> ## Content Index > Fetch the complete content index at: https://fessup.mymidnight.blog/llms.txt > Use this file to discover other available public pages before exploring further. # The Chronic Pain Performance - URL: https://fessup.mymidnight.blog/the-chronic-pain-performance/ - Published: 2026-08-04T18:18:45.000Z - Updated: 2026-10-07T16:11:00.000Z - Description: How Fear, Stigma, and Public Policy Changed What It Means to Ask for Pain Relief - Author: Jerry Fess - Tags: chronic pain, paget's disease, epidemic, performance, physical therapy, bone pain, pain, opioid, addiction, therapy, spinal stenosis, chronic illness, fibromyalgia, cervical stenosis, Newsletter, #Migrated-1791389245739, #Import 2026-10-07 11:10 **“Do I look like I’m in enough pain today?”** That’s a question no patient should ever have to ask. Yet it’s the question I ask myself before every pain management appointment. Not because I’m trying to fool anyone. Not because I’m trying to exaggerate my pain. But because somewhere along the way, I began to wonder whether simply *being* in pain was no longer enough. ## When Patients Become Suspects If you’ve never lived with chronic pain, it’s difficult to explain what it feels like. Pain isn’t just something you experience. It’s something you live inside. It follows you into every room. Every errand. Every meal. Every attempt at sleep. Every moment of your life. According to the CDC, about one in five adults in the United States lives with chronic pain. That’s millions of people waking up every morning wondering how they’re going to make it through another day. I’m one of them. I live with cervical spinal stenosis and Paget’s disease of the bone. Some days it’s muscle pain. Other days it’s deep, aching bone pain that seems to come from everywhere at once. You learn to adapt. You learn to smile. You learn to carry on conversations while your body quietly screams. You learn to hide it. > **“The irony is that after years of living with chronic pain, many of us become experts at hiding it.”** And that’s where the problem begins. Those same coping skills that help us survive become the very reason people question whether we’re really hurting. If I laugh... Am I really in pain? If I make eye contact... Am I really suffering? If I don’t grimace every time I stand up... Maybe I’m exaggerating. Every appointment starts to feel like an audition. Should I limp more? Should I tell them about every ache instead of trying to stay positive? Should I stop joking? Should I let them see every wince I’ve spent years learning to hide? Because if I don’t look miserable enough... Will they think I’m drug-seeking? > **“No patient should ever feel like they have to perform their illness just to be believed.”** --- ## A Treatment Plan That Worked For nearly three years, I was under the care of a pain management clinic. ![person sitting while using laptop computer and green stethoscope near](https://images.unsplash.com/photo-1576091160550-2173dba999ef?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=M3wzMDAzMzh8MHwxfHNlYXJjaHw0fHxkb2N0b3J8ZW58MHx8fHwxNzg1ODY1ODUyfDA&ixlib=rb-4.1.0&q=80&w=1080) Photo by [National Cancer Institute](https://unsplash.com/@nci?ref=fessup.mymidnight.blog) on [Unsplash](https://unsplash.com/?ref=fessup.mymidnight.blog) Together, we developed a treatment plan that wasn’t perfect, but it worked. Notice I didn’t say it cured me. It didn’t. It simply lowered the volume enough that I could have a life again. > **The pain never disappeared. It simply became manageable enough that I could begin living instead of merely enduring.** My medication has never made me euphoric. It has never made me feel “high.” It has never taken my pain away. What it has done is make my pain manageable enough that I can be a person again. I can write. I can create. I can walk Pepper. I can go to the grocery store. I can participate in my own life. That isn’t addiction. That’s quality of life. But pain management wasn’t just a prescription. It was a partnership. During those three years, I faithfully attended physical therapy. Week after week. Month after month. Year after year. We worked on cervical traction, strengthening exercises, posture, stretching, mobility, and countless techniques designed to reduce my pain and improve my function. Some things helped. Some didn’t. But I never stopped trying. Because that’s what people living with chronic pain do. We chase hope. We keep searching for the next thing that might give us just a little more of our lives back. I’ve never believed there was one magic treatment that would make my pain disappear. If there were, I would have found it by now. Over the years I’ve learned that managing chronic pain means putting together as many pieces of the puzzle as possible. I still receive trigger point injections in my neck and shoulders, and they provide meaningful relief from some of my muscle pain. They’re not a cure. But they help. I stretch at home every day. When my neck flares up, I use a home cervical traction collar a couple of times a day. I still do many of the exercises I learned in physical therapy because they’ve become part of my daily routine. I do these things because I want to feel better. Not because someone tells me I have to. Because I refuse to give up on myself. People often assume chronic pain patients are looking for a pill to solve everything. Nothing could be further from the truth. > **“If a pill solved everything... I wouldn’t still be stretching. I wouldn’t still be exercising. I wouldn’t still be using traction. I wouldn’t still be getting trigger point injections. I wouldn’t still be talking about my pain in therapy. I wouldn’t still be searching for new ways to reduce my pain.”