Pain. The 7th vital sign. It’s our body’s way of warning us about danger and disease. When working with my patients, it’s a question I always ask: Do you have any pain right now? As clinicians, we utilize multiple pain scales to objectively rate this subjective symptom. It’s such an important question, I’ve even learned how to ask in Spanish.
This knowledge came in handy one day when I worked a post-op unit at the hospital. There was a Spanish-speaking patient on my list, and the translator lines were down. I know enough Spanish to get by, and I was at least able to ask her how much pain she was in, and to teach her nurse how to as well. It was definitely 10/10. Her nurse was then able to give her pain meds, and later that day, that patient was getting up and walking with ease.
Acute pain like we experience post-operatively is one thing. We typically know what caused it, and know there is a timeline for healing when this symptom will resolve. Some of us even voluntarily put ourselves through painful experiences like childbirth or running a marathon. And some of us are even addicted to post-workout pain that lets us know we really pushed ourselves in the gym. But chronic pain is a different story altogether.
When we think of people who have chronic pain, society has painted a picture of someone who is lazy, drug seeking, and entirely unpleasant. Am I right? I hate that term. I prefer to use the phrase persistent pain. I think that’s more accurate. When I encounter patients with these issues, I have this conversation with them, and we rephrase it. This type of pain requires a skilled clinician to get to the root of the problem, not merely a bunch of band-aids to cover it up or healthcare providers to write you off as crazy simply because they haven’t found the cause.
There is a spiritual component to pain, though, especially persistent pain. When pain begins to rule your world, it can really affect you emotionally. When you go to bed thinking about pain, wake up with it, get poor sleep because of it, and then it keeps you from doing the things you enjoy, the cumulative stress is detrimental to your quality of life. This is especially true if you seek help for managing your pain, and it seems that no one wants to take the time to listen. You can begin to feel hopeless.
I really didn’t fully grasp the spiritual component of persistent pain until I experienced this myself. After dealing with abdominal pain and bloating for a couple of years, enduring multiple tests that cost thousands of dollars out of pocket, and seeking help from multiple doctors, I finally figured out the root of my pain after meeting a new friend. She had experienced the same exact issues. It was her IUD. The light bulb went off for me. This little device my OB-GYN had convinced me to get was causing inflammation and pain. I sought help from my doctor, and she refused to remove it. When I found a doctor who would, my pain went away almost immediately. I audibly gasped the moment it was no longer a part of my body, the relief was that immediate and noticeable.
It took a couple more months for the pain to completely subside, but the benefit to my mental health was significant. For the first time in three years, I had hope. I had a doctor who listened and respected me. And I could finally take control of my life and my health. That moment sparked the beginning of my fitness journey that made me a marathoner. I am so grateful. I wish I had not experienced this, but it helps me relate better to my patients who live with persistent pain.
Not everyone with persistent pain is so lucky to find such a simple solution or to so easily find a doctor who will listen. The emotional burden of the pain can become overwhelming. I have two stories about persistent pain with regard to my clinical practice as a physical therapist, and both are equally sad.
Several years ago, I evaluated a patient who had been to the ER several times for severe back pain. Reading the notes, it was clear that he was written off as a drug seeker, even when he also reported weakness and difficulty walking. Each time, he was sent home with the advice to take ibuprofen. His last visit, another symptom had developed: he had lost control of his bowel and bladder. This, my friends, is cauda equina syndrome, and is a medical emergency. This means that there is an impingement of the lower spinal nerves impairing these functions. Finally, more substantial testing was performed. He had a spinal tumor. My evaluation revealed that he had lost all sensory and motor function of his legs. I was as kind as I could be to him, but my powers were limited. I assured him he would get the help he needs. Writing his note, I cried. And I felt so angry that no one took him seriously. This man was also Black. I am certain this impacted his care initially. I still wonder what his outcome was.
I treated another patient who was injured at work. Mysteriously, they “lost the tape” that showed what happened. Workman’s comp and her employer decided she was exaggerating her symptoms, and demanded that she return to work, failing to allow her to seek proper medical care. She was only allowed to see the doctor they sent her to. Finally, she got a second opinion outside the approved work network. She had a back injury that required surgery. And since her care was delayed by months, her life was impacted significantly, as her rehab would be long and difficult. I sensed her mistrust, her fear, her anger, and I had the patience to ask and let her tell her story. I hugged her and let her cry about it. And I got counseling added to her care plan. She was also Black. I know this impacted her initial care.
It makes me angry that certain populations are written off when they try to seek help with pain. This includes non-whites and women. Somehow, many of us get lumped in a bunch who just want opiates and attention. Sigh. This only compounds the stress experienced when dealing with persistent pain.
However, even my own father wasn’t spared from the “pain is all in your head” narrative. When I was in grad school, he was in a freak accident where a truck pulled down a sign, falling onto his car and him. He was checked out in the ER, but they failed to determine what was causing his left shoulder pain. Even at his follow up appointment with his primary care doctor, he was told he was simply stressed out and needed to relax. A few days later, while on a mini vacation in rural North Carolina per doctor’s orders, he became very ill. The accident actually caused his spleen to rupture, and it made him septic. He spent two weeks in the ICU. Left shoulder pain is a hallmark pain referral pattern of a ruptured spleen. The ER doctor should have known. This phenomenon was even described in my orthopedic differential diagnosis textbook.
Pain is also an expected consequence of aging as our joints deteriorate and muscle mass decreases. My patients with osteoarthritis are well acquainted with the companion of pain. The goal with these folks is to give them tools to manage it, and it’s a task best made multifaceted, controlled medically with topical, injected, and oral medications, and through exercise and movement to strengthen the muscles around the joints and reduce stiffness. When all else fails, there is typically a surgical solution.
But there are multiple other conditions that cause pain that have no definitive cure. For these people, they also must learn to live with the companion of pain and inflammation. They have no choice. We just help them manage as best as we can.
In other parts of my practice, I actually have the power to alleviate pain. Besides prescribing exercises and providing manual skills to help, I also have other tools to use. TENS can be very powerful in temporarily alleviating persistent post-herpetic pain and muscular pain. And I’ve found that taping can help with a multitude of issues, from helping support a flacid post-stroke shoulder that is subluxing to relieving stress to a fellow runner’s calf muscles. It brings me great joy to relieve pain.
Persistent pain is a companion no one wants. As a constant burden, it begins to overwhelm your world, and weighs heavy on one’s mental health. Compounding on this is the journey in finding a resolution to the pain, seeking the help of medical professionals who will listen. As a physical therapist, there have been many times that my skills have been able to help in this process. Having experienced this myself helps me to relate to these patients better, and it brings me much joy to alleviate pain. I certainly hope that none of you have ever had to deal with persistent pain, but if you do, don’t lose hope. Find someone who will listen and help.
None of the experiences I mentioned occurred in my current practice setting. Have you ever experienced persistent pain? How did you manage? As always, I hope you all are safe and healthy.