Chronic pain destroys our normal assumptions about the world. It never releases us from its grip and continually frustrates our hopes for gradual improvement. Ultimately it introduces us to an unsettling counterworld where, as Emily Dickinson described it, time has stopped. (The time before pain is almost inconceivable, or else recedes in memory like a faded dream) It is a place where, gradually, almost without noticing, you find yourself at last all alone. Chronic pain penetrates so completely that it leaves no escape. It lives within us like an unimaginably dull nightmare.

Nightmare is not simply a figure of speech when applied to chronic pain. Lawrence LeShan, from the Institute of Applied Biology, described the universe perceived by the patient in chronic pain as structurally identical with the universe of the nightmare. Nightmares, according to LeShan, possess three unvarying features; 1) terrible things are being done and worse are being threatened; 2) we are helplessly under the control of outside forces; and 3) we cannot predict when the ordeal will end. LeShan concludes; "The person in pain is in the same formal situation: Terrible things are being done to him and he does not know if worse will happen; he has no control and is helpless to take effective action; no time limit is given." Only one feature should be added to LeShan's description. Chronic pain is a nightmare from which we may never truly awaken - or a waking state in which the nightmare never ends. One pain patient expressed the uninterrupted dislocation he felt as follows: "It's always three o'clock in the morning."

We can better grasp the dilemma facing people with chronic pain - especially their sense of dislocation - if we consider the ways in which our culture teaches us to confront pain with silence and denial.

It is mostly acute pain that we learn about. No one teaches us what to do with a pain that never stops. Nevertheless we learn. Patients with chronic pain soon discover that their complaints often exhaust, frustrate, and finally alienate family and friends and physicians. Many patients thus learn to retreat into a defensive isolation. They experience firsthand the failure of words in the face of suffering. Virginia Woolf wrote: "The merest schoolgirl, when she falls in love, has Shakespeare or Keats to speak her mind for her; but let a sufferer try to describe a pain to a doctor, and language at once runs dry."

Chronic pain opens on an unsocial wordless terrain where all communication threatens to come to a halt. Cries for help prove mostly useless. The person in pain belongs to a world that no one else can entirely share or comprehend. Perhaps there is something finally incomprehensible in pain that supplies, as Emily Dickinson saw so clearly, its peculiar quality of blankness. "It was the whiteness of the whale that above all thing appalled me." writes Melville's narrator, Ishmael, in Moby Dick. This mysterious, unresponsive absence of color - "a dumb blankness" as Ishmael calls it - seems to him somehow infinitely terrible. "There yet lurks an elusive something in the innermost idea of this hue," he writes, "Which strikes more of panic to the soul than that redness which affrights in blood."

Pain partakes of this eerie and sometimes appalling power to drain off everything that gives the world vividness, color, coherence, and value. The blankness of pain may be its most terrifying attribute. It casts us back upon a featureless landscape.

This was a narrative, fueled by some unmistakable insights on the misery experienced by chronic pain sufferers. It's author is unknown.

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