This is a little more technical post that may not be of interest to everyone, but several people were interested in the chronic pain stuff and since I've been working on turning it over in my brain so much, it might help me to straighten it out better in my head if I write it. And it sounds like it might be beneficial to some people that either have or know people with chronic pain. This will probably be a number of posts because it's such a complex thing and I've got a lot on my mind in regard to it.
I'm a physical therapist, and chronic pain has been a pain in my butt since I started practicing. I have met tons of wonderful people with this horrible problem, and it is SO frustrating to be so incompetent in the face of it. Things like fibromyalgia, chronic fatigue syndrome, chronic back and neck pain after things like a car accident or falls, ongoing extreme pain and sensitivity after an traumatic fracture, and many more things. All too often, there is lots of pain, but little known reason for it. I treat lots of pain every day, but these are the kinds of things that I dread seeing walk through the door, because these are some of the people that most need help, and they seem to be the people that I can help the least.
When they come to see me, there is always a specific problem that I am supposed to be treating. Back pain. Neck pain. Arm pain. Muscle and joint pain. Trigger points. The thing is, I'm usually pretty good at treating those things in a scenario when things are mostly caused by a mechanical reason. For example, I remember one patient who came in with back pain and he'd had a surgery for it, but was still having pain. I took one look and saw one shoulder sitting back farther than the other. I took him in front of the mirror, showed him how he was rotated and stood him up straight. His pain decreased immediately, and we identified some work areas where he was constantly twisting in that direction and fixed him. Ahh, I like the easy ones like that.
What I don't like are the ones that have been in for numerous back surgeries for a number of different things with a varying degree of success, but never manage to be pain free. They've already been to a number of physical therapists and they've already done a lot of exercises, and with only limited progress. Those are the ones that I know are going to go out the door with only a limited amount of progress.
Or people who have had a car accident and they are so fired up with muscle and soft tissue pain that all the things that I normally do that usually leave people feeling fantastic just leave these folks feeling worse. And why does it last so freaking long (sometimes years) after a car accident?
Here's what's always gotten me about chronic pain. I am only going to treat the body part, right? But when I'm taking a history, people with chronic pain often have a whole host of things going on:
-Depression (makes sense; seems like dealing with unexplained, ongoing pain that is often not well understood by healthcare providers would be awfully depressing.)
-Anxiety (again, makes sense)
-High blood pressure (a body under that much stress? Makes sense.)
-Insomnia (those two are often present and are completely unfair that they exist together.)
-Pain in multiple sites
-Pain that's often fairly generalized and hard to describe exactly where it is or what is causing it
-Sometimes complain about being cold all the time
-Poor hair growth or hair loss
-Don't feel like themselves and wonder who they are and how they got to be where they are
-Chronic knots/trigger points in the muscles
-Difficulty concentrating or thinking
I'm sure there's others, and not everyone has everything on the list, but usually it's a combination of several of those things. These are the people that I have to be really careful with my treatment, because too much often brings about an exaggerated pain and/or fatigue response. These are the people that usually have lots of knots that are causing pain, and feel better when I release those knots, but come back and report that they felt good for a few days (if we're lucky) or maybe only a couple of hours. And when I get my hands on the knots again, they're back to where they were when I started.
Then there are often those people that I treat that have some very mild forms of some of those symptoms, but it's not quite as bad and is not enough to be completely debilitating, even though it's affecting the quality of life. In so many people, they tell me about these different symptoms with a hint of helplessness in their tones and attitudes that breaks my heart. They usually finish with some sort of a comment about how "maybe I'm just crazy." I can see how they would feel that way, given that there's this huge variety of things going on that seem to be so unrelated on the surface, and because they've usually had a number of tests that don't show anything and doctors are baffled by what to do with them. The good doctors tell them "we just don't know." Other doctors say "there's nothing wrong with you" or they want to send them only to a psychiatrist. It's even worse if there was some sort of an accident claim and someone is questioning whether they are really feeling all the things they say they feel. Patients end up feeling defeated, and I don't blame them. I can't tell you the number of times someone shrugs and tells me that they live with daily pain and they've just learned to ignore it.
I had no idea why some of these symptoms would show up so many times. It was frustrating, because I'd be addressing this one small bit of a huge problem. I knew they needed more, but I didn't know what, or where to send them to try to find more relief. All pain clinics want to do is to find the right drug cocktail (or so it seems). Many of the patients had already had many of the most modern medical tests in our arsenal. I would straight up tell patients that I don't know why these things are happening, but they aren't making it up. And I would wonder why these things were happening, wonder why we could get something to loosen up, but not stay that way, why chronic pain is so freaking resistant to treatment. But I had no idea where to start with it all, so I usually just left it at that. I wondered why, and tried to treat the muscles and nerves (mostly peripheral nerves) and joints as best I could and figured a tiny bit of progress is better than no progress at all.
That is some of my professional experience of chronic pain. Next time, I'll tell you about a bit of personal experience (though I never had a lot of the symptoms listed above, and didn't even really recognize it in those terms for a while... Well, how about I wait and explain it then, hmm?)