15 Thing No One Tells You About Chronic Pain as a 20-Something

[SD45T-2]

https://www.yahoo.com/health/15-things-no-one-tells-you-about-chronic-pain-as-a-123994261648.html

1. Sometimes you feel like a lab rat/medical experiment gone awry.

“House M.D.” doesn’t even begin to cover all the weird treatments and experiments you’ve undergone to aid your health. Your “medical team” becomes the people you know and hear from most.

Yes, I have actually said that my life is sort of like a long episode of "House" except I'm not dying and there aren't any attractive women. It's nice to know there are other people out there who understand.

 

[PeaceBaby]

You must have called me here because you need a hug. Request granted:

Tell me more about your situation.

 

[EJCC]

 

[miss fortune]

some aspects sound quite similar to being a younger person who is a recovering addict and I can sympathize with that a good deal (and I know it's not really equal because the addict category brings it upon themselves)... it sucks and can make parts of a normal social life for the age group super awkward. Also the whole "do I tell this person?" thing... ewwww

other parts though... can't really imagine that

 

[gromit]

I'm actually taking a course as part of my program about the neurological factors contributing to chronic pain and ways that we as physical therapists can assist in modifying those neurological factors and help people experience less pain and have more endurance and energy and ability to do the things they want to do with their lives. I was really excited when I saw this as an option for the electives we can choose from, since I've worked with people with chronic pain in my internships and had no idea how to best help them.

From what I'm learning in the course, it does seem like there is a bit of trial and error, it's not an exact science, and each person experiences pain a little differently and responds a to different things a little bit differently.

Have you heard of the book "Explain Pain"? It's a little bit goofy at times but I think they break down the latest understanding of pain in a way that the average person can understand. It's one of the textbooks for my course and I like it a lot.

 

[Tellenbach]

You may want to read Chapter 4 of Emanuel Revici's textbook "Research in Physiopathology As Basis of Guided Chemotherapy With Special Application to Cancer". You can find it on the net.

Pain is the principle clinical manifestation characterizing the next phase of the disease. As we shall explain in greater detail later, pain arises from changes in the pH of the intercellular fluid that bathes sensorial nerve endings.

For one thing, it was noted that in some patients with chronic pain -- assoicated with tumors, arthritis or other conditions - the pain intensity was not constant. In many of these patients, variations in pain intensity could be seen to follow a pattern. Although the variations usually are referred to as 'spontaneous', we could show that they were related to the time of day.

In one group, pain was severe in the morning and diminished toward evening, while in another group, little or no pain was felt in the morning and exacerbations occured in the evening

Basically, pathological pain is associated with tissular pH changes; some pain is associated with high pH and some with low pH. There are chemical agents (also described in Chapter 4) that will correct these imbalances and eliminate the pain. Interesting theory. He's done the research, but this textbook has been largely forgotten and ignored by mainstream medicine.

 

[SD45T-2]

You must have called me here because you need a hug. Request granted:

Tell me more about your situation.

Thanks. It's because of the "tag all friends" feature.

These days the sinus/ear problems are overshadowing the orthopedic stuff. The ENT said the CT scan didn't really shed any light on my problems, which is frustrating. My left frontal sinus seems to be doing poorly. Maybe the left maxillary sinus too. The allergist the ENT referred me to said I don't seem to have much in the way of allergies (I sure didn't see that coming) and that it's mostly nonallergic rhinitis. Balloon sinuplasty might be the way to go, but the ENT said he wasn't going to try to twist my arm because it's only a maybe, and an expensive one at that.

My ears have been giving me a lot of trouble too. Pressure, pain, dizziness. Maybe I need ear tubes. It's kind of amazing that I never had them before considering I got ear infections all the time when I was little.

I'm actually taking a course as part of my program about the neurological factors contributing to chronic pain and ways that we as physical therapists can assist in modifying those neurological factors and help people experience less pain and have more endurance and energy and ability to do the things they want to do with their lives. I was really excited when I saw this as an option for the electives we can choose from, since I've worked with people with chronic pain in my internships and had no idea how to best help them.

From what I'm learning in the course, it does seem like there is a bit of trial and error, it's not an exact science, and each person experiences pain a little differently and responds a to different things a little bit differently.

