by Christina Radatz-Sachs, M.S., CHES

"Pain is a common symptom defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” This statement characterizes the evolved nature of pain as a warning system and feedback mechanism that influences how we adapt to our environment. However, pain at its core it is suffering and its persistence can be insufferable for people and diagnostically problematic to those who care for the sick, as well being a burdensome cost to society (Davidoff, 2016)."

The beautiful artwork at the top of this page accompanying the title was created by Ashley Davidoff, M.D. Artist Davidoff painted this image to represent pelvic pain and said the following, as part of her explanation for the piece:

"The female pelvis contains many important organs and structures. Portions of the gastrointestinal tract, urinary tract, as well as reproductive organs are located within the pelvis. Several of the causes of female pelvic pain involve the derangement in the arrangement of these structures. The diseases that can cause pelvic pain are innumerable (Davidoff, 2016)."

As someone who experienced chronic pelvic pain in the past, I can identify well with what I feel the painting is conveying.

Of course, chronic pain comes in many forms, with innumerable causes -- and sadly, is experienced by millions. Estimates suggest that 20% or more of adults suffer from pain globally and around 10% are newly diagnosed with chronic pain each year (Goldberg and McGee, 2011). The high prevalence of chronic pain and resulting societal burden has become a public health priority; though previously, pain of a chronic nature was generally viewed strictly as medical problem, and not a public health issue (Häuser, Wolfe, Henningsen, Schmutzer, Brähler, & Hinz, 2014).

Based on my experience, friends and family who have dealt with chronic pain, along with what I've gathered from various readings, the shift from a medical-only focus to a public health matter occurred, in part, to a frustration on the part of physicians and patients alike.

Generally, the most significant aspect of chronic pain is the management of its symptoms. Our Western conventional medicine is particularly adept at treating and managing SHORT-TERM injuries and other pain-related conditions; but when pain is not brief, becomes continuous and for long stretches of time, the heart of chronic pain's complexity is revealed.

Like layers of an onion, issues from physician liability for prescribing narcotic pain medications, to patient's increasing tolerance (sometimes resulting in addiction) and potential suffering, to societal economic impact from reduced productivity, loss of work days, cost of health care, and more -- the issues seem endless. Add on that many chronic pain cases cannot even identify the source, or cause of the pain, and one can see how patients and physicians can experience such exasperation. It is easy to understand why alternative therapies and self-treatment options are so often widely (and desperately) sought after.

What often happens in the process is the person who is suffering may start to ask "why?" Even if a specific diagnosis is made and the cause of the pain is identified -- the ongoing, day in and day out experiencing of pain long-term, with seemingly little to no escape or reprieve causes the person to wonder why them, why do they have to be the ones to endure such a thing? Some may blame themselves, thinking that perhaps prior poor health choices, or "bad behavior" resulting in some type of spiritual "punishment" has brought on what they now have to deal with. Others may think genetics, environment, stress, or other conditions set the stage for the daily pain and discomfort pervading their lives.

Loss of employment, relationships, changes in living arrangements, financial hardship, and more are often the by-product of more severe chronic pain cases. Some may be fortunate to have supportive loved ones and economic means to cope, while others do not. For a while, I was in the latter group.

Once a happily married and successful executive with friends and family, I ended up in near-ruin and close to a full breakdown in mental/emotional state, after an undiagnosed blood clot almost took my life. Within two years, the rest of my family died unexpectedly, my alcoholic husband "could not deal" and bailed, I was left with disability income only (but thank God for at least that), in a city where I knew no one after a military transfer halfway across the country. By the time the clot was finally diagnosed, I had substantial valve damage from months of swelling in my leg. Life would never, ever be the same, or even close. I didn't always make the healthiest coping choices; but as an artist and writer, fortunately I turned to both to "deal." And the result? Searching (and finally finding) meaning in the depths of despair . . . and hope and purpose, at the bottom of the pit.

