It may start when I first noticed myself lurching stiffly as I walked, in the sleepless weeks after my first child was born. Or earlier, when back pain plagued me at my desk job. Or maybe the story only really begins when I was first given a diagnosis, years after that. But I’d rather start this story a little later, when after some years of being clawed constantly by stiffness and pain, I began trying to claw back the life pain had taken from me. It’s my story, so I get to choose. We’ll start there, in 2015.
Today, I am flying from Toronto to New York City. Travel—formerly my great delight—has lately become something of an ordeal. My neck cranes forward, pushed by stiff, hunching shoulders. The muscles at the front of my neck are as tight as steel cables; a dull burn at the back of my neck radiates down to my tailbone. My lower back feels unstable, an oddly unbearable sensation, as if my spinal column were inadequate to support the rest of me.
I have a spine disease called ankylosing spondylitis. AS is a degenerative autoimmune disease. A form of inflammatory arthritis, it typically strikes young people in their primes—in my case, at twenty-eight, shortly after the first of my two sons was born. AS is roughly analogous to having rheumatoid arthritis in the spine. My immune system attacks my body, causing chronic inflammation that began in the sacroiliac joints, at the base of the spine, and for the past ten years has been gradually moving upward.
The disease and resulting pain have devastated my life. I’m still trying to find my way now, a decade after the first symptoms foreshadowed it. In severe AS, inflammation causes the vertebrae to fuse together by a process of erosion and remodelling of the bone. If I’m unlucky, bone will form between my vertebrae and I will be left with a completely immobile, terribly fragile spinal column, or “bamboo spine.” Two gut-shredding years of anti-inflammatory medicines left me with an ulcer, debilitating heartburn, and various food intolerances, as well as constant fear of potential side effects—like sudden and occasionally fatal gastrointestinal bleeding and heart attacks.
One of the particular torments of this condition is an inability to find comfort either sitting down or standing up. Seated in the departure lounge, I shift and wriggle in my seat. I take a little pill bottle from the pocket of my coat and hold it in my hand.
Through the window, the water in the harbour is slate blue, the financial district buildings beside it grey and blue as well, reflecting dull sky and dull water. It’s like being in a black-and-white movie—or a cyanotype, rather, blue scale. What a November day. But I am going on holiday. I’ve left my loved ones at home for the weekend, and for the next six hours, I’ll leave my pain behind as well—along with its accompanying stress, sorrow, and existential angst.
I chase the pale-yellow pill, an opioid called tramadol, with a bitter sip of coffee.
The radar weather on the TV screen above me shows a shifting, restless display of green-on-green clouds. It’s a good metaphor for the feeling I have during the hour or so after the pill: all the weather in me churning and gathering up and clearing itself out. I’m calm but alert. Anticipating. I still feel the pain that dogs me, but already its force is provisional, its minutes numbered. It no longer depresses me as it so easily can.
At last, with an unforced sigh, I’m released from pain. I finally lean back in my seat. The airport chatter is muted now. There is a faraway clattering of glasses, and the cackle of friends laughing to my right is now more distant. A man in a blue surgical mask cleans white cups off a table. As I take in the details, I begin to notice my breath going in and out—my stomach slowly rising and falling, air sweeping through my nostrils, down the back of my throat, filling up my lungs. A seagull floats unsteadily on the rough breezes outside.
By the time my flight is called, I’m able to stand up briskly, limber and quick. I walk carefully to my gate, smile serenely at the attendant as my passport and boarding pass are checked, and glide into the airplane.
The sky has brightened, the cloud cover lifted. As I settle into my seat, successive waves of good feeling wash over me like the surf. My holiday has begun.
In her book A Field Guide to Getting Lost, Rebecca Solnit writes of opiates and how they turn you “into a cool spectator of your own sensations and desires and of passing time, as languorous as all those images of divans and draperies and long pipes had promised.”
