Originally published July 24, 2016
Recovering from shoulder surgery seemed like a perfect time to explore the difference between pain and suffering. My current sankalpa (a deep intention or promise made to myself) is to not suffer. Of all the sankalpas I’ve had over the years, this is proving to be powerful. For example, on a several hours long telephone call with tech support, I witnessed at one point, as I hung my head into my hands, that I was truly suffering. But once I recognized the suffering, I found could choose not to suffer and laugh it off. I didn’t have that choice before I witnessed and recognized the suffering. This sankalpa has inculcated a vigilance against suffering in the core of my being.
But I knew the real test was to come. I adopted this sankalpa as soon as I learned I needed surgery to repair a torn supraspinatus tendon and bone spur in my left shoulder. I had my right shoulder done 7 years ago, and the whole experience was one of great pain and suffering over a long period of time. As part of our Yoga Therapy training we are offering a workshop on Yoga for Pain and I decided this would be a good time to experiment with different techniques throughout recovery. Or more accurately, as one of my students put it, I decided to embrace this AFGO (if you’re not familiar with the term please Google it –see Internet slang).
The real test was the first night after surgery. I had a nerve block, but the pain in the shoulder started returning even before the nerve block wore off. The dose of opioid pills I took before bed only lasted 2 hours. I got up, changed the water in the Cyro Cuff (an icing contraption), focused on my breath and repeated mantra. The pain just kept getting worse. I changed the ice water at the top of each hour. After 3.5 hours the pain became unmanageable and I took another dose. That dose did not work at all. I got up every hour for more cold water in the Cyro Cuff. After 2 hours I took another dose. That didn’t work either. On a scale of 1-10 the pain was a 12. At least I fell asleep for an hour. I was up every hour for fresh ice water and managed to wait for 3 hours before taking the next dose. I knew it was too many pills, but I did not know what else to do.
What I didn’t know, and believe I should have told about before surgery, was that I was experiencing a rebound effect from the nerve block, where the pain is actually much worse than if I had not had the nerve block. According to the research paper I read this often occurs at night and a multimodal approach to pain control is recommended, taking Ibuprofen or Naproxen (which has caused me 3 ulcers in the past) along with the opioid. I was not told about either the possibility of the rebound effect or how to manage it until my doctor called at noon the next day. He had been in surgery, and had not gotten the messages I left at 8 and 10 am about the uncontrolled pain. Once I added the NSAID along with omeprazole the pain became more controllable and I now had stomach issues to contend with.
Despite my sankalpa, I was definitely suffering, and I believe could have been avoided with advance education. Why wasn’t pain control discussed in the pre-op appointment? If I had been given the information before surgery I might have made a different decision about the nerve block. To make things worse, now I didn’t have enough pills to make it through the weekend. The doctor on-call made it clear that there was nothing he could do and I would have to go to the ER to get more pills, and it was my fault for “sucking down the pills”.
The next lesion: anger is suffering. I was angry at all the nurses and doctors who failed to give me the information I needed to adequately manage pain. In order not to suffer, I counted all the pills I had left, and calculated I could get through the weekend by limiting my intake to one pill every 5 hours. This required setting a new goal for pain control. The path to not suffering was not trying to escape the pain but to accept it and surrender to the experience, while practicing self-care.
I surrendered to resting, and listening to my body. Being upright too long was too painful. Lying down with ice, and later heat was bearable. Breathing, repeating mantra, staying present without judgment all helped. I am grateful for the knowledge of all the yoga tools at my disposal. And with less medication the mind was more clear. I could actually be a bit productive on the computer between naps, and was better able to notice the small improvements each day. Using the tools of yoga enabled me to more easily accept the physical pain and avoid suffering. Pain is in the body. Suffering is in the mind.
The upside to this experience is I am getting good experience in using yoga techniques for pain control, which will be helpful for our training program. But it also leaves me with the feeling that doctors and hospitals must do a better job helping patients with pain management and avoiding opioid addiction. The strategy of giving patients fewer medications than necessary with no further information, does a great disservice to the patient. If the medical professionals I relied on for my care presented me with full information about pain management, I could have avoided suffering.
Pain is a sensation that can be witnessed, acknowledged, and ultimately tolerated. Suffering results from what our mind does with the pain. Feeling out of control can cause suffering. Regardless of the pain, suffering can be brought within our control through education and training.