I've had physical therapy a couple times. Once for my shoulder and once for my knee. I've been trying to ride my bike faithfully this summer. I have to be careful not to push too hard or my quad might pull my kneecap out of alignment and make it seize up. My lowest gear is 24:30, so I can just crawl up the tough hills if I need to.

It recently dawned on me that I should probably go to the gym to work on some of this stuff in conjunction with cycling. The leg extension machine at 24 Hour Fitness has adjustable range of motion, which means I wouldn't have to start the extention from a deep knee bend. My orthopedist and the physical therapy folks said to avoid that when I'm working on my quads.

Have you heard of the book "Explain Pain"? It's a little bit goofy at times but I think they break down the latest understanding of pain in a way that the average person can understand. It's one of the textbooks for my course and I like it a lot.

Never heard of it. Thanks.

 

[kyuuei]

It is a full time job, except you don't get to take any sick days. I remember Christmas last year I spent 2 days unable to sit at all because the weight of my own upper body would throw my hips into immense amounts of pain. I pretty much stayed dehydrated because it was easier to be thirsty as shit than to go to the bathroom. It was the first time I needed to resort to muscle relaxers as well.

The worst is that I have so many good days in a row that it feels like someone hands me this when it flares up.

 

[gromit]

I've had physical therapy a couple times. Once for my shoulder and once for my knee. I've been trying to ride my bike faithfully this summer. I have to be careful not to push too hard or my quad might pull my kneecap out of alignment and make it seize up. My lowest gear is 24:30, so I can just crawl up the tough hills if I need to.

It recently dawned on me that I should probably go to the gym to work on some of this stuff in conjunction with cycling. The leg extension machine at 24 Hour Fitness has adjustable range of motion, which means I wouldn't have to start the extention from a deep knee bend. My orthopedist and the physical therapy folks said to avoid that when I'm working on my quads.

Never heard of it. Thanks.

Yeah that a great idea

You can also do mini squats which don't put you into deep knee flexion but you still get a workout to the quads and glutes.

If you want any other modified exercise ideas, let me me know the muscles you wanna work on and any pain limitations!

 

[SD45T-2]

Yeah that a great idea

You can also do mini squats which don't put you into deep knee flexion but you still get a workout to the quads and glutes.

If you want any other modified exercise ideas, let me me know the muscles you wanna work on and any pain limitations!

Thanks. In physical therapy I did the one where you step up on the box sideways with one leg. You probably have a better name for it.

My orthopedist has reminded me on a few occasions that it would be good for me to work on my hamstrings too. I just can't do seated leg curls. For some reason it causes pain on the right leg and runs kind of rough. Assuming I'm identifying these parts correctly, the pain is at the tendons at the bottom of the semitendinous and semimembranous. Lying leg curls aren't pleasant, but they're more doable. IIRC, the nearest 24 Hour Fitness also has a lying leg curl machine, so that seems like the way to go.

 

[gromit]

Thanks. In physical therapy I did the one where you step up on the box sideways with one leg. You probably have a better name for it.

My orthopedist has reminded me on a few occasions that it would be good for me to work on my hamstrings too. I just can't do seated leg curls. For some reason it causes pain on the right leg and runs kind of rough. Assuming I'm identifying these parts correctly, the pain is at the tendons at the bottom of the semitendinous and semimembranous. Lying leg curls aren't pleasant, but they're more doable. IIRC, the nearest 24 Hour Fitness also has a lying leg curl machine, so that seems like the way to go.

I have been thinking about this and I can't for sure deduce from what you're telling me why you're having pain with one and not the other.

I do know that your biceps femoris crosses the knee AND the hip, so when you have your hip bent in a sitting position AND you straighten your knee then that muscle is pretty stretched out. but when you're on your stomach your hip isn't bent forward so the muscle doesn't get stretched out as much.

So it could be that your biceps femoris is tight and that causes the other hamstring muscles (semitendinosus/semimembranosus) are straining as a result of that tension. The other thing is that the biceps femoris aren't able to contract as strongly when it's in that fully lengthened position, so that could be causing the semitendinosus and semimembranosus to have to work harder.

So I'd say maybe try a quick warmup then stretching your hamstrings before doing some lighter resistance hamstring sets in the seated position OR stick to the stomach-lying ones for awhile until you build up strength.