Yes. For the relief of severe pain, I take painkillers derived from and inspired by opium. I have taken morphine, extracted from the sap or resin of the opium poppy (and so “opiate,” a subset of the larger category, opioids); hydromorphone, a strong semisynthetic opioid made from morphine; and tramadol, a relatively weak synthetic opioid with a structure similar to those of codeine and morphine. All three of these drugs temporarily mask symptoms of my condition, against which even unhealthy amounts of Tylenol don’t stand a chance. They do so without the major side effects I’ve experienced with other medicines. Of the three, I like tramadol the best. It works on the brain both as an opioid and also as somewhat of an Effexor-like antidepressant. Tramadol relieves pain incredibly well, helps me sleep through physical discomfort, and perks my mood enough to manage the demands of the day.
Once I have decided that today is going to be a tramadol day, and I’ve given myself a deadline before which I absolutely will not cave in and take it, my experience of pain is transformed. Rather than grinding and hopeless, it feels charged, electric. The difficulty I have standing up (or sitting down) begins to feel noble. The constant, miserable, and exhausting stretching I do to relieve pain and stiffness in my joints acquires a warm-up quality.
I am already removed one degree from my own experience, and it is a little more observable, a little more interesting. I know that, in a little while, after some sore but delicious anticipation, the pain will melt away in an exquisitely gradual, perceptible way. And then I will feel expansive and happy.
Having some sort of time limit on suffering makes it endurable. It’s the same way in which running a marathon is tolerable because you know that it will eventually end. Every step gets you closer to relief. I don’t think I’m a lightweight. I like to believe that I’m an expert on pain after hours devoted to close study of it during the births of my two children—one at home, one in hospital, neither with painkillers. Those experiences taught me that the most intense pain imaginable can be tolerated for a time, and that the way we experience that pain—empowering, terrifying, humbling—can vary dramatically.
And so even childbirth, the most painful thing commonly experienced, doesn’t work as an objective measure. There are other sorts of pain, harder to describe. Chronic or recurring pains are insidious. They eat away at energy, optimism, endurance, sense of self. More relevant than a measurement or even a description of pain, then, is the completely subjective impact it has on one’s thoughts, behaviour, and physical health. Pain above a “level five”—moderate pain that dominates your thoughts and to which you cannot adapt, according to one scale designed to measure it—frequently results in temporary personality disorders. At higher levels that continue without relief, personality or other psychological disorders are almost ubiquitous, and suicide is common. If pain were a substance, it would be a dangerous, mind-altering one indeed.
But a quest for pain relief that settles on opioids can bring an escape that is more than just physical. Since well before pain became an issue for me, I have dealt with setbacks by trying, not always successfully, to follow writer Neil Gaiman’s advice: “Husband runs off with a politician? Make good art. Leg crushed and then eaten by mutated boa constrictor? Make good art. IRS on your trail? Make good art. Cat exploded? Make good art.” The breakup, the breakdown, the lousy boss, the crummy landlord, the diagnosis—they’re all experiences that I can one day turn into writing. That desire to produce something, anything, that feels meaningful becomes more urgent as the setbacks increase.
So much literature has speculated about the uncertain relationship between opioids and art. Art certainly acts, like drugs, as a form of short-term relief, and it helps me put routine pain into perspective. Even better, it’s comforting to find that my experience makes me (or lets me fancy myself) part of the long lineage of speculation on the relationship between art and drugs. Still, my own experiences have left me confused about whether opioid-based pain relief—or the other, infamous effects of opium-related drugs—actually improves my creative processes. And about whether pain itself makes me a better writer or a worse one. All I know is that both opioids and writing seem to have become vital to my existence.