** The reality is that chronic pain is rarely managed with one treatment. For me, it’s medication... plus physical therapy... plus stretching... plus traction... plus trigger point injections... plus counseling... plus determination. Every one of those things helps. None of them, by themselves, are enough. Pain management shouldn’t be about choosing between medication or physical therapy... injections or counseling... surgery or exercise. The best pain management uses every appropriate tool available to help a patient reclaim their life. That’s why it hurts when people reduce my entire treatment plan to a single prescription. They don’t see the hours spent in physical therapy. They don’t see the stretching I do every day. They don’t see the traction collar sitting beside my chair. They don’t see the trigger point injections. They don’t see the counseling. They don’t see the daily work that goes into simply trying to function. One of the most valuable parts of my treatment wasn’t physical at all. It was being heard. Talking about chronic pain in therapy became just as important as many of the physical treatments I tried. Chronic pain doesn’t just affect your body. It affects your mind. Your relationships. Your confidence. Your identity. Your hope. Sometimes I’d leave a therapy session with exactly the same pain level I walked in with. But emotionally... I felt lighter. Because for one hour, I didn’t have to prove anything. I didn’t have to convince someone my pain was real. I could vent. I could admit how exhausting it is to hurt every single day. And someone simply listened. That mattered more than I can adequately explain. > **“Living with chronic pain isn’t just about managing pain. It’s about managing everything pain tries to take away from you.”** --- ## The Day Everything Changed Then everything changed. ![top view photography of broken ceramic plate](https://images.unsplash.com/photo-1508935620299-047e0e35fbe3?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=M3wzMDAzMzh8MHwxfHNlYXJjaHwyfHxnbGFzcyUyMGJyZWFraW5nfGVufDB8fHx8MTc4NTg2NTkxMnww&ixlib=rb-4.1.0&q=80&w=1080) Photo by [CHUTTERSNAP](https://unsplash.com/@chuttersnap?ref=fessup.mymidnight.blog) on [Unsplash](https://unsplash.com/?ref=fessup.mymidnight.blog) The pain management clinic I’d been seeing for nearly three years began making major changes. Eventually, it closed. Just like that, the treatment plan I’d spent years building disappeared. I wasn’t just losing a doctor. I was losing stability. I was losing a relationship with a medical team that knew my history, understood my diagnoses, and had worked with me to find a balance that gave me some quality of life. I remember lying awake that night wondering what would happen if I couldn’t find another physician willing to continue my care. Would my pain become unbearable? Would I lose the ability to write? To create? To walk Pepper? To hold on to the small piece of life I’d fought so hard to reclaim? Suddenly, I was left with two choices. Find another physician willing to continue managing the medication that had helped me for years... ...or begin tapering off it completely. Imagine hearing that after years of following every rule. No failed drug tests. No early refill requests. No misuse. No broken pain contracts. I had done everything that had been asked of me. Yet I still found myself wondering if the treatment that had helped me live my life was about to disappear. My primary care physician did everything she could to help. She listened. She understood how disruptive this was. She referred me to another pain management clinic, hoping they could continue my care. I walked into that appointment hopeful. That feeling didn’t last long. The first words out of their mouth were: **“We don’t prescribe opioids. We only do injections.”** There was no conversation about what had successfully managed my pain for the previous three years. No one asked what treatments had worked for me. No one asked what had allowed me to function. No one asked what had given me back a small piece of my life. Instead, the conversation immediately shifted to scheduling epidural injections in my neck and lower back. I remember sitting there thinking... **“Wait... don’t you want to know what has already been helping me?”** I’m not opposed to injections. In fact, I already receive trigger point injections in my neck and shoulders, and they provide a lot of relief from some of my muscle pain. If another injection has a reasonable chance of helping, I’m willing to consider it. I’m not opposed to surgery if it’s truly the right answer. But I have cervical spinal stenosis. I also have Paget’s disease of the bone. Much of my pain is a deep, aching bone pain that affects multiple parts of my body. So I couldn’t help asking myself... **How does spine surgery treat pain throughout my skeleton?** How does an epidural fix widespread bone pain? Those are honest questions. Maybe those procedures will help part of my pain. Maybe they won’t. What troubled me wasn’t that injections were offered. It was that no one first asked what had already been working. Shouldn’t the first question have been: **“Tell me what’s worked for you.”** Not every patient is the same. Not every diagnosis is the same. Not every treatment works for every person. Medicine is supposed to be individualized. That day, it didn’t feel that way. > **“Treatment should begin with a conversation, not a policy.”** --- ## Fear in the Exam Room As time has passed, I’ve realized this story isn’t just about patients. ![Wooden gavel resting on a dark surface next to book](https://images.unsplash.com/photo-1767972463877-b64ba4283cd0?