When pain settled into Blair Golson’s hands, it didn’t let go.
What started off as light throbbing in one wrist 10 years ago quickly engulfed the other. The discomfort then spread, producing a pain much “like slapping your hands against a concrete wall,” he says. He was constantly stretching them, constantly shaking them, while looking for hot or cold surfaces to lay them on for relief.
But worse was the deep sense of catastrophe that accompanied the pain. Working in tech-related startups, he depended on his hands to type. “Every time the pain got bad, I would think some variation of, ‘Oh no, I’m never going to be able to use computers again; I’m not going to be able to hold down a job; I’m not going to be able to earn a living; and I’m going to be in excruciating pain the rest of my life,’” he says.
Like many patients with chronic pain, Golson never got a concrete diagnosis. For a decade, the 38-year-old Californian went from doctor to doctor, trying all the standard treatments: opioids, hand splints, cortisone injections, epidural injections, exercises, even elective surgery.
Golson’s pain was not caused by anything physically wrong with him. But it wasn’t imagined. It was real.
“PAIN CAN BE ‘REAL’ PAIN — AND IT CAN BE CAUSED BY BRAIN CIRCUITS. WE HAVE TO GET OVER THIS CONCEPT THAT EITHER THE PAIN IS REAL OR IT’S ALL IN MY HEAD AND I’M MAKING IT UP.”
After weaning himself off the opioid Vicodin and feeling like he had exhausted every medical option, Golson turned to a book that described how pain could be purely psychological in origin. That ultimately took a pain psychologist, a therapist who specializes in pain — not a physician — to treat the true source: his fearful thoughts. Realizing that psychological therapy could help “was one of the most profoundly surprising experiences of my life,” Golson says. No doctor he ever saw “even hinted my pain might be psychogenic,” meaning pain that’s psychological in origin.
Golson was lucky; few chronic pain patients ever get the chance to understand the psychological dimensions of their pain or try psychological therapies.
There are 100 million Americans who suffer from chronic pain, and an unknown number of them are like Golson, with back pain, neck pain, fibromyalgia symptoms, or other forms of pain that have no diagnosed physical cause.
It’s not that their pain is “in their heads.” The truth is much more nuanced: All pain can have both physical and psychological components. But the psychological component is often dismissed or never acknowledged.
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