I didn't grow up on a farm but my maternal grandparents were Saskatchewan farmers. I always enjoyed poking around the farm watching my grandfather work. One thing I learned is cows will dutifully follow any routine you set for them without much fuss. They rarely do anything unexpected.

Cows by David Sykes via CC BY-NC-ND 2.0 — Cows by David Sykes via CC BY-NC-ND 2.0

One thing you won't find in these pages is such consistency from me. Already, when I look back on my last couple posts I see that on one hand I have advised "don't give your pain too much attention" and on the other that there are "no boundaries" between your pain and other parts of life. I'm sort of saying "keep it away from parts of your life" and that you can't "keep it away" at the same time. This is likely frustrating for some. Living a life with pain is just like living a life without pain (is there such a thing?) — there are many ways to live it successfully.

What I share on this blog are things I have thought, observed, studied or read and the impact that has had on me, as a person with pain, or the people I've tried to help with pain. These tidbits come from people's stories and from the published scientific literature. The science is growing tremendously and there are many areas of agreement, but still much to be learned and sorted out.

There are three potential sources for inconsistency in what I write:

personal stories have shown me different things help different people
what I say in the future may contradict what I say now because the story of what helps, and the evidence to support the story, is still being written
difficulty in writing about mind and body

Let me expand on the third point. Chronic pain is at the epicenter of a struggle of mind/body dualism. The dualism refers to the objective nature of disease or injury of the body and the subjective nature of experience of the mind. As we have said, pain is an experience and thus belongs firmly in the mind, in consciousness, but everyone knows when you cut your finger it hurts. So we feel as though something is happening "to us" in the body to cause pain, yet the experience itself is generated "by us" in the software of our mind. This opens up entangling loops of cause and effect getting us into all sorts of troubling conniptions. All the struggles about chronic pain we have in the healthcare, insurance, and legal systems, in science, policy, culture and everyday interactions with people can be traced back to where one sits on the mind/body dualism fence. It can be maddening.

“A foolish consistency is the hobgoblin of little minds.”

— Ralph Waldo Emerson

Even though I know that there is no mind/body separation, I find it difficult to not think about them separately. This has a lot to do with language and words, which by their nature are divisive. So thinking, discussing, and writing about body and mind as one is almost impossible as we don't have words for it. With a patient, I am at one moment talking about something in their body as a "pain generator" (like that cut finger) and the next moment talking about "mental factors" that can reduce (or increase) pain. Finding ways to talk about this as one thing is challenging. It can give the appearance of being contradictory. Sometimes I find myself searching a patient's face for some non-verbal sign that they "get" what I am clumsily trying to explain with words. Stories often work a lot better. I'm sure I come off as a charlatan sometimes, but that is the risk one takes in occupying an unfamiliar and perhaps uncomfortable space.

In his essay, Self Reliance, Emerson said, "A foolish consistency is the hobgoblin of little minds." He referred to not being consistent or conforming just for the sake of appearances — especially when new information comes to light. There is likely to be a lot of new information about pain coming to light in the next decade.

Unlike the cows I watched as a child, I intend to be a bit controversial, contradictory and act unexpectedly knowing we need this sort of disruption to challenge our assumptions. The only thing I'll be consistent about is a desire to see progress in pain relief and empowering people to lead better lives and help each other do so.

Have you experienced contradictory ideas about chronic pain and treatment?