You want to push into some gentle pain but not so far into the pain that it flares you up so you're taken out for a few days. The idea is getting more regular exercise to the muscles so that you can gradually do more and more. I'm sure you already know this anyway

 

[Z Buck McFate]

Have you heard of the book "Explain Pain"? It's a little bit goofy at times but I think they break down the latest understanding of pain in a way that the average person can understand. It's one of the textbooks for my course and I like it a lot.

I'm really glad you posted this, gromit. It's led to watching a few Butler/Moseley youtube videos, and it's been really helpful. They're right, there really isn't much preoperative education. I have two herniated cervical disks right now. The first suggestion I got (and so, the first thing I did) was to have a steroid epidural- but I had a really bad reaction and ended up in twice as much pain. Then they sent me to an orthopedic chiropractor. It's pretty much exclusively the biomedical that gets focused on. Just yesterday I finished the 6 weeks the chiro initially appointed for treatment- it hasn't really helped, I asked him what else I could do and he answered that surgery was the only other option. He said that he thinks there's been some improvement, and he believes continuing to see him might help. I agreed to another week of visits while I decide what to do- but something about being told his approach was the only alternative left to surgery rubbed me the wrong way.

Something that strikes me as somewhat odd is that I remember this chiro saying- at some point in all the explaining he's done in the past 6 weeks- that the herniation isn't really the reason for the pain, that the pain is from something else. But he quickly glossed over it. I think his point in saying it was to make clear that it's possible to get to a point without pain without surgery to fix the herniation, but (I get the impression) he thinks the physical manipulation he does in the office- along with the exercises/stretches he prescribes (which all falls entirely within the 'biomedical' realm)- is the only other way to alleviate the pain.

So anyway, I'm glad I found this the other day.


And [MENTION=15246]SD45T-2[/MENTION], I'm probably only experiencing fraction of what you have to go through- it's gotta suck. I'm so sorry.

 

[gromit]

I'm really glad you posted this, gromit. It's led to watching a few Butler/Moseley youtube videos, and it's been really helpful. They're right, there really isn't much preoperative education. I have two herniated cervical disks right now. The first suggestion I got (and so, the first thing I did) was to have a steroid epidural- but I had a really bad reaction and ended up in twice as much pain. Then they sent me to an orthopedic chiropractor. It's pretty much exclusively the biomedical that gets focused on. Just yesterday I finished the 6 weeks the chiro initially appointed for treatment- it hasn't really helped, I asked him what else I could do and he answered that surgery was the only other option. He said that he thinks there's been some improvement, and he believes continuing to see him might help. I agreed to another week of visits while I decide what to do- but something about being told his approach was the only alternative left to surgery rubbed me the wrong way.

Something that strikes me as somewhat odd is that I remember this chiro saying- at some point in all the explaining he's done in the past 6 weeks- that the herniation isn't really the reason for the pain, that the pain is from something else. But he quickly glossed over it. I think his point in saying it was to make clear that it's possible to get to a point without pain without surgery to fix the herniation, but (I get the impression) he thinks the physical manipulation he does in the office- along with the exercises/stretches he prescribes (which all falls entirely within the 'biomedical' realm)- is the only other way to alleviate the pain.

So anyway, I'm glad I found this the other day.


And [MENTION=15246]SD45T-2[/MENTION], I'm probably only experiencing fraction of what you have to go through- it's gotta suck. I'm so sorry.

Glad you found that helpful! It's kind outside the mainstream stuff, but still backed up pretty well by science, although of course the field continues to evolve as new discoveries are made!

Not to toot my own profession's horn but your chiropractor is not bringing up a very viable option to try prior to surgery: physical therapy. A PT who works with necks and/or spines (or maybe even something like chronic whiplash which is very specialized) will be able to see whether you need some strengthening or building up endurance in particular muscles, or techniques to improve mobility in the areas with reduced motion, or techniques to help you relax muscles that are "firing" or activating too much, basically muscle tension.

The thing with herniated discs is that a LOT of people even without spinal pain have them, so just because an x-ray shows a herniated disc doesn't mean that is the cause of the pain and that fixing the disc - eg via surgery - fixes the pain. there's a good chance the pain is generated from something else (irritated tissue, muscular disuse, posture, whatever). The other thing is that herniated discs have been shown to resolve themselves over time in some people.

