Two days after my mother moved a concrete flowerpot from our living room to our patio, her feet went numb. A week later, she discovered that she couldn't straighten her back. She felt bowed, as if contorted into the beginning of a back bend. Then her lower back began to throb. She went to a doctor, who stuck needles in her calves and, perplexed by her lack of sensation, ordered an MRI. He showed her the results, explaining that 12 of her spinal disks — the soft jellylike cushions between her vertebrae — had degenerated, causing her spine to compress and pinch the nerves. An additional disk was herniated. Sometimes a degenerated disk can be removed through surgery, with the surrounding vertebrae fused. But 13 disks, more than half the total in a human spine, were far too many for an operation, her doctor said. So she went to another doctor — and another. Seven doctors said the same thing: Nothing could be done. That was in 1995. My mother has been on painkillers ever since.
I was 13 when this happened. I remember that she spent a year and a half in bed, and I know her condition will likely worsen as she ages. I've gotten used to her medication schedule, and I understand that sometimes the pain gets so bad that she has to lie down for a few hours until it subsides. When I go home to visit, I have to carry everything for her, even her purse. But I don't know much else about her official condition, known as degenerative disk disease. I have a hard time imagining what it's like to live with constant, debilitating pain — pain that dominates your thoughts, dictates what you can and can't do and alters your relationship with your body, your place in the world.
Chronic pain is an umbrella term for any type of persistent pain, from migraines to fibromyalgia, that lasts anywhere from several months to the rest of your life. The National Center for Health Statistics estimates that 76.5 million Americans suffer from it, with arthritis and back pain accounting for up to 60% of the cases. For some reason — researchers have not yet figured out why — most of the sufferers are women. We're familiar with acute pain, of course: the type that results from a specific injury like a burned finger or broken bone. When you hurt yourself, nerve fibers called neurons send electrical signals to your spinal cord, which transmits some of those signals to the brain, which in turn interprets the location and severity of the pain. The sensation of pain reminds us to keep the injured area protected (do you want to keep using that broken arm? I didn't think so), giving it time to heal.
But sometimes there isn't an easily identifiable reason for the pain. Sometimes the thing that's broken is the nerve. Maybe it continues to send pain signals long after the original injury has healed, or maybe there was never an injury at all. Until the 1960s, scientists believed that the paths that nerve impulses take when they travel to the brain were predetermined, a sort of neural highway. But actually, the routes are flexible, and a damaged nerve can affect those around it, altering the paths. Research has shown that if your brain feels pain for a long-enough period, it will change. "Eventually, neurons start to die," explains Dr. Michel Dubois, chair of pain medicine and palliative care at New York University's Langone Medical Center. "Pathways change. The emotional part of your brain is affected. But even though we know more about the neurons and the way the body works, we don't know much more about pain than we did 200 years ago. Pain is still pain. We don't know how to make it go away."
All the Things Pain Isn't
Without her wrist brace, Kristi Shaffer doesn't look injured. She is tall and athletic, with long, wavy hair that she dyes red — except for her bangs, which she prefers to keep blond. She is 37, but her two-toned hair and triple-pierced ears make her seem younger, which makes her pain all the more surprising to those who meet her.
Shaffer's employment history is a series of unusual jobs — leading trail rides through the desert, monitoring security cameras at a casino — but now she is unemployed and on disability, living at home with her parents and her 8-year-old son in Pahrump, Nev., about an hour outside Las Vegas. She has chronic regional pain syndrome (CRPS), a rare but debilitating disorder that affects an estimated 1.5 million people in the U.S. — or fewer than 2% of all chronic-pain sufferers. Her condition is permanent.
In October 2007, she was working for a company called Best Bet Products, which repairs and delivers slot machines to nearby casinos. Slot machines weigh anywhere from 50 to 300 lb., depending on their size and what's inside them; Best Bet employees were supposed to use dollies or forklifts to transport the equipment, but, Shaffer says, sometimes none were available. One afternoon she was standing on scaffolding in the company's warehouse, lifting empty machines onto a storage shelf. "I reached down with my right arm to pick one up — it was only about 50 lb. — and when the machine's weight settled on my arm, I swear I could hear a pop. Then my arm went numb," she says. Within a few hours, her wrist doubled in size. She drove to the ER, where the attending doctor told her she had pulled a tendon. "He gave me some Vicodin and sent me home. That was it."