Sometimes I imagine my ambitions as circus lions circumscribed by rings of fire. The fire is pain. Pain causes physical limitations, eats at my fragile sense of optimism, confuses my thoughts, imperils my livelihood, deadens the association-making ability from which creative work emerges. Pain makes me strained and cranky as I try to play with my two young children, who can absorb depression just as they thirstily absorb every other influence. Endurance is possible, but endurance on its own does not equal a full, contributing life. Our purpose in life is not, cannot be, simply to suffer.
In the evening, my children are asleep and the house is hushed save for the wonder of their little bellows-like breathing, which fills our apartment. I stand by the fridge and pour myself a mug of milk. Earlier in the day, anticipating this moment, I tried to focus on the exact nature and quality of the pain I experience—wanting to go beyond aversion, to get something out of the experience knowing that I have the power to banish it later on, when I am ready. That moment is finally here. I swallow a tramadol pill and a few pieces of bitter dark chocolate to keep me awake for the most magical part of my day. After an hour, as the pain melts away, I settle in at my desk.
So I write this under the influence. It’s a release that I’ve earned through the sheer effort of waiting for it all day. The ropey muscles of the neck that pull my head forward, the tight muscles around my hips, mid-back, and sacroiliac joints—they all seem to loosen at last. I sigh audibly, letting my shoulders fall. Gravity stops pounding me into submission. All at once, I seem able to inhale more oxygen than usual.
That breath is rich and deep. I’m also breathing more slowly than usual. I close my eyes almost unconsciously. When I let them close, just for a moment, there’s a pleasant weight on my eyelids, as if I were falling into a dreamless, restorative sleep. At the same time, I seem to float, perhaps on a pool raft drifting on saltwater waves, with a sort of inner buoyancy. It is wonderful.
I could stay in it forever, like those Victorian gentlemen found by worried families after days—prostrate on a back-alley opium-den couch, obscured in a cloud of stale smoke. But I open my eyes after a moment because, in the infinite peace and wisdom now upon me, I also see my goal: to write, to create, clearly and without stress.
First physical pain recedes, and then emotional pain. I was depressed, and now I am not.
Nothing is hazy or distorted or vague. There is no drunkenness, no lack of balance or blurring. I can once again see all the little worries and big angsts in my life from a bearable distance. And now, taken a little out of myself, I can also see and feel compassion for other people’s struggles, am interested once again in their stories. For these few hours I have regained the essential human characteristic of someone who is well and flourishing: a healthy curiosity about everything that is not me.
Not least, the thread of thought I want to track down and record in writing plays out smoothly, and I can follow it. Opioids seem to make it easier to derive symbols and metaphors from one’s imaginings or from the raw material presented by reality. On tramadol, I range freely in my thoughts. I can draw analogies, coming up with unexpected parallels between disparate things or ideas. This effect on analogical thinking is mentioned over and over in the literature on opium. More important, to my mind, is the calm, playful focus I can achieve with tramadol. It’s a state conducive to the odd combination of discipline and freedom that any artmaking requires. Peaceful, concentrated work is the best opioid side effect of all.
I close my eyes again. There are endless variations in the texture of good feelings that keep me here, happily working at my desk. Every time I close my eyes—every time I inhale, deeply, then exhale—these feelings are intensified. This eye-closing, this looking within: it’s a subtle action that, over a group dinner or in a café, I’ve sometimes caught friends catching, to my shame.
But why should I feel ashamed?
In the popular image of the prescription drug user, the drugs become a numbing substitute for life, but that is the opposite of my experience. I know that, if I hadn’t been taking tramadol, I would not have been sitting down as I wrote this. Because I simply wouldn’t have been able to sit down. Or, for that matter, to make dinner for my family, wash dishes, sweep crumbs off the table, or help my son floss his teeth. I don’t know how I would manage the unrelenting, ever-surprising trek of a rich, busy life without the sweet relief of painkillers. Sometimes I feel desperately grateful.
Adapted and abridged from On Opium: Pain, Pleasure, and Other Matters of Substance © 2021 by Carlyn Zwarenstein. Reprinted by permission of Goose Lane Editions.