The interesting thing that the book I linked to points out is that acute pain is often linked to a damaged tissue, but then some types of chronic pain can persist more as a neurophysiological "echo" of that tissue damage.

I think often it is a combination of postures, movement patterns (including which of the many tiny muscles around your vertebrae decide to activate first when performing a single motion), and some lingering neurological sensitization that combines to result in chronic spine pain.

I don't know though, I am still a student, so I would say if you are interested in trying another alternative prior to surgery, then to definitely see about finding a PT who has the experience and training to help you (not all PTs have the same skillset, there are official and unofficial specialties, so make sure you find one that has what you need to help you get better!)

 

[Z Buck McFate]

Not to toot my own profession's horn but your chiropractor is not bringing up a very viable option to try prior to surgery: physical therapy. A PT who works with necks and/or spines (or maybe even something like chronic whiplash which is very specialized) will be able to see whether you need some strengthening or building up endurance in particular muscles, or techniques to improve mobility in the areas with reduced motion, or techniques to help you relax muscles that are "firing" or activating too much, basically muscle tension.

I gave the abridged version. I did try physical therapy. (Unabridged under spoiler.)

It actually happened IN physical therapy for my lower back. I wanted more endurance so I asked my doctor to order lower back PT- within two days of starting the exercises, my shoulder/arm was in searing pain. I don't think the PT I went to handled it very well. I explained it to her as well as I could, she'd noted that it seemed like a neck issue and- in addition to continuing the exercises she gave me (even though they were causing shooting spasm-y kill-me-now pain, which I was very clear about)- she gave me some additional neck exercises to do. After a month of that not working, I went in to a spine guy. After looking at an x-ray (and noting severely degenerated disks), he ordered an MRI (here).

I'm still kind of puzzled as to why the PT I was seeing didn't take what I was saying more seriously. I'm not exaggerating when I say I couldn't raise my right arm without serious shooting spasm-y pain in my shoulder. I walked around holding my right arm with my left hand until I finally got a sling- because just the weight of my right arm hanging at my side was unbearable. The TENS machine didn't even make a dent. And it started with the exercises she gave me- I'd never had any shoulder/arm issue even remotely like that before. I mean, that's weird, right? How would you handle that, as a PT? (The disks had obviously degenerated before it happened- I know that doesn't happen overnight. But it just seems weird to me in retrospect that she didn't seem phased by the onset of a brand new extreme pain- that she just gave me more exercises instead of ordering an x-ray or something.)

So the spine guy told me that the next step would be an epidural steroid shot. I decided to try the PT a little bit longer. It *seemed* to eventually to be getting better. But then shoveling the driveway (Chicago, winter) in February made it go south again and then some- less searing pain, but my arm felt constantly asleep/like dead weight with pins and needles. So I tried the epidural steroid shot and that's when things REALLY went downhill. Lol.

/unabridged version

The interesting thing that the book I linked to points out is that acute pain is often linked to a damaged tissue, but then some types of chronic pain can persist more as a neurophysiological "echo" of that tissue damage.

I think often it is a combination of postures, movement patterns (including which of the many tiny muscles around your vertebrae decide to activate first when performing a single motion), and some lingering neurological sensitization that combines to result in chronic spine pain.

Yep, the "echo"- I think it's so interesting that can happen! I had a chiro who explained this to me about 10 years ago- that it's like when a path gets made in tall grass from people constantly walking over a certain area, the brain will keep getting a message that is actually obsolete. Or something. He did traction to my back, to "reset" the nerves or something like that, and it totally worked.

It must be hard to determine the difference, even by looking at MRI? Because I'm not really getting a definitive answer about whether it's more "echo" or not. It seems like they are going more on whether or not the chiro is able to get rid of the pain than by looking at the actual MRI. (And that seems to me like putting a little too much faith in one chiropractor's skill. I might need to hunt that first chiro down- he was amazing.)

I don't know though, I am still a student, so I would say if you are interested in trying another alternative prior to surgery, then to definitely see about finding a PT who has the experience and training to help you (not all PTs have the same skillset, there are official and unofficial specialties, so make sure you find one that has what you need to help you get better!)

