowledge. Descartes was concerned with how much the human mind was actually capable of knowing. He was concerned that the mind is capable of being deceived, like it is when we're dreaming. He became convinced that there was no way of knowing whether any of our perceptions exist external to ourselves, and that ultimately the only thing a person can know irrefutably is that they exist (since there's no way to think that we don't exist, since something must be doing the thinking in the first place.) From here, Descartes posits that we know that we have perceptual experiences. We don't know the cause for these perceptual experiences (i.e. if an actual computer exists outside of you, of if you're just dreaming it up in your head) but we can't refute the fact that we experience something. So for Descartes, we're only capable of knowing two things: that we exist, and that we perceive. We're absolutely incapable of knowing anything beyond these two irrefutable facts.*

 Thinking about pain within the Cartesian perspective helps take a lot of weight off my shoulders. When you understand that your perception doesn't necessarily mirror anything "in the real world" you can begin to accept your body as you feel it. As someone who has struggled for years to get a diagnosis-- I have blood-work which repeatedly shows up clear of inflammatory markers and yet have autoimmune arthritis which plagues me with pain and deformity-- it helps to understand that the act of diagnosis is intrinsically devoid of logic or merit. Whether something shows up on a piece of paper or not, the only things which I can be sure of are the things I experience: joint pain.

Afflixerim ergo sum: I hurt, therefore I am.

I've talked in the past about how to communicate with others about your pain, but it's equally important that you have internal dialogue about how your pain interacts with your perceptions and your life. Pain has a multifaceted influence on your views of the world; the way you look at a sunset, your perspectives on political issues, your viewpoint on your family. While we shouldn't feel guilty or ashamed of these interactions, understanding when and where they occur can help us frame them differently in the future. After spending the last couple weeks with pain that was MUCH higher than normal due to an injury, I've thought of several questions the chronic pain patient should ask themselves about how their perception of pain influences their life.

•Has your pain changed your outlook on life? More realistically, this question should be, "How has pain changed your outlook on life?" It's inevitable. These changes can be both positive and negative. Maybe you always used to be a cup-half-full kind of person, but find yourself looking at things in a more negative light now. Maybe you find yourself more appreciative of the small things in life now, like a nice cup of tea with a friend. 
•Who do you see less now that you're in pain? Who do you see more? Why do you think that is? Pain changes relationships. It's not anybody's fault, it just happens. Recognize which people have stepped up and become more supportive, and who has fallen by the wayside. If there are relationships with people you'd like to rekindle, try to recognize why they may have deteriorated in the first place. It's a hard conversation to have with yourself, but so necessary.
•What have you learned from being in pain? I'm a firm believer that each experience we have teaches us something. Pain is no exception. Pain has taught me that I'm capable of surviving much worse than I ever would have thought possible. What has it taught you?

•When do you decide to push yourself despite the pain? When do you know it's time to rest? When dealing with chronic pain, you realize that life must go on. There are days when you have no idea how you're going to make it out of bed, and yet still manage to get yourself to that appointment, feed the kids and gas up the car. Try to identify what it is that drives you on those days, what makes those days different. Oftentimes, it's the urgency-- you can't just skip a Dr's appointment-- and it's okay if the answer is caffeine/adrenaline. It's also important to recognize that pushing yourself isn't always a good answer; it can decrease your actual efficiency and make you feel freakin' rotten. Understand when your body is telling you to rest; try and notice the signs that you're pushing yourself too far.

•Where can you go that helps lessen your pain? Distractions help lessen pain. What places distract you with their beauty, curiosity, or absurdity? Sensory distractions like soft blankets, relaxing music, and scented candles/incense help you experience things other than pain. Find what works for you.

*(Later in his writing, Descartes comes up with a cockamamie idea that we can eventually justify other sensations through the existence of a supremely powerful god... there we diverge in beliefs.) 

