I have been told by more than one medical practitioner that I have a high pain threshold. After I watched one doctor insert a needle into a knuckle torn open on the edge of a cat food can, he said, "The last time I did this, the man passed out. You didn't even flinch."
How to explain to him that I grew up in a family where crying over a scraped knee prompted my grandmother to tell me, "Don't be soft"? My father, a soccer coach who wanted to raise his girl to be as tough as any boy, used to tell me whenever I hurt myself, "Walk it off."
We judge each other’s tolerance for pain. We tell ourselves that pain makes us stronger, that it sharpens our character, that it demonstrates our will. We expect high-paid athletes to play hurt. We debate whether women should use drugs during labor. We wonder if we rely too much on over-the-counter medications for the ordinary aches and pains of life. That must be why I opened this essay about my addiction to painkillers by telling you that I’m not a whiner. I want you to know that I’m not the kind of person who runs to the emergency room with a hangnail. I can take it.
In fact, it’s this high pain threshold that might have gotten me in trouble in the first place. When pain derailed my life more than a decade ago, I did not stop to attend to it. I popped a pill prescribed by my doctor and kept going, which eventually landed me in detox with a full-blown addiction to OxyContin.
Eleven years later, I find myself wondering what it means to stay “sober.” I suffer from migraines, the variant known as cluster headaches — also known as "suicide headaches" — and as I lie in dark rooms, waiting for the headaches to pass, the question I ask myself is this: How much pain can I tolerate? Or really: How much should I tolerate?
My story begins in 1996, when I blew a disk in my neck, diagnosed at the same time I found out I was pregnant. I spent that whole pregnancy trying to gut out the pain because I was terrified of hurting the fetus. I refused to take medication; I wouldn't even drink coffee.
In the Middle Ages, prior to the adoption of Roman law, guilt or innocence could be established by undergoing an Ordeal. The Ordeal required one to agree to be subjected to something extraordinarily painful and to come out the other side not having capitulated to the pain. Thus, one could prove one's innocence. By enduring months of shattered nerves, I felt I had passed my own version of the Ordeal. I had put the baby's well-being above my own.
But it came with a cost. Two years after my child’s birth, I began taking handfuls of prescribed opiates in order to maintain my working life. I wasn’t just physically dependent on the drugs. I relied on them to numb the pain of a collapsing marriage and a job I hated. My pain had been real, but I was chasing something else with that opiate addiction — a euphoria that made all of life's other problems disappear.
Much of this I came to understand in sobriety, where I committed to living drug-free. I spent years in 12-step programs, and these days, I love my life. My two nearly adult children are thriving. I'm in a passionate, committed relationship. I have a great job teaching at a small college. And I write every day.
In my 40s, however, the migraines began. It took months to diagnose them correctly. Twelve months of various drugs to prevent and try to control the pain. My migraines became more frequent, and worse. I went from a migraine a week to a migraine every day.
Eventually I got the cluster headache diagnosis and was given stronger opiates— oxycodone. I wanted to be smart about this, and so I worked out a deal with my partner that we would keep the oxy in a safe. If I needed the meds, I had to ask him to get them for me. I was trying to figure out how to trust myself to manage my pain. I needed checks and balances. I needed the watchful eye of someone else.
But one dreadful night, I woke up at 3 a.m. with a cluster headache so hideous I went into the living room and tried to drill my head into the couch's armrest. Counterpressure seemed to be the only response I could summon to pain that overwhelming. And so I crouched there, trying to press my head through the armrest as if I could push the pain out the other side of my skull. I woke up my partner to get the medicine, but I cannot even imagine the agony that would have ensued if he’d been unavailable. What would I have done? How long could I have lasted?
I still remember the moment — exactly 45 minutes after I had taken the pill — when the 10 mg of oxycodone floated through my system and, as if by magic, washed my headache away like water in a bathtub drain. It was such blessed relief. If I could have met the person who first compounded oxycodone, I would have kissed his feet in gratitude.
This puts me in opposition with many people in the 12-step program I used to belong to. Many of them tell me I can never touch these drugs again. Once an addict, always an addict. The question of pain medication in sobriety — as well as the use of antidepressants and other psychotropics — is a thorny one. What constitutes medical necessity, and what constitutes a relapse? As far as I know, there is no official stance from any 12-step program on how much pain medication is allowed. Instead, the answer is up to the individual, and in an effort to stay pure and above the fray, members can be hard-core. I met a woman who refused pain pills for her broken arm. Another person talked about enduring knee replacement surgery without taking any meds afterward. Some will not even take aspirin.
I stopped attending meetings when I started taking oxy again, afraid I would meet with too much opposition because I was breaking the program’s fundamental rule. According to them, I'm using again. According to me, I'm doing what I need to function. I refuse to spend my life lying in a dark room, moaning as someone attempts to prise off my cheek or occipital bones as if they were bottle caps.
Because pain is not ennobling. It does not make me a better person because I've been told that I can withstand pain better than many men. I'm not a hero because I show up for work every day regardless of whether I have a migraine or not. Pain is what it is, and I choose to take medication to control my pain so that I can work, and write, and interact with my family.
That also means I have to be wary of myself. I have migraines nearly every day, and I catch myself, before I take a dose of medication, questioning whether the pain I'm feeling is real or whether I'm just jonesing for a pill. Chronic pain creates a dissonance. Since no one can see your pain, you are the only reliable source for knowing whether you hurt.
But pain takes up far too much room in my head. When the pills wear off, I have to decide whether to take more. I look at the clock. Has it been four hours? Is it close enough to bedtime that I can tough it out until I go to sleep? Is this my body trying to trick me into giving myself more pain medication than I really need? Am I having a hard day emotionally and looking for something that will make me feel better? Where is my pain on the pain scale? Do I think that, if I just wait, this migraine will clear by itself? Do I really have a headache?
I know the danger I am in. It's why, when my oxy dosage hit 60 mg a day (a fraction of what I had been taking when I went into detox), I told my doctor I wanted to wean myself down. The problem with opiates, as anyone who had taken them long term can tell you, is that the body requires more and more to treat the same level of pain, and it doesn't take much to ramp up from 10 to 20 to 120. That’s where I was in the past, and I am determined to never go there again.
And so, I switched from oxycodone to methadone. It is still an opiate, but unlike drugs like Vicodin or oxycodone, it does not create the euphoria that accompanies the pain relief. Methadone, I am convinced, may be a long-term drug for me until we can finally find the right combination of pills that will prevent my getting the headaches in the first place. (I am currently using a medication experimentally, to see if it can provide prophylaxis.) I figure that if I am not gaining the benefit of the high from taking the pills, I can trust myself not to be an addict when I take the pills for pain. There will be no emotional benefits except the relief that arrives when the pain breaks. Still, I worry and try to stay conscious of my own usage.
As I write this, my left eye is the center of my universe. For 24 hours now, I have been hobbled by pain so bad that I long for the relief of either throwing up or passing out. I write now because to confine myself to a dark room would simply cause me to languish in the same place and think about how much pain I am in. It is better to stay busy and hope for brief moments of distraction when the pain may disappear for a moment or two.
I tell myself that the cluster headache will break sometime. It has to. My job right now is to bear the Ordeal. I am innocent, I say. I am innocent.