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=M3wzMDAzMzh8MHwxfHNlYXJjaHw0Mnx8cmVndWxhdGlvbnN8ZW58MHx8fHwxNzg1ODY2MDIxfDA&ixlib=rb-4.1.0&q=80&w=1080) Photo by [Sasun Bughdaryan](https://unsplash.com/@sasun1990?ref=fessup.mymidnight.blog) on [Unsplash](https://unsplash.com/?ref=fessup.mymidnight.blog) It’s about doctors, too. I don’t believe most physicians went into medicine wanting to abandon people living with chronic pain. Many are caught in an impossible position. Over the past decade, the practice of prescribing opioid medications has changed dramatically. Physicians face increasing scrutiny from regulators, insurers, health systems, licensing boards, and government agencies. Many worry that prescribing these medications, even appropriately, could lead to investigations, disciplinary action, or even jeopardize their careers. Imagine spending years becoming a physician because you wanted to relieve suffering... ...only to find yourself wondering whether helping the patient sitting across from you could cost you your medical license. That’s heartbreaking. Fear now sits in the exam room with both of us. The doctor fears losing their license. I fear losing the treatment that has allowed me to have any quality of life. > **“Neither of us should have to practice medicine from a place of fear.”** The opioid epidemic is real. It has devastated families and communities across this country. People living with addiction deserve compassion, evidence-based treatment, and support. But another truth deserves to be heard. There is a profound difference between **physical dependence** and **addiction**. Physical dependence is a normal biological response that occurs when the body adapts to certain medications over time. It can happen with opioid medications, but it can also happen with antidepressants, steroids, anti-anxiety medications, and many other prescription drugs. Addiction is different. It is a medical disorder characterized by compulsive use despite harmful consequences, cravings, and a loss of control. Those two terms are not interchangeable. Yet many chronic pain patients are treated as though they are. That stigma follows us into every appointment. Every pharmacy. Every refill request. Every skeptical glance. Research has shown that people living with chronic pain experience significantly higher rates of depression and suicidal thoughts than the general population. When effective treatment disappears without an appropriate alternative, the consequences can be devastating. > **“Legitimate pain patients are paying the price for a crisis we didn’t create.”** That sentence isn’t meant to dismiss the tragedy of addiction. It isn’t meant to suggest that opioid medications should be prescribed without caution. It’s simply an acknowledgment that two public health crises can exist at the same time. We should be able to address addiction without abandoning people living with legitimate, documented chronic pain. Those goals don’t compete with each other. They should exist together. --- ## Listening Before Treating This isn’t about demanding opioid medication for everyone. ![a few pills on a table](https://images.unsplash.com/photo-1666902797199-126078fb589d?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=M3wzMDAzMzh8MHwxfHNlYXJjaHwxM3x8bGlzdGVuJTIwcGlsbHxlbnwwfHx8fDE3ODU4NjYxMjV8MA&ixlib=rb-4.1.0&q=80&w=1080) Photo by [Kobe Tang](https://unsplash.com/@kobetang?ref=fessup.mymidnight.blog) on [Unsplash](https://unsplash.com/?ref=fessup.mymidnight.blog) This isn’t about pretending these medications don’t carry risks. And it certainly isn’t about ignoring the devastating impact addiction has had on so many families. It’s about recognizing that chronic pain isn’t one disease. It doesn’t have one cause. It doesn’t have one treatment. And it certainly doesn’t have one solution. Some people find relief through physical therapy. Others through injections. Some need surgery. Some benefit from counseling. Many need a combination of treatments. And yes, for some of us, opioid medication remains one important part of that plan. The goal shouldn’t be to eliminate one tool from the toolbox. The goal should be to use every appropriate tool available to help each patient reclaim as much of their life as possible. That’s exactly what I’ve been trying to do. I’ve embraced physical therapy. I continue doing the stretching exercises I learned there. I use my home cervical traction collar when my neck flares up. I receive trigger point injections because they genuinely help relieve some of my neck and shoulder pain. I talk openly about my chronic pain in therapy because mental health is just as important as physical health when you’re hurting every day. I don’t expect one pill to solve everything. I never have. I’ve spent years doing everything I can to help myself. Because that’s what good medicine should be. Not one treatment. Not one policy. Not one-size-fits-all. A thoughtful combination of therapies, tailored to the individual sitting in front of the physician. Most of all, it’s about remembering that behind every MRI... Every diagnosis... Every prescription... Every pain contract... Every drug screen... There is a human being. A person who wants to play with their grandchildren. A person who wants to walk Pepper. A person who wants to create. A person who wants to work. A person who wants to sleep through the night. A person who simply wants a life that’s bigger than their pain. When I walked into that new pain clinic, no one asked me what had been helping me for the previous three years. No one asked what had allowed me to function. No one asked what had given me back a small piece of my life. Instead, the conversation began with scheduling procedures. Not with understanding my history. Not with asking about my diagnoses. Not with asking what had already worked. Just... *“Here’s what we do.”* Maybe that’s where modern “interventional” pain management has lost its way. The best treatment plan doesn’t begin with an injection. It doesn’t begin with a prescription. It doesn’t begin with surgery. **It begins with listening.** Because no one should have to perform their pain before they’re allowed to tell their story. Pain management should never begin with, *“Here’s what we do.”* It should begin with one simple question, ***“Tell me your story.”*** --- *For every chronic pain patient who has ever felt they had to prove their pain to be believed.* *\- By Jerry Fess* --- [Buy me a coffee](https://buymeacoffee.com/jerryfess?ref=fessup.mymidnight.blog) [Leave a comment](#ghost-comments-root) [Subscribe](#/portal/signup)