Sunday, June 2, 2013

When Side Effects Make You Crazy (Here's How To Cope)

Chronic illness equates to the use of lots of different types of medication. Try as we might to avoid them, use of prescription medication is often inevitable if we wish to preserve functioning. One of the major downfalls of prescription medication are the side effects; one glance at the sheet attached to any prescription shows innumerable complications. Most of them won't effect you, but some will.

Some of the most troubling side effects of medications are side effects which change your psychological state. Common drugs for chronic pain like prednisone, pain medication, and GABA-receptor medications all come with a slew of mental side effects, including personality change, depression, and confusion. While side effects which manifest physically can be presented efficiently to a doctor, mental changes are less clear-cut and can be missed/ignored by doctors. Physical side effects can be mitigated with complementary treatments, but doctors are often more hesitant to prescribe therapies to help mental changes. Even worse, changes to your mental state touch literally all aspects of your life; there's no way to get out of your head. Of course, the first thing to do when you experience troubling psychological side effects from a medication is to call your doctor, who can make professional assessments and alter your medication if necessary. However, if you're told to just wait them out, here are some tips for not losing your mind.

1. Journal your emotional changes. Journaling has been proven to be an extremely useful coping mechanism when dealing with stress, but the benefit here is two-fold; journals also help show if your side-effects are easing up with time (or getting worse.) Make sure to record any out-of-the ordinary feelings you're experiencing, and try to quantify how strongly you're feeling, and note if there were events which triggered the change. 

2. Post-It© everything! Confusion is a huge aspect of psych. side-effects, and if you don't get control, it can ruin your life. Things like forgetting to take medication or forgetting to take dinner out of the oven can pose a serious threat to your health. For me, the GABA-receptor drugs (gabapentin and pregabalin, specifically) make me feel 6-drinks-in hammered, and consequently just as forgetful as an alcoholic. To help mitigate the confusion and forgetfulness, plastering brightly colored sticky-notes on everything helped me keep refreshing my mind. Notes showed when I'd taken my medication, which step I was on in my homework, where I'd put my cane... The bright colors really attract the eye and help highlight the important things you're doing.

3. Make sure others know what's happening. It's easy to hide when you're feeling not-yourself, but it's one of the worst times to withdraw. Letting other people know about your side-effects can have a huge protective effect: your loved ones can help look out for you, help you see changes in your personality you might miss just by self-evaluation, and help you explain your side-effects to a doctor if it becomes necessary. Similarly, letting them know about your side effects as a prophylactic effect on your relationships: everyone knows that any out-of-the-ordinary responses from you are not your fault, and remove your moral blameworthiness. I know that when I'm on prednisone, one major side effect I get is aggression, so letting those around me know beforehand that I'm going to snap helps them forgive me.

4. Cultivate some zen. The environment you put yourself in has a tremendous effect on your mental environment, so be sure to use your surroundings to your advantage. If you're dealing with "positive" psychological effects like aggression or anxiety, being in a calming surrounding with low lights and soft music can help. "Negative" psychological effects like tiredness and confusion can be remedied somewhat by maintaining adequate lighting, surrounding yourself with color, and keeping your space very tide. Music is great to help instantly make a place more zen when you can't be bothered rearranging anything else.

5. Don't blame yourself. Maybe this goes without saying, but the emotions you feel as a result of medication are not your fault, and you're not responsible. The only thing you can control are your physical responses to the mental state. It's easy to feel like a crummy person when you're snapping at your loved ones, forgetful, or depressed, but these things are beyond your control, and they will pass. Take lots of deep breaths, and learn to forgive yourself. You can get through this.

6. Talk to someone, and know when things have become an emergency. A lot of medications have warnings about increased suicide risk, and this is a very real, deadly concern. It's important that you have someone to talk to about any feelings you might be having, but particularly about any suicidal ideation. Your doctor or a therapist are great people to have conversations about your mental health with, so is a responsible loved one or your patient advocate.  If you need someone to speak to immediately, call 911. Alternately, here's an international list of suicide-hotlines. If you're feeling like killing yourself, or if any of your psychological side-effects are life-threatening, please get help.