Painageddan: My first hand account of surviving a Pain Crisis and latest, ongoing flare.

Educational Article for Peer Support: Navigating Acute CrisisI. Introduction: Strategy in the Worst State

I am sharing a raw, immediate account of a sudden and overwhelming pain and panic episode. This was a re-experience of one of the worst physical and mental states I have encountered in my chronic pain journey.

I am sharing this not just to recount the event, but to show how specific, practiced techniques—rooted in understanding our own nervous system—can be deployed in real-time to survive a crisis. The goal is to move from a state of "pure animal mind" (fight-or-flight) back to a state of self-control (parasympathetic calm).

The following section is my unedited, word-for-word inner dialogue and physical actions as they unfolded during the crisis.

II. The Actual Account:

Day 1, Painageddan

I came out of my bad dream feeling breathless and sweaty, but still numb. My mind went over the last images that my brain had given me before I woke up, and a sense of fear enveloped me the next second. As my systems came online, it hit: agonizing pain everywhere from my head, through my entire body and down my legs to my feet. My big toe is extended, flexed outward and stuck,  with a Charlie horse in my calf and foot. 

I quickly scanned myself. I’m shaking, my breath is short, I feel breathless, my heart is pounding in my ears—a jackhammer.

Once I appraise that, I recognize that I am in fight or flight mode and something is wrong. Luckily, throughout the years, through my reading and my experiences with others, I immediately thought: Fight or flight. I have to reverse this. I need to go into parasympathetic mode. What do I do?

My next thought: I need vagal nerve activity. I began humming, humming, and then next began my breathing. The humming is known to be able to activate the vagal nerve, and breathing, taking control of my breath and ensuring that I’m breathing out twice as long as I take the breath in, holding at the end of my breath, attempting silence of everything for two seconds.

I start with that breathing technique. It works before I begin to feel the panic just ease up a bit. I continue to hum and then start singing when it doesn't seem to do much more. So, I alternate between singing and taking big gulps of air in during the song, waiting where I need to to blow all of the air out and take it one more time in to sing. I continue to do that, and I feel the jackhammering in my head.

...And I feel the... the jam jamming... Oh, the loss of words. The loss of words. 

I want to call out to my husband for help, but I can't seem to get my whirling mind to order myself to speak. All I can do is to try to slow everything, my breath, my heartbeat, and mostly, my panicked mind. 

 "Yes, I think my heart rate is going down. I know I need the next thing: pain pills."

 I start tapping along the carotids of my neck. The vagal response can be activated for the parasympathetic system, and the parasympathetic system is exactly what I need. The opposite of fight or flight. Whereas the sympathetic system is firing me up and hitting the gas, the parasympathetic system can help begin slowing down, slowing down on the brakes, gaining control, getting back to normal.

I begin to feel like I can speak. My breathlessness and panic are subsiding, are going back. I think now about what I’m going to do with my medication. I have morning meds, but I know that they’re all long-acting, and the only short-acting that I have is my Statex morphine.

I quickly scan myself again. I feel like there is a socket, maybe at the top of my head or somewhere. And then down... it feels like aluminum has been put through my spine and down to my pelvic region, down both legs, and into my toes. It feels like that whole rod is being tightened inside while simultaneously being electrified with a steel rod pain—hot pain that I can barely understand. Outside on my skin, and worse, not even my skin... my entire being, outside of the spine that I feel and the breath that I hear and my heart that is pounding. This is my entire universe for a few moments. The electricity is like sparkling, hot welding shards, and it rumbles and goes in waves, like an electromagnetic field where all I’m getting is the electric. It surrounds me and is in me.

I know I’ve got to continue to work on calming myself. I need to get to the point where my breath is controlled enough that I can call out to get help. You see, I am mostly bedridden. My legs will hold my weight, but I can no longer get my mind to control them. I cannot really tell them to lift. Sometimes I can, but it’s not sufficient to make a step. This means that I'm not going to be able to get up and get my medication. I need to control my breath just enough that I can yell for my husband.

This is crazy, I’m thinking. I haven't been like this for at least a year and a half, and these episodes were what eventually sent me to the hospital for a number of tests. But I had had it largely under control. My mind briefly touched on: Where is this? Why is this? How is this happening again? Because this is how I was when I started. This is me back in 2002 and 2003 as the symptoms grew and these attacks became, and no one understood. Back to the time where no one really believed that the hell I was describing could possibly be real. 

Back in the moment. I continue to use my breathing exercises until I feel that I can get enough out to call for my husband, David. 

I yell to him  in that certain tone that he knows means I’m in trouble, and he comes in like a hero, the way he always does. 

He sees I can’t talk, and for a moment—for just a moment—I can see him considering and calculating, and trying to understand what the next step should be. And then I see it hit him: We’ve been through this before. This is the worst of the worst. And he knows what to do.

