Wednesday, July 26, 2006

Pain Is Us

Some of you readers may remember that I had an MRI of my LS spine in May. Turns out that I have two bulging discs and a nerve root sleeve cyst about 1 cm in diameter in the lumbar vicinity. What I gather so far from my reading is that these cysts are basically divertiulae of the arachnoid membrane and are filled with cerebrospinal fluid. A dye injected into the CSF will often be blocked by the cyst which can be shown to cause claudication, nerve compression and other symptoms. While Medcyclopaedia says that these cysts "do not have clinical significance", most of the other articles I've read beg to differ and describe various neurosurgical interventions employed in many countries for such outgrowths. While the disc bulges may reverse themselves, this cyst is not going anywhere and I surmise that it may be causing the significant pain which I've been enduring for some months now, even though my chiropractor seems to pay it little mind, instead suggesting that the Prozac and Prilosec I take are causing chronic myositis.

While chiropractic has helped to some extent with temporary pain relief, and massage therapy can soothe the muscles which seem to be in constant spasm, my PCP offered a referral to a physiatrist which I gratefully accepted. He also gave me a prescription for Vicodin which may as well be candy for all the effect it has. (And darn, Vicodin has so much less street value than Percocet!----just kidding....). My PCP also offered me more powerful narcotics like Oxycontin, but I declined, not wanting to go down that slippery slope.

Having lived with some modicum of chronic back pain for several decades, it's certainly an eye-opener to now have pain which has significant power to change my quality of life if I allow it to do so. I still swim, walk, drive, work, bike, and do housework, but my awareness of discomfort, alteration in sleep quality, and increased irritability and fatigue are noticeable to not only myself but also to my wife and colleagues. This experience is humbling vis-a-vis my patients with chronic pain, but also causes me at times to wish that some of them could have just a little more tolerance, turning less towards the narcotics and more towards the mind and the breath. Yet they are not me, we come from different worlds, have learned different survival skills, and have differing perceptions regarding the power and responsiblity of medicine and intervention to take away our pain. I don't deceive myself that the physiatrist will have all the answers, and I also don't deceive myself that a neurosurgeon will be able to completely eradicate this cyst since it will most likely grow back. I also accept that the physiatrist may say that the cyst is not an issue and we should look at other potential causes for my pain.

When looking at a patient with debilitating pain, it's now even more apropos for me to say "there but for the grace of God go I", especially since I now seem to be in some place akin to "there". Anywhere but here, you say? Possibly, but here I am. For now.
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