[TAE] The Perils Of Pain Management

Monday, July 28, 2014

Awhile ago, I talked about Spoon Theory and what it’s like to live with chronic pain.

Since then, I’ve been subjected to even more medical tests and had more confirmations of my issues. For a quick recap, I have:

Degenerative Disc Disease – a type of spinal arthritis that causes the discs in the back which serve the purpose of cushioning the vertebrae and providing shock absorption to slowly “deflate” to the point that the bones are scraping and rubbing on each other.

Osteophytes – which is a fancy way of saying “bone spurs.” Basically a side effect of the above. As the bones rub against each other they grow bony protrusions to heal the bone as it’s damaged by the friction of…well, life. These bone spurs press into the spinal column, which causes numbness in certain positions and at certain times – mostly in my limbs.

Osteoarthritis – which is just plain-old normal arthritis – the loss of cartilage with overuse or age, that causes the bones of joints to rub together much like the bones in my spine. This is worst in my knees, my fingers, and my left hip.

A pinched nerve in my left hip – as a result of the arthritis and the formation of osteophytes in my hip joint, a nerve that normally passes through the area without even touching bone is actually “caught” on one of the bony protrusions. This stops me from being able to raise my right leg more than a couple of inches off the ground without searing pain as the nerve is compressed by the bones. This has been confirmed via MRI recently.

And a myriad of other little issues, from edema in my legs to a bit of carpal tunnel syndrome in my wrists, to bad eyes, etc.

What it comes down to is that I generally suffer from quite a lot of pain every day. And pain is exhausting. It’s depressing. It’s demoralizing. And it doesn’t go away in a situation like mine. So you have to learn to live with it.

Learning to live with it requires a medical branch known as “Pain Management.” At Pain Management, they’re authorized to prescribe drugs much stronger than prescription strength ibuprofen and things like that. My Pain Management doctors have put me on a hydrocodone mix called Norco. I’m at the mid-level of that particular medication – 7.5 mg of hydrocodone and 325 mg of acetaminophen.  I take that up to four times a day depending on how bad the pain is.

Here’s the thing about pain management, though. The goal is to manage the pain. To make it so that you are in a level of pain that tolerable and livable. The goal is NOT to make the pain go away completely.

Why, though? Why not try to make the pain go away completely?

It comes down to the fact that pain is important. Pain is the body’s way of telling you that there’s something wrong. The worse the pain, the worse whatever’s wrong. And when you have conditions that require pain management, the whole point is to mask the pain so you aren’t feeling it at quite the level it actually is.

You know what’s wrong. You’ve had the diagnoses, you’ve seen the x-rays and MRI results. You know that there’s something very wrong with you. You don’t need your body constantly reporting damage that you can’t do anything about.

And so, you turn to drugs to mask the pain. The issue comes when the masking works a little TOO well.

The first time I was put on Vicodin – the predecessor of Norco – it was for a badly infected wisdom tooth. The pain in my tooth was so horrible, I went to the emergency room for it. They gave me two 5/500 Vicodin, and sent me home once my blood pressure came down.

By the time I got home, the meds were in full effect. And for the first time in ten years, I had almost no pain. Nothing in my knees, almost nothing in my back and my neck, nothing in my hands – and nothing in my tooth. I felt great.

That night, I proceeded to clean two large areas of the house, do laundry, take a shower, and do a few other things that I normally can’t easily do because of pain.

The next day, the medication had worn off. And I found out that the absence of pain does not mean the absence of injury.

I learned that night that I have to be VERY careful when my pain is being managed. Because when my pain is masked by the drugs, I feel normal. Or as close to normal as I ever feel. The pain is easy to push through, if there’s any at all. I can do all sorts of things easily.

But in doing so, I risk making my conditions worse.

With every movement, my bones grind together. With every bend and lift, my nerves are compressed and damage is done. And when I do more, thanks to the warning signals of my body being masked by pain medication, I risk making the damage even worse.

These are the perils of pain management. I need the pain medication to live something like a normal life. But if I’m not still careful while leading said life, I’ll make the damage that causes the pain even worse.

Pain management is a balancing act. Some days are easier than others – but even on the easiest of days, care has to be taken. I have to balance how good I feel with how many spoons I know I have – even if the pain management is giving me phantom extra spoons.

So for everyone out there living with chronic pain and under pain management – beware of the phantom spoons. If you spend them, they have to come from somewhere.

And eventually, you’ll probably regret spending them. Take care of yourself. In or out of pain. Remember that your body reacts with pain for a reason.

Sometimes? A little pain can be a good thing.