I've been dealing with chronic pain for two years. It started on an absolutely normal day in September of 2022. I was sitting at work and all of a sudden I felt this sort of dull stab in my lower left back. I hadn't had any accident or injury, and I always lift heavy objects with my legs, so it was kind of a surprise, and also a mystery. And trust me, you don't want anything medical to be a mystery. The pain lessened when I stood, and got worse when I sat, especially on a hard or unsupportive surface. Always in the same spot - lower left back. Sometimes it radiated upward, because your other back muscles will often try to compensate for the weakened one, and that just throws a wrench in the whole system (and a knot in your trapezius).
Because it happened at work, they sent me to a worker's comp doctor, and he diagnosed me with inflammation of the sacroiliac joint. They took an X-ray; nothing was wrong with my bones. I was prescribed the normal regimen of physical therapy. I also saw a chiropractor, who was very nice but whose back-cracking and "electrical stimulation" that I couldn't feel did absolutely nothing for me. He did give me one of the best pieces of advice I've received during this journey, which was that if your body needs ice, ice will feel good when you apply it to the injury. The heating pad, my constant and steadfast companion, did nothing for this pain. Ice was the only thing that helped.
Despite doing physical therapy exercises with the commitment and intensity of a religious zealot, the pain didn't go away. I got more in shape and gained core strength, which is always good, but I still couldn't sit for more than a few minutes at a time. So I adapted. I just started standing all the time, and lying down when I couldn't stand. Fortunately standing desks are de rigueur in the workplace, so I blended in there, but it got a little weird in the break room when I was standing to eat my lunch. Once someone asked me if it was a new diet thing. And on occasions where I had to sit? I just dealt with the pain. Ice. Acetaminophen. Support belts. Repeat.
Last spring, I finally decided to tackle the issue again and asked my PCP for imaging. I was worried I'd have to beg and plead my case for an MRI but fortunately I was ordered one right away (my insurance plan is pretty good right now). When the MRI showed I had a bulging disc I felt a sense of relief. Not pain relief of course, but it made me feel like maybe I hadn't been crazy after all, that maybe this wasn't just psychosomatic or from stress. So I waited two months for an appointment with a spine specialist. And after listening to my symptoms and looking at my MRI, she said the bulging disc wasn't causing my pain because if that disc were the issue I would be feeling nerve tingling in an entirely different part of my body.
Reader, I cried. I have a naturally high pain tolerance - I had an entire organ removed and through the recovery process only took one oxycodone - but low-grade everyday pain just wears on you constantly. It makes you more tired and irritable. There's no simple chemical solution for chronic pain. The vast majority of painkillers are meant for urgent, short-term use only. (The opioid epidemic showed us that.) I used the heated seating device in my car so much (because a two-hour daily commute racks the back) that I gave myself a rash called erythema ab igne, which is when long-term exposure to heat gives you a weird long-term rash.
The thing about my pain is that nothing shows as wrong on any imaging or even on my body. No bruising or swelling. The only evidence is my word and I'm always worried that won't be enough for doctors. Many studies show that doctors persistently ignore and undertreat women's expressed pain compared to men.
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Finally, I managed to get an appointment with a pain management doctor. There are not nearly enough pain med doctors for the demand and their slates fill up fast. I was lucky. This doctor took me seriously, listened to my symptoms, and offered me concrete steps. Thinking it was still sacroiliitis, inflammation of the sacroiliac joint, he gave me the standard injection of anesthetic (for short- term relief) and a corticosteroid (for long-term relief.)
The anesthetic worked for two hours. The steroid didn't. The pain returned.
When I am faced with a problem that makes me want to drink, I always think to myself, "Will drinking actually fix this problem?" Usually, the answer is no. But when it comes to severe back pain? I have to reach for different ways to cope with temptation because I know all too well that alcohol would in fact make my back pain feel better. I haven't relapsed. But it's tough sometimes. There are so many other people out there who use alcohol to self-medicate because it is the cheap and easy way to numb pain.
Officially my diagnosis is "myofascial pain syndrome," which is fancy for "your muscle and fascia tissue is inflamed for no particular reason that science can tell." And finally, the good doctor tried something called "hydrodissection," which sounds terrifying, because it kind of is. It's a procedure where an ultrasound guides a needle that sprays a tiny, concentrated stream of saline in between muscles and fascia to loosen everything up. And that, finally, worked - some. I can sit for short periods. My pain has lessened. It's not gone - I think I just have a bad back - but it's helped so much.
Ironically, all the things that weren't helpful - the imaging, the physical therapy, the steroid injection - were all covered by my insurance. The hydrodissection, which actually provided pain relief, was entirely out of pocket. As our population ages and deals with more chronic pain issues - arthritis, disc compression, etc. - the few pain management doctors we have are going to be swamped, and non-pharmaceutical treatments that actually work may very well cause patients to go broke. As a country, we already tried treating chronic pain with pills and unleashed an epidemic of addiction, overdoses and death. We need more options on the table, and we need them sooner rather than later.
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