'I had lived with pain for so long that it nearly defines you'
Changes in our understanding of how to treat chronic pain mean that people do not need to suffer in silence any longer and often finding the right treatment or even activity can be a game changer for people living with the disease, writes Kathy Donaghy
Pain is about protection. It motivates us to do things differently.
While this is often very helpful in some situations, like not jumping on a sprained ankle, in the case of chronic pain, the pain can become overprotective. In simple terms, pain can persist even when tissues have healed and the amount of pain often doesn't match the health of the body's tissues.
Pain is complex and not yet fully understood. But we do know that factors other than tissue injury are involved. How we move, our life experiences and lifestyle, our thoughts, expectations and beliefs can all contribute.
For Ciarán McCauley, a 55-year-old actor with the Blue Raincoat Theatre Company in Sligo, and father to seven-year-old Luca, living with chronic pain was a daily constant for years. His problems stemmed from a number of back injuries which required three surgeries in the space of six years.
As a result of damage to his sciatic nerve, Ciarán ended up with a condition known as foot drop, which affected his right foot. In his case, it meant his foot just didn't work properly and he couldn't flex it.
Over time the pain in his foot grew from a feeling of having pins and needles to a level that kept him awake at night. For a period of 10 years, Ciarán describes the pain as constant but because he was a self-employed actor, he had to get on with it.
"On a scale of one to ten, the pain would travel up to an eight or nine and down to a two or a three. It would flare up regularly. The biggest impact was in terms of sleep when even the touch of the sheet would wake me. I was always trying to stay positive but I felt it couldn't continue. Everything I was reading about the lack of sleep was saying this is going to shorten my life," he says.
It was a visit to see his brother Andrew, a physiotherapist who has done a lot of work on chronic pain, that changed the course of Ciarán's life. A late night conversation where Ciarán outlined to his brother how bad things were for him was the start of a new journey to healing.
"I was at my wit's end at the time. The medication wasn't working. The sleeping tablets were no good to me. Andrew described pain as being the body's way of warning you to stop something, although for me it was like a valve or switch that was in the 'on' position and I couldn't turn it off," says Ciarán.
There wasn't one thing in particular but a series of things that turned his life around. One of the first things he did was to see a physiotherapist. Through the recommendation of his brother, he was put in touch with Dr Derek Griffin, a clinical specialist in physiotherapy at the Bon Secours Hospital in Tralee, Co Kerry and this set him on the path to a new way of thinking and understanding.
He started doing yoga. While he'd tried it in the past, he hadn't taken to it. But his wife, Louise Waters, had trained in a type of yoga called vinyasa flow and Ciarán found that he really enjoyed this.
He took up cycling a bike with special tyres that allowed him to cycle on the beach at Strandhill near his home. He dived deep into his own personal online research about what was going on in the body when there's chronic pain. He also gave up alcohol, and while he wasn't a big drinker, he gave up drink completely and has been alcohol-free for over a year now. He practised meditation.
Above all, he says, he realised that there wasn't going to be a magic bullet that made everything OK. But over time, the small changes he was making on a daily basis were adding up to big changes in how he was feeling.
"It was all about the little things I could do that made me feel more in control. Every day now I wake up at 6.30am and I cycle for 45 minutes rain, hail or shine. The foot restricts me in terms of some things but the pain is down to a minimum.
"I describe it now as feeling like I'm wearing a thick sock - I'm barely aware of it. There have been times the pain has flared up but it's onwards and upwards," says Ciarán, who recently appeared with actor Colm Meaney in TV comedy film Halal Daddy.
"Every journey starts with the first step. I had lived with pain for so long that it nearly defines you. Finding ways to keep yourself motivated is important. Life is very good for me. I'm blessed with my son Luca and with my wife. I live in a beautiful part of the world. Gratitude is a big part of my mantra in the day".
Ciarán says his advice to people suffering with chronic pain is not to take no for an answer. "Try to be positive. Don't say 'I can't do this'. Someone will be able to help you. There will be the right exercise or activity for you. There will be something you can find and always feel like you're searching for the right answer. You have to feel there's hope no matter how bad you think things are," he says.
Next Sunday, September 8, marks World Physiotherapy Day and this year the Irish Society of Chartered Physiotherapists, which represents over 3,000 chartered physiotherapists in Ireland, is focusing on chronic pain and the role physiotherapy and physical activity has in its management and treatment.
According to Dr Derek Griffin of the Bon Secours Hospital in Tralee, figures show that about one in five people live with some type of chronic pain, with low back pain being the most common type.
"The problem with chronic pain is that it's often not attributable to any specific injury or incident. Pain is not always a measure of injury or damage. There's a whole host of factors at play. Even factors before pain begins, such as stressful life events in early life and our general health, can influence our risk of developing pain in the future," says Dr Griffin.
He says while in the past people's pain may have been dismissed because nothing was showing up on a scan, the medical profession's understanding of pain means that nowadays the patient is more likely to come away understanding that their pain is real, irrespective of what factors contributed to it.
"In recent years the research has been developing and we understand that pain is a very individual experience. We know now that pain is not just about what's happening in the tissue - our prior experiences, beliefs about pain, coping skills and lifestyle all play an important part. All of those factors influence each other," says Dr Griffin.
"When it comes to treating people with pain, the most important thing is that the clinician listens to the patient. When a person comes in to me, it's about giving them the opportunity to tell their story. I'm interested in that story and in when the pain developed and what was going on in their life around that time.
"I'm interested in looking at their whole life rather than just looking at what triggers the pain. I want to understand their beliefs around pain and in looking at how they sleep and if they have become dependent on medication. That gives me a better idea of how to break the cycle," he says.
Treatment, according to Dr Griffin, comes down to the patient's values and goals. "I'm asking the patient what things are they not doing that would make a difference to their lives if they were doing them? Does that mean getting back to exercise or socialising or work? It's about helping the person improve their quality of life by getting them to participate in things that are important to them," he says.
"The way we can retrain the nervous system is to facilitate and encourage people to do the things they may have been avoiding in a gradual manner. Pain management in the 21st century looks a lot different to how it used to - it's about developing active coping skills, from incorporating physical activity into people's lives to looking at ways we can help them improve their sleep. My job is to get people to take control of their situation," he says.
⬤ For more information,see the Irish Society of Chartered Physiotherapists at iscp.ie
Health & Living