He goes and he grabs my long-acting, my morning medication, which I had not taken for 12 hours, and my breakthrough Statex, and my marijuana vape. The Statex is normally for breakthrough, and I only use the vape with the THC in it when I cannot maintain a normal amount of pain. I mean, I woke with a sudden experience where it came in as an 9 out of 10, just almost beyond words or thought. Just pure experience. My entire universe with only my thoughts speaking to me and everything else consumed by the pain. I don't see, I don't really have any input that way. ALL  I’m doing is processing the pain.

So quickly, he gives me my morning pill dose and runs to get a coffee and a Coke. The morning medication, I know, will not even kick in for about two and a half hours. Most of it are long-acting morphine, my daily diabetes medication and modafinal (unfortunately a stimulant, which I probably should have taken out but didn't think so in the moment), and some medication to protect my stomach.

I recognize that this is going to take too much time to get relief. I reach for my other medications and grab the short acting Statex ( that is my morphine 10 mg short-acting) , and my mind—which has been so trained over these years to make logical, organizational to-do list structures, step one, step two—runs to: "You need to crush these, and you need to put them under your tongue and you need to hold it there so that it can get into my body the quickest it can."

I know that I'm also going to need coffee and Coke. I need to load up on them quickly now. In this case, it's difficult because my heart's already racing, and adding caffeine,(a stimulant) would naturally make that worse. But it also works to potentiate the opioid. And I know that the effect of the opioid will be stronger than that of the caffeine. And so I make the decision quickly be estimating benefit versus risk. What's going to work better? What's going to be more effective with the least side effects or risk? I decide I will use the caffeine in the Coke and the cola. It's a trick I had read in Dr Tennant's first book “The Intractable Pain Patient's Handbook for Survival.” Free here: 

https://www.coccyx.org/medabs/IntractablePainSurvival.pdf

I crush the Statex and put it under my tongue, as bitter as it is, and let it rest while concentrating on continuing my breath, my breathing, ensuring that I take a full belly breath in and then release it, and release it with twice the length of time that I took the breath in. 

As the pain and this panic subsides, I'm able to stretch that out to give myself a two-second count worth of nothingness at the end: no breath in, no breath out, and no thought. I do this to the best of my ability and pray for some relief to come. 

My husband comes and sits beside me and holds my hand. I know that his touch will reduce the pain in my for me by about 30%.

 Is it placebo? Is it oxytocin from touch? I don't know. But I know that one of the best ways for me to get back to my parasympathetic system and to get my pain under control is to have the touch of my husband, either with a hug if I can breathe well enough, or with him just holding my hand.

Eventually, I sink down so that he is beside me and I have my head in his arm. Everything is calming.  The pain remains but begins to lower, in tandem with my panic. 

We try to keep everything quiet as I control my breathing, feeling a little bit like when I was able to get a little bit of control by using breathing exercises, feeling some control return despite the chaos of the pain that is delivery. 

I take a breath and I begin to feel e like I am back in control. The emergency is over. My executive functions come back online. I can begin to get control over my mind and body. Before it was pure animal mind, pure fight or flight. The worst part being: it's got  to be  fight. We cannot flee from ourselves. We cannot run from the experience. And so we must tame the animal first, make friends or at least make peace, and then move forward as the master of ourselves once again.

III. Summary for Learning: Takeaway for Peers 

This raw account offers vital, actionable insights for managing a sudden pain and panic crisis. It demonstrates a multi-layered approach to shifting your body and mind out of the emergency response.

1. Engage the Parasympathetic System (The Brakes)The immediate priority is to activate the Vagus Nerve—the main communication line to the calming nervous system.

   • Vocalization: Immediately start humming, singing, or chanting. The vibrations help stimulate the vagus nerve and slow the heart.

   • Targeted Touch: Gently tap or massage along the carotid arteries in your neck.

   • Human Anchor: Recognize the therapeutic power of trusted touch. A partner's hand-holding or hug can instantly provide a measurable reduction in pain and anxiety, helping the system settle.

2. Master the Breath (The 2:1 Rule)Control over breathing is control over panic.

   • Lengthen the Exhale: Focus intensely on ensuring your exhale is twice as long as your inhale (e.g., breathe in for 3 seconds, out for 6 seconds). This actively slows your heart rate.

   • The Reset Pause: Try to hold your breath for 2 seconds at the end of the full exhale. This interruption helps reset the panic cycle.

3. Strategic Medication UseIn a crisis, every second counts for breakthrough medication.

   • Optimize Absorption: If approved by your prescriber, consider the fastest method for your short-acting medication (e.g., sublingual delivery by crushing and holding it under the tongue). This can only be done with short-acting medications. Do not attempt with extended release formulations. 

• Benefit vs. Risk Calculation: Be ready to quickly evaluate whether a risk (like caffeine stimulating a racing heart) is worth the reward (like caffeine potentiating the opioid for faster pain relief). The goal is to quickly choose the most effective option to end the crisis.

The final takeaway: 

You cannot flee the pain, so you must tame the animal within. By deploying these trained responses, you shift from being a victim of the episode to being the master of your own system.