Title: Pain

Author: Stephanie de Montalk

In: Sport 33: Spring 2005

Publication details: Fergus Barrowman, 2005

Part of: Sport

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Sport 33: Spring 2005

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During March, April and May I strove to bring the pain under control. All the while the 'Pessimism of the Intellect' strained against the 'Optimism of the Will'—to appropriate Antonio Gramsci's activist slogan.

But, as I persuaded myself that hyper-avoidance of sitting would allow the inflammation to ease and the thinning nerve to slip free, I also agitated: to what purpose was I to stop driving, dining out, going to the cinema; to eat and write standing all day, plate perched on a sideboard, computer uncertain on a coffee table balanced on top of a work station and keyboard wobbling on a box on top of an ironing board? Unlike Stevenson, Symonds and Pope, was I being discouraged from writing? If so, by whom and to what end?

Was I to accept the veracity of metaphysics—described by Arthur Schopenhauer as man's 'most sublime tendency'—in which case was the pain good ghost, goblin, or ambivalent jinn? Was I to set conventional medicine against fringe disciplines, amulets and small synchronicities; to explore metaphor, myth and random events; and to embrace the dictum of fifteenth-century Austrian physician and surgeon Paracelsus that 'Magick is a Great Hidden Wisdom—Reason is a Great Open Folly?'

Or was I to pursue the fruits of philosophy: Marcus Aurelius's page 12reasoning that 'What we cannot bear removes us from life; what lasts can be borne'; Michel de Montaigne's advice that we should 'learn to suffer whatever we cannot avoid', and his conviction that the key to living a complete life is the ability to make positive use of adversity; Friedrich Nietzsche's premise that just as 'a tree that is supposed to grow to a proud height [cannot] dispense with bad weather and storms', a fulfilled life (the attributes of which, unannounced by Nietzsche, are assumed to include courage, ambition, humour, independence and artistic dedication) is not possible without pain; or, to return to Schopenhauer, the proposal that 'we require at all times a certain quantity of care or sorrow or want, as a ship requires ballast, in order to keep on a straight course'.

The isolation from informed medical expertise was magnifying my credulity, the doubt of self-diagnosis my uncertainty.

I delivered PNE printouts to my GP, a sports medicine specialist, a neurologist, and a pain specialist—the consultant of last resort. The condition was not known to them, but, unlike medical professionals condemned on the Internet, they were keen to be informed.

In accordance with my new diagnosis, amitriptylin—in low doses a neuropathic analgesic—was prescribed. Long used as an antidepressant, amitriptylin's pain-reducing value (discovered by accident more than a decade ago) at a dose below that effective in the treatment of depression, like anticonvulsant medications such as neurontin which work in much the same way, lies in its ability to stabilise or block nerve pain receptors. The drug, taken at night, was befuddling and dried my mouth, but enabled sleep. I was also prescribed codeine, natural derivative of opium, now manufactured from morphine to which it reverts in the body, for alleviation by day. The efficacy of codeine for nerve pain was held to be uncertain: opiates, I was warned, are quick to build tolerance, can be habit-forming and provide minimal relief for only a few.

I brushed aside questions of dependence, determined an opium-related drug would work for me. Thomas de Quincey had taken tincture of opium to relieve facial neuralgia and succumbed to its 'dreams and noonday visions'. Addiction had been the lot of Samuel Taylor Coleridge too. Surely an enhanced literary output would page 13compensate for the inevitable withdrawal and descent to reality? Moreover, I responded to the idea of using a derivative of 'the aspirin of the East', valued since antiquity: of Arabia's 'gift of God'; Greece's 'the juice'; the basis of soothing, costly, luminescent laudanum as Paracelsus had first mixed it, combining the powder he dried from the milky juice of the unripe seeds of the poppy scored in the morning with a knife, with the powdered, whisper-thin softness of gold and delicate rose of Indian pearls. The basis, furthermore, of the strong, modern, semi-synthetic narcotics (including heroin) derived from morphine; and the inspiration for thousands of synthetic opoids (like methadone and pethidine). A drug powerful enough to access the central nervous system, rather than toy with the peripheral pain receptors as the non-narcotic analgesics had done.

'Nerve pain is unlike that of trauma or surgery, in character and habit,' the pain specialist concurred, 'and chronic, unrelieved pain at your level will be difficult to control.'

He explained that changes to the nerve fibres were producing an abnormal signalling system. This was the reason amputees felt the pain of phantom limbs, and surgeons during World War II amputated early before the neurons became confused and started to send incorrect messages; and the reason only specific neuropathic drugs like amitriptylin could 'down-regulate' the receptors of damaged nerves and calm the pathways. Dosage would be a question of trial and error, he continued, codeine, at best, an ancillary tool.

I enquired about a TENS (Transcutaneous Electrical Nerve Stimulation) machine, the impulses of which block pain by confusing it, and closing a gate of transmission. 'The nerve is too deep,' he said, setting the suggestion aside.