Monday 16 July 2012

Health: Chronic Pain: Welcome To My Hell

Twenty-four hours a day, seven days a week. My number one preoccupation is pain management. Even if I manage to do my job, go buy groceries, do something mundane like my laundry, or even type these words, it is but a momentary distraction from the ever present mishmash of aches, shooting pains, numbness and tingling I feel throughout the upper left quadrant of my body. A sports injury has traumatized my left shoulder and arm but more importantly, left me with a herniated cervical disc. Yes I have to heal from nearly tearing my rotator cuff (Thank God I stopped short of doing that!) but the written report of a MRI of my neck explains in medical jargon:

At C5-C6 and C6-C7, there are small posterior osteocondral bars and uncovertebral osteophytes with suspected resulting moderate to severe bilateral neural foraminal stenosis, poorly evaluated due to motion artifact.

The expression "motion artifact" refers to me moving during the MRI. Periodically, I have a bout of pain, sometimes really bad pain and at the time of the MRI I had an attack. While standing up I wasn't too bad, it was excruciating lying down in the MRI machine and despite my best efforts to grit my teeth; I couldn't help shifting in a vain attempt to lessen the pain. Apparently the doctor thinks the image is good enough so for the moment, nothing else has been scheduled.

In trying to interpret all the medical terms, I am reminded what a sports medicine specialist told me: "If this hadn't happened now, it would have happened in two or three years." It would seem that the wheels have been slowly falling off the wagon for some time now.

In a nutshell I have a number of issues that seem to be in part related to aging (I'm going to be 60 this year!) but may or may not be related to what I'm doing. I would like to think I'm taking care of myself, eating right and exercising regularly, but considering my sedentary lifestyle (I work with computers), have I been paying attention to the ergonomic side of my workspaces? Have I been exercising correctly? (The immediate and obvious cause of my injury was over-stretching the tendons in my left arm while doing push-ups.)

All of this has left me dealing with pain I must now qualify as chronic. While my reading shows slightly different definitions of the word chronic, the consensus of opinion is that chronic pain is pain which goes beyond what one would consider a normal period of time for healing. I think of pain as the body telling me that something is wrong but if the pain continues after what one may think is a normal time for healing (I have just passed the 14 week mark: three and a half months), I have to start thinking that something is permanently damaged as the body can't heal itself.

Am I right or wrong? Am I being impatient? While each case is different, while the severity of injuries vary greatly, I have read that rotator cuff injuries can take anywhere from six months to a year to heal. I have read that 90% of herniated discs heal on their own and take from one to six months or longer. Is any of this applicable to my situation?

First of all, the time frames given indicate to me that I still have a way to go before throwing in the towel and saying that my body cannot heal my injuries. Secondly, a ninety percent success rate for my herniated disc healing itself seems promising. However, having just passed the three month mark, I would have expected to be further along (or am I saying, "I would have hoped"?). This is certainly giving me cause for concern. Is my injury not part of the 90% but of the 10% representing a degree of severity warranting more drastic measures like surgery?

A few years ago, I thought of making a once in a lifetime trip to China. This last fall, a business colleague went and the story of the trip, the glorious pictures and the details of the reasonable all-inclusive costs renewed my resolve to make the pilgrimage in the fall of 2012.

I'm laughing about such an idea now as that plan has been completely taken off the table. As I've explained elsewhere, I can't walk a hundred feet (30 m) without feeling tingling and numbness in my left hand and shooting pains in my forearm. It is so unpleasant, sometimes excruciating, I haven't gone for a stroll in over three months. Yes I walk to the grocery store but I do so while gritting my teeth. Walk on the Great Wall of China? Ha! I'd love to walk around the block.

Gee-sus H. K-rist, how do people deal with this? Every goddamn waking moment revolves around pain. Even if at one precise moment I think I'm not feeling too bad, all I have to do is stand up and walk around a bit to bring on a wave of tingling, numbness and shooting pains.

Wikipedia: Chronic Pain: Epidemiology
In a systematic literature review published by the International Association for the Study of Pain (IASP), 13 chronic pain studies from various countries around the world were analyzed. (Of the 13 studies, there were three in the United Kingdom, two in Australia, one each in France, the Netherlands, Israel, Canada, Scotland, Spain, and Sweden, and a multinational.) The authors found that the prevalence of chronic pain was very high and that chronic pain consumes a large amount of healthcare resources around the globe. Chronic pain afflicted women at a higher rate than men. They determined that the prevalence of chronic pain varied from 10.1% to 55.2% of the population.

10.1% to 55.2%? Good lord, just how many people are there in the world suffering from on-going problems? How many people have what I have?

