During a freak accident at work back in 1996, Patty Monteath suffered a compound fracture in her ankle. The bone eventually healed, but she has been in excruciating pain ever since. The injury resulted in a neuroma, a thickening of nerve tissue that’s caused by compression of the nerve itself. The pain is so severe that it hurts to wear shoes or socks.

“Painkillers like morphine can’t even touch it,” Monteath tells the Georgia Straight in a phone interview. “It’s so sensitive that when I’m sleeping, I have to keep the bed sheets away. If the wind is blowing on top of my foot [outside], I have to turn around.…You live in a permanent state of exhaustion.”

Like millions of other Canadians, Monteath has been in the unenviable position of learning that the effects of chronic pain go far beyond the physical.

“One of the biggest problems is that people think it’s in your head,” Monteath explains. “You start feeling like such a wimp, because you can’t do this and you can’t do that. It’s as much about controlling the pain as it is trying to cope with your life in a totally new way.”

The power of the mind can, in fact, play an enormous role in the treatment of chronic pain. Monteath learned that firsthand when she visited St. Paul’s Hospital’s pain centre. There she met Roger Shick, a psychiatrist who heads the centre’s multidisciplinary and collaborative team, which also includes a neurosurgeon, physical therapists, occupational therapists, a psychologist, social workers, an anesthesiologist, a pharmacist, nurses, pain specialists, and other health professionals.

People visit the centre because of debilitating pain caused by everything from car crashes and sports injuries to fibromyalgia and rheumatoid arthritis. By the time people get a referral from their family doctor to attend the clinic, they’ve typically experienced chronic pain for years, Shick tells the Straight, and it can take as long as a year to get an appointment.

“When you live with pain every single day, it wears you down,” Shick says in a phone interview. “When the pain won’t go away, and you can’t find a cause or generator of the pain—when you can’t see anything on a blood test or X-ray or CT scan or MRI—to be believed is a big thing. Otherwise, patients start to think, ‘Maybe it is in my head.’ They question their ability to read reality, and that makes everything worse.

“Usually what happens is the pain gets memorized in your brain,” Shick explains. “You could take the pain away by taking someone’s leg off, but they’d still have leg pain: phantom leg pain.”

But here’s where neuroplasticity—the concept that the brain can adapt and reorganize itself through new neural connections—comes in.

“Through relaxation, meditation, self-hypnosis, the unconscious mind can tune out that pain and find a quiet, serene place,” Shick says. “In the mind, you can let the pain go away. It’s a way of taking a break from your pain. It’s about tuning in to another part of your mind.”

Not to be confused with the kind of trances made famous by Reveen, the self-hypnosis Shick is referring to is a state of highly focused attention.

As an example, he points to a patient who had migraine headaches so intense that the man would walk into Shick’s office yelling, swearing, and holding his head. Shick instructed him to “go to the most comfortable place you’ve ever been in your whole life.”

“He became quiet,” Shick says. “His breathing slowed down. His face looked more relaxed.…when he opened his eyes, I said, ‘Where did you go?’ He was five years old at this shack in Texas with his parents, and it was raining, and he could hear the pitter-patter of the rain on the roof. There was laughter. It was a warm, cozy, familiar scene. His [improved] physiological state is what he invoked by his memory.”

Shick is quick to acknowledge that self-hypnosis doesn’t work for everyone. Often, people are as skeptical as they are desperate. But after years of constant agony, they’re willing to try anything.

Using the techniques Shick taught her, Monteath has learned to contain the pain by focusing her attention.

“[Before,] the pain spiralled right up my leg from my foot,” she explains. “In the last few years, I’ve managed to use it [self-hypnosis] to a certain degree; now the pain very seldom gets above my knee.”

The pain centre team’s other approaches to managing pain include neuromodulation through the stimulation of selected nerves in the spinal cord by tiny electrical pulses or the use of a surgically inserted pump that dispenses medicine continuously. Then there are exercises, physical and occupational therapy, psychological strategies, and other methods, usually used in combination.

According to the Chronic Pain Association of Canada, about 18 percent of people in this country suffer from severe, ongoing pain. The Edmonton-based organization’s Web site notes that persistent, extreme pain makes it hard for people to concentrate, perform routine tasks, and remember things. Depression and loss of independence are common. The financial burden can be devastating to individuals and families.

Monteath says her “warped” sense of humour helps keep her going, as does her stubbornness.

“You have two choices: you can stay in bed all day, or you force yourself to get up and do whatever you can,” she says. “I try and do at least one productive thing a day, even if it’s doing a few dishes.”

Distraction plays a role as well: Monteath finds it relaxing to do puzzles, garden, and volunteer when she feels well enough.

Then there’s the support she gets from doctors like Shick.

“They’re never willing to give up,” she says. “There’s always hope.”