Thomas Jefferson once wrote in a letter that “the art of life is the art of avoiding pain.” But when pain becomes unavoidable, what happens to the art of life? Jefferson may not have addressed the point, but millions of people in chronic pain deal with this question day after day.
Doctors are starting to deal with the question as well. Once attuned mainly to medical outcomes, pain specialist (and other physicians) increasingly recognize that the well-being of people with chronic conditions hinges on far more than physical problems or discomfort.
Take the case of arthritis sufferers. In a recent survey of more than 32,000 adults, those with arthritis reported being in poor-to-fair health three times more often than other people did. Maybe that is not surprising when you are talking about the top cause of disability in the United States. But the survey went beyond how arthritis affected people physically to ask how they felt mentally and how often their condition prevented them from participating in regular activities-in short, how well they were coping and getting along. In both cases, people who had arthritis again suffered more than people who did not.
Such findings point to the importance of what is come to be called health-related quality of life. It is a concept that considers not only the medical measures of your condition-whether you give your pain a 3 or a 7, for example, or how far you can bend your knee-but emotional, social, and other subjective aspects of life as well. It may seem abundantly self-evident that quality of life erodes when you are in constant discomfort. But in many cases, pain chips away so slowly at function, feelings, and favorite activities that patients are not aware of how-or how much-life has changed. For example, if you have given up tennis because of knee pain, it may not strike you that other enjoyable activities that once seemed important, such as attending matches as a spectator, have also fallen by the wayside.
“Nobody suffering from chronic pain is going to be happy and satisfied about that,” says Michael R. Clark, M.D., director of the chronic pain treatment program at Johns Hopkins University School of Medicine’s department of psychiatry and behavioral medicine. “The question is what you want out of life and what you can change to make your quality of life better.”