Dr. Viktor Frankl, a neurologist and psychiatrist who lived through interments in concentration camps during the Holocaust in World War II, wrote of his experiences in a book titled, "Man's search for meaning: An introduction to logotherapy." In his work, he discussed primarily these four concepts pertaining to meaning, especially found during/following suffering (Lee, 2015):

~~> There is meaning in suffering

~~> Meaning can be found through our capacity for creative expression

~~> One can find meaning by interactions with their environment and the people around them

~~> We can find meaning by changing our outlooks when faced with challenges (or situations that may be difficult)

By the time I finally started to write again and create some clay pieces, I think I was looking at my past, present, and future in a more macroscopic perspective. I was attempting to sort out all of the pieces (especially in my writing), figure out if there was any rhyme or reason to what has happened and what I could do with all that I had gone through. I got to the point of deciding I was going to find a way to use it all, and turn it around for a good purpose. Though still -- I hurt -- physically, mentally, emotionally, spiritually.

Since learning about the field for artists in residence, I've wondered what would have occurred if such a person had come to visit me during the week I was in the hospital (when the clot was finally "caught") . . . I believe at that point, shock, fear, and confusion were the most prominent feelings. I like to think if I were that artist visiting a patient who described his/her current state as such, I would determine the type of activity to offer based on the level of overwhelm the patient reported to me and/or, my perception of that degree of anxiety. If they seemed to be rather expressive and capable of a more ambiguous, unstructured activity, I might propose an activity like collage. On the other hand, if they seemed to need being led and given a more straight-forward, structured activity, I might propose something like choosing five words to describe how they're feeling and to write/draw the words out in some colorful way -- such as using "bubble letters" and coloring them in afterwards.

For how lonely, scared, and discombobulated I felt as a patient then, I think either of those activities would've proved valuable in "grounding me" and helping to feel at least some tiny measure of control and focus -- that I could do SOMETHING with all that anxious, nervous energy would've surely contributed to some level of calm.

I think of Dr. Frankl describing the times he'd be digging out in the frozen snow for hours on end, so cold and starving -- and how he would use his imagination to conjure up very specific memories of his wife -- to the point he felt she was there with him. This seemed to provide him a bit of reprieve, an escape, from the harsh reality surrounding him. Though not an art activity, I believe that within the brain, reconstructing memories and conversations with fine details is still a creative process -- and that Dr. Frankl did experience some version of flow state in his private world of visual recreations.

My own escape in writing and clay engaged me at some key points and I indeed experienced flow state a number of times. I think of each of those little "reprieves" as me creating in my mind a different reality going forward -- one that I would be in control of creating and that my pain and losses would not be for naught. Rather, I would do what it takes to make myself qualified to help other people deal with trauma in life.

Phase One of that vision was realized in October 2015, when I passed the exam to become a nationally Certified Health Education Specialist (CHES); Phase Two was completed in May 2016 when I graduated with a master's degree in health education and behavior.

Whether the final phase comes in the form of my contribution to the scientific base of knowledge/literature via my PhD; or creating/running my own nonprofit providing mental health services to underserved populations; or teaching the next generation and sharing my story to inspire; or serving at the bedsides of patients as an artist in residence; or whatever else I can do to use my losses for another's gains -- I'm open to multiple possibilities of serving others and contributing to society. I understood Dr. Frankl in many ways (though for different reasons, of course) and wholeheartedly agree with him that this identification of meaning in one's life through such service is indeed a path to true happiness.

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REFERENCES

Davidoff, Ashley. (2016). Art in Anatomy. Retrieved on February 13, 2017, from http://www.artinanatomy.com/shop/abdomen/abdominal-and-pelvic-pain/

Goldberg, D. S., & McGee, S. J. (2011). Pain as a global public health priority. BMC public health, 11(1), 770.

Häuser, W., Wolfe, F., Henningsen, P., Schmutzer, G., Brähler, E., & Hinz, A. (2014). Untying chronic pain: prevalence and societal burden of chronic pain stages in the general population-a cross-sectional survey. BMC Public Health, 14(1), 352.

Lee, J (2015). Meaning and Self Transcendence, Health & Creativity, Module 6.