Since word has gotten out about my dilemma, I have been surprised to find out just how many people I know whether personally or as an acquaintance at work, have suffered all sorts of injuries and put up with all sorts of pain. A guy I barely know told me that two years ago he tore his rotator cuff and required surgery. A lady told me she's had two spinal fusions, one in the neck and one in the lower back, due to car accidents. (I promised to buy her a coffee if she told me about her experiences with the fusions: loss of mobility, amount of pain or no pain, residual problems.) One fellow in hearing about a pinched nerve attack I had a couple of months ago, brought in some of his Tylenol 3 telling me he's collected quite a stockpile of drugs over the years due to his various problems including bad knees, a bad lower back and a bad shoulder.

The above mentioned Wikipedia article states:

Chronic pain's impact on cognition is an under-researched area, but several tentative conclusions have been published. Most chronic pain patients complain of cognitive impairment, such as forgetfulness, difficulty with attention, and difficulty completing tasks. Objective testing has found that people in chronic pain tend to experience impairment in attention, memory, mental flexibility, verbal ability, speed of response in a cognitive task, and speed in executing structured tasks.

Considering that my focus is on my pain, it is difficult to think of anything else. I've joked about how at work, somebody will be discussing business with me and I look like I'm listening attentively but I'm really thinking, "I don't care." If the pain spikes, let's make that "I don't give a rat's ass."

You have no idea of what I'm talking about
I've said this before: if you have never been through this, you have absolutely no idea of what I'm talking about. Hell, I had no idea of what I was talking about before this happened. Yes, I know the meaning of the term chronic pain. Yes, I've talked with people who have described it to me. But that was merely understanding the situation from a purely intellectual point of view. I heard the words but did not "feel" their meaning. It is not until you actually go through the trial by fire that you say to yourself, "Oh, now that's what the word excruciating means." And now I know. Oh yes do I know! Excruciating... bad word, bad word. Avoid at all costs. Mayday! Give me drugs or have mercy and knock me unconscious.

Final Word
In a couple of days, I have a follow-up with the neurologist who did an EMG test, confirmed a suspected herniated disc, and then ordered the MRI of my spine. What will he say? What is the prognosis? My future is in his hands.

I can't continue to live like this because this isn't living; this is enduring. Yes, I'm not living my life, I am enduring my life. I don't think of going to China; I think of how I am going to get through the day. Do I try another ice pack? Do I heat up my bean bag in the microwave to apply a hot pack to my neck? Do I give up and resort to medications? Is ibuprofen enough or should I step it up a notch and use the pregabalin my family doctor prescribed to me? Can I take my mind off things if I poke myself in the eye with a pencil? Okay, that last one was to prove I haven't completely lost my sense of humour.

I look out my window and I see people walking, jogging, and enjoying the outdoors. I see people having picnics, playing in the park, living their lives and enjoying themselves. My life has come to a dead halt. My entire world has shrunk down to my apartment, a microcosm of cold and hot compresses. I jokingly said to an acquaintance that if I ever get out of this mess, I'm going to start attending church regularly. See? I really am desperate! Ha ha ha.

God, am I screwed or what? I wrote this elsewhere and meant it: I wouldn't wish this on my worst enemy. Life really sucks right now. Boy ain't I a ray of sunshine.


Wikipedia: Pain
Pain is an unpleasant feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping the "funny bone." The International Association for the Study of Pain's widely used definition states: "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage".

Wikipedia: Chronic Pain
Chronic pain is pain that has lasted for a long time. In medicine, the distinction between acute and chronic pain has traditionally been determined by an arbitrary interval of time since onset; the two most commonly used markers being 3 months and 6 months since onset, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."


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Cathy said...

In 2002 I had a car accident that injured by neck. During tests they discovered I have bone spurs and arthritis. I've not had a pain free day since that accident.

To begin with there would be periods throughout the day where the pain would hit. Over the last 7 years it has been pain 24/7 and I've come to terms with living my life in chronic pain.

I have days where cognitively I'm shot. The fatigue is worse than the pain though when it comes to functioning and keeping you with my daily routine. It is true that people have no idea. To look at me I appear to be healthy and fully functioning.

I’ve learned something valuable about myself through the experience…I’m a very patient and tolerable person. I may not be able to function at 100% but I’ll be damned if I’ll give in or give up.

You keep chugging along. With medical intervention and time you will get the relief you desire. My mother just had a stimulator inserted that took care of 95% of her pain. She had her spine fussed when she was 73 and 10 days later was out Christmas shopping.

If you have access to good healthcare there have been wonderful advances in how pain is treated.

Shannon said...


I can totally sympathize. I have a painful degenerative genetic condition. People who don't have chronic pain really do not understand. In the course of my 16 year battle with pain, I started a chronic pain blog to try to help others avoid some of the pitfalls I fell into and to help provide information they may not know about. I try to be informational, educational and inspirational no matter what type of pain my followers have. Perhaps you'll find something helpful on my site:

Nip Pain in the Bud & Let Your Soul Blossom

Good luck to you!