The Pain Will Continue Until Morale Improves

“I wanna run through the halls of my high school
I wanna scream at the top of my lungs
I just found out there's no such thing as the real world
Just a lie you've got to rise above”

—John Mayer, No Such Thing

There's this elephant in the room that's so big it's starting to take up space in my head. I joked about it early on.  “Don't you stick that knife in your leg Ricky Bobby”.  In the event that this was all in my head…psychosomatic…it always seems kind of funny, that that might be the case.  But it hurts too much to laugh. 

I wrote an entire chapter on the pain when I started this journey.   The pain I was feeling  seemed uncategorized and way off the chart from what I was being asked by the medical community.  The pain seemed to be unwritten, in some nonlinear region, not described by their “tell me you pain on a scale of 1 to 10”.  Now a few weeks later with more knowledge and pain under my belt, and the more and more reading I do that says pain is subjective the more and more  pissed off I get.  Not so much for me but for anyone out there experiencing nonlinear pain that is being ignored by the medical community and being pigeonholed into some belief that their pain is subjective and they are, at the end of the day,  being pussies (it's my blog I get to say what I want to say).  By saying pain is subjective the community is basically saying that the pain I am feeling is not the same pain someone else might be feeling and since it's subjective someone else may not feel the pain as severely as I am and that they could potentially be walking, and not in a wheel chair,  because they would be able to endure the pain differently and would be able to walk simply by enduring it.  I thought as we went through this the credibility factor as we got closer and closer to a diagnosis would in fact prove the pain is real. Instead what I'm experiencing is more and more discussion of the subjectivity of my pain, and that, In fact the longer this drags out and the more it looks like the pain is all in my head.  Well anyone who thinks that can kiss my ass. To me the evidence that is being ignored has become more and more compelling. I don't like to see surgery as the only option but unless we have a few more breakthroughs happen, and happen very quickly…I don't see anywhere around a surgical solution.

I've heard this bullshit about subjective pain throughout my life as I've dealt with various bouts of pain in different ways, shapes and forms when trying to understand the pain of others. For sure I have friends who have jumped out of airplanes and/or landed hard on aircraft carriers and should be feeling the pain of compressed vertebrae in their spine far  more than what I have been feeling. I've read Sarno's book and believe there are times certainly when motion is lotion and getting out on your feet and moving will take care of some of what may be wrong, and this includes stress and giant forms of anxiety. Muscles get tight. I've played soccer my entire life.  I've pulled multiple muscles. I've sprained my ankles. I've had twisted knees.  As I discussed in 2013, I went through this with my C56 after taking a pretty hard hit from the side. I know when it's time to rest, ice, and compress a muscle.  I also walked you through my motorcycle accidents which tend to account for perhaps a lot of arthritis in my spine.  I know when pain is a phantom and when pain is pain, and it hurts.  

Some pain is indeed a function of nature versus nurture and past trauma and can be included as a significant influencing factor based on your past and what you've experienced.  As doctors struggled to figure out and attempt to treat what might be going on, scales were created, and words were used. This apparently is why words are so important to the diagnosis.  Over the past month I've been asked those words so many times in so many different ways it's clear to me the well-intentioned medical workers asking those words have simply no idea what they're talking about.

Basic searches for pain show up in two categories,  and when I'm being asked about my pain by most of the medical staff I'm being asked about whether this pain is somatic or visceral. Somatic pain being what we typically feel from my household injury such as a cut, or stubbing a toe or spraining an ankle. Visceral pain normally occurs from an internal disease or surgery. Both of these categories of pain seem to be the types of pain that can be addressed on a scale of 1 to 10…they are very linear. And there are specific words that mean specific things in either both categories.  Visceral--deep, throbbing, aching, diffuse.  Somatic--stabbing, sharp. That's what the mental community is looking for. There is a third type of pain that doesn't seem to be addressed in these simple queries. I am not being asked about nerve pain, which strangely when dealing with anything related to your  spinal column, should immediately be singled out as nerve pain. At a minimum it should not be left out of the assessment.  Trauma that affects the spine should be the first indicator, since I had not fallen off my roof, I believe that type of trauma was ruled out in the ambulance. Autoimmune diseases create a huge amount of nerve pain, metabolic diseases, and infections such as shingles. When patients present in these categories the 1 through 10 scale should be thrown out and patients should be met  where they are…probably with a level of pain that can't be categorized or understood so the medical professional shouldn't even try to assess pain.  Rather they should assume that it is off the charts and simply ease their suffering so they can begin an actual dialogue about what may be going on and how to treat the condition…not the pain…