Again, helpful! It wouldn't have occurred to me to ask if there were PTs who specialized (even though, immediately after I read it, it seemed like it should have occurred to me- duh). I think I'll call the spine guy's office on Monday and ask about it, that's definitely another avenue to consider. Thanks!


[Sorry about the thread hijack, SD45T-2. ]

 

[SD45T-2]

I have been thinking about this and I can't for sure deduce from what you're telling me why you're having pain with one and not the other.

I still have some pain/discomfort with lying leg curls, it's just significantly less than with seated leg curls, which are just about impossible for me.

[Sorry about the thread hijack, SD45T-2. ]

That's okay.

 

[Z Buck McFate]

That's okay.

So what are the orthopedic issues you have? You mention having had PT for your shoulder and knee. Can they find any reason? Or is that the problem- you're having pain issues but they can't figure out why?

 

[SD45T-2]

So what are the orthopedic issues you have? You mention having had PT for your shoulder and knee. Can they find any reason? Or is that the problem- you're having pain issues but they can't figure out why?

I have some joints that don't work well plus some tendinitis and bursitis. I mentioned in a previous post about my right kneecap being a bit out of whack. I've had all kinds of blood tests, so we've ruled out a bunch of stuff.

 

[grey_beard]

Thanks. It's because of the "tag all friends" feature.

These days the sinus/ear problems are overshadowing the orthopedic stuff. The ENT said the CT scan didn't really shed any light on my problems, which is frustrating. My left frontal sinus seems to be doing poorly. Maybe the left maxillary sinus too. The allergist the ENT referred me to said I don't seem to have much in the way of allergies (I sure didn't see that coming) and that it's mostly nonallergic rhinitis. Balloon sinuplasty might be the way to go, but the ENT said he wasn't going to try to twist my arm because it's only a maybe, and an expensive one at that.

My ears have been giving me a lot of trouble too. Pressure, pain, dizziness. Maybe I need ear tubes. It's kind of amazing that I never had them before considering I got ear infections all the time when I was little.

I've had physical therapy a couple times. Once for my shoulder and once for my knee. I've been trying to ride my bike faithfully this summer. I have to be careful not to push too hard or my quad might pull my kneecap out of alignment and make it seize up. My lowest gear is 24:30, so I can just crawl up the tough hills if I need to.

It recently dawned on me that I should probably go to the gym to work on some of this stuff in conjunction with cycling. The leg extension machine at 24 Hour Fitness has adjustable range of motion, which means I wouldn't have to start the extention from a deep knee bend. My orthopedist and the physical therapy folks said to avoid that when I'm working on my quads.

Never heard of it. Thanks.

Jumping in uninvited as is my wonted behavior -- have you considered paying $$ (up to say $150) in order to have a qualified physiotherapist or bicycle mechanic make sure you are precisely fitted to your bike? Having the seat too high or low, the handlebars too low, too short or long of a frame, and all kinds of things, can lead to many, many different aches and pains after a ride?

Secondly, about the machines at the gym for your quads, you can emphasize different parts of your quads on different parts of the extension: those last 5 or 10 degrees before fully extended seem to work the part of the quad just above and to the inside of the knee.

Also, have you considered some of the other machines at the gym to exercise other muscles ? Imbalance in strength between opposing leg muscles can cause pain too.

(good luck )

 

[SD45T-2]

Jumping in uninvited as is my wonted behavior -- have you considered paying $$ (up to say $150) in order to have a qualified physiotherapist or bicycle mechanic make sure you are precisely fitted to your bike? Having the seat too high or low, the handlebars too low, too short or long of a frame, and all kinds of things, can lead to many, many different aches and pains after a ride?

I'm a pretty casual rider. I think my bike is one of the last model years Specialized used chromoly frames for the Hardrock line. The main source of discomfort is my butt if I haven't been riding regularly.

Secondly, about the machines at the gym for your quads, you can emphasize different parts of your quads on different parts of the extension: those last 5 or 10 degrees before fully extended seem to work the part of the quad just above and to the inside of the knee.

Yep, that's what I'm going for.

Also, have you considered some of the other machines at the gym to exercise other muscles ? Imbalance in strength between opposing leg muscles can cause pain too.

Yeah, I discussed that in subsequent posts.