Thursday, April 19, 2007

Me, My Pain, and a Hangover

Remember those silly t-shirts that said, "My parents traveled to (name of city) and all I got was this lousy t-shirt"? Well, my body and brain are saying a similar thing to me this morning: "Our resident mind decided we needed a muscle relaxant last night and all we got was this lousy hangover".

My back was killing me last night, even after a Neuromuscular Therapy appointment, an hour on the TENS unit, and a little more bodywork by Mary in the evening. So, I took a muscle relaxant to decrease the muscle spasms in my lower and mid back, and hoped that I perhaps might sleep through the night, something I haven't done for weeks now. Sadly, I still awoke at 2am, did yoga for twenty minutes, subsequently removing myself to the downstairs bedroom for the remainder of the night. Did I sleep? Yes, with continued discomfort, and awoke with a brain filled with stuperous cotton candy, awful cotton mouth, and a body ready for nothing but lethargy. I had to laugh, knowing that today would be a 12-hour workday, with per diem home visits from 7:30 to 9:00am, regular job from 9 to 5, and evening clinic from 5 to 8pm. Amphetamines, anyone?

That said, my day today has been spent assuaging the pain of others, obtaining narcotic scripts for chronic pain, giving attention to others' aches, pains, and complaints. Sometimes, based upon my relationship with a patient, I might decide to share with them my own struggles with chronic pain if I feel that my personal disclosure would be of some benefit. More often than not, though, I realize that I, as a working professional, have access to many other treatment choices (ie: massage, neuromuscular therapy, acupuncture, a gym with a pool), and thus the disclosing of my own struggle could, in fact, elicit envy in my patient rather than my intended purpose of commonality. Therapeutic use of self is a tender beast.

Speaking of tender beasts, my back twinges and aches now as I type. Non-steriodal anti-inflammatories (NSAIDs) like Tylenol, Motrin, and Aleve do nothing. Massage seems only to scratch the surface now. Trigger-point injections did almost nothing, and a spinal injection yielded less than two weeks of moderate relief. Where to turn? My patients take narcotics for chronic pain: Oxycontin, oxycodone, Fentanyl, Percocet, Vicodin. I'm just not willing to go there. So, here we are, me and my pain. Oh yeah, and the hangover, too.

Over time, pain becomes part of the physical and psychological landscape, like the feeling you have being in your own skin, or the familiar brush of one's arm against one's side. Pain becomes an appendage, something that's just there, like an extra limb growing in the wrong place. It becomes difficult to even imagine what it was like to not have this pain. Was there even a time when it wasn't there?

So, when my patients complain of pain and ask for meds, I serve them as best I can, knowing full well that those meds may mask the pain to some extent, but the underlying pathology---if one can be discerned at all---often remains a mystery. Even those with correctable pathologies---a herniated disc, for example---may find little or no relief after spinal surgery, the pain sometimes even worse than before their operation. Sadly, there are many cases where the cure indeed seems worse than the disease. And then it's too late.

For now, I grin and bear it, laugh if I can, and try to make friends with this ache that just never seems to go away. If you, dear Reader, suffer from a similar chronic and recalcitrant affliction, welcome to an enormous club. Membership is free, of course, but the price you will pay is dear.
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