Having been an analyst all of my life with an engineering background, measuring what's going on has been my natural state.  I measure everything to the annoyance of most people around me. Everything has a scale and I evaluate everything on that scale. But you have to use the right scale for the job.  When I brought up pain in my early chapter, “Pain goes to the Moon” I was addressing nerve pain. Since I personally felt this level of pain previously when I had a pinch in my C56. It wasn't something that could be endured and if I wasn't on my way to the emergency room I was heading upstairs to jump off my roof.  Somatic and visceral pain can easily be placed on a scale of 1 to 10 since it exists in a very linear region. Nerve pain on the other hand clearly is not linear. Pain from nerve damage, pain from arthritis, pain from things like other immune diseases such as shingles, should never be addressed on a linear scale. I would go so far as to say if a medical professional addresses nonlinear pain with a linear scale it's time to bring up the “M” word. Which I most definitely will do before this journey I am on is over.

I've had another affliction where I can safely say if you consider what I'm talking about you might have a more profound understanding of where pain can come from that could be off the scale. Gout is one such affliction. I like to talk about gout because in the literature it is referred to as the disease of kings. And since I have it occasionally, mostly likely from eating pounds of steamed shrimp in one sitting… I must be some type of king.  Typically it manifests in the big toe…but to understand what's going on here is to understand where significant pain can come from. Simply put, uric acid is going to crystallize in the joint of your big toe.  Think about that as if all of a sudden as someone has inserted broken glass into the joint of your big toe. This is an emergency situation and something that cannot be ignored. That's a level of pain that is going to be necessary to address and quite possibly runs higher than a 10. Nerve pain runs significantly higher than a 10 but gout is going to drive you straight to the emergency room. If someone tells me gout is subjective and I can show you the crystalline uric acid in my joint I am going to place most of my foot straight up your ass.

The same is true when I can show you an MRI with a bulging disc that is impinging on a nerve root. If you can see a herniated disc pressing on a nerve and a doctor is telling you that your pain is subjective I'm going to tell that doctor to go straight to hell. 

We learn as analysts that correlation is not causation. Yet sometimes correlation is exactly causation. Such as when you can see crystalline uric acid in the toe, or a shingles rash, or a herniation that's pressing against a nerve root.  Sure steroids and NSAIDS may shrink it…bring them on.  But also, there are mechanical ways to remove that herniation from the nerve root.  Traction springs to mind…yet that is alternative care.  Physical Therapy is what was prescribed.  Range of motion…nothing to remove the herniated disc from the nerve.  Alternative care, such as chiropractic care, can manually manipulate joints to try to decompress what’s going on.  WHat wouldn’t that be acceptable care?  Surgery, for sure, will be manipulating that nerve…either by trimming the disc to get the impingement off the nerve, or ultimately removing the disc altogether and fusing the vertebrae.   

I've had my second epidural this week…another manual method to try to reduce the size of the herniation and get it off the disc. . The effect of lidocaine had on my L34 and my L45 was almost immediate.  Yesterday I had a decent report but today the lidocaine seems to be wearing off so I'm hoping the steroid will kick in shortly. The point I'm going to make is that we believe my pain is coming from this area…this area was addressed with a very specific needle and a very specific amount of painkiller that very specifically changed the level of pain that I was in. There was nothing subjective about it. This was a highly objective procedure and it was highly targeted and carried out in an extremely precise manner.  And it had a very precise and immediate effect.  The same kinds of things have been occurring and have been observable throughout this three week ordeal…if I expand the L45 by bending my torso, I can remove the pain.  If I do a posterior pelvis tilt, I can remove the pain even more.  Yet I remain without a diagnosis with the medical community relying on some strange hope that my condition will either disappear on its own or I should begin coping with my own pain and stop bothering them. 

If I can feel the pain come and go it is not subjective.  It is clearly objective.  So to me it is incumbent upon the medical community to come up with a better way to assess pain.  They take our blood pressure and pulse every four hours whether we need it or not.  How about, take our pulse when our pain is induced, as a base line?  Measure something.  It’s random and disassociated it they don’t deliberately try something as novel as doing this.  The faster I pound on this back the more he sounds like a motor boat.  Cause and effect.  He puts pressure on his foot, his pain goes up, his pulse goes up accordingly.  Simple. Objective. Measurable.  There are other ways to do it.  

I’ll continue to take the meds as prescribed.  Methocarbamol to relax my muscles, Motrin and Tylenol to combat some of the pain, and Gabapentin to do the rest for my physical nerves being affected.  The pain will continue until morale improves.  Never has that been more true when defining pain as subjective in the individual.