The Mental Toll of Chronic Pain

Sometimes the mental toll of chronic pain can be as bad if not worse than the physical ramifications. While western medicine mainly focuses on treating the body only, there should be more focus on the treatment of the body as a whole. The Chinese and other Eastern cultures have known for thousands of years that you cannot treat the body without treating the mind and the spirit. I feel that modern medicine needs to learn this! Some pain management clinics do have psychologists or other mental health professionals available to their patients but the vast majority in this country do not.

Most Family Practitioners and Internal Medicine Physicians are not equipped to handle any type of acute pain situation very well much less a chronic pain problem. They try and bless them they are the patients first line of defense in this poor maze of jumbled facade of errors that our medical care has become in the U.S. today. However, the statistics show that hardly any of the physicians that are in practice today are even aware of what pain protocols are! If they are ill equipped to treat the physical symptoms, how on Earth do they attempt to start to conquer the emotional and mental problems that chronic pain can cause?

As a chronic pain patient myself, I ask this hoping to get insight for myself and others as I do not have a good answer for this! I really wonder if there is a good answer in our standard of medical care today. If there is I for one do not know about it. I have found some others who are advocates for people who are in chronic pain.

There is a great site called The American Pain Foundation. If you have not visited them in the past, I highly recommend you give them a try. They have chats, a message board that you can get information and advice from Nurse Practitioners and Physicians Assistants who work in Pain Management as well as support from other people who experience chronic pain. They also hold frequent chats with some well known people in the Pain Management world. You can sign up for email alerts for upcoming events or chats there.

Massage Techniques for Chronic Pain

Therapeutic Massage:
This has been used for hundreds if not thousands of years and started in the Chinese, East Indian and Thai cultures as far as we can find in research. There are Hawaiian, Swedish, and other types of massage as well that are valuable for different issues. Today I want to talk about the types of massage I feel are more valuable for acute and chronic pain. These are my opinions only from my experience both as a practicing massage therapist for four years and as a chronic pain patient for the last eight years.
NMT- Neuromuscular Therapy is at type of massage that incorporates the use of finding trigger points for muscles that are either knotted or tight. The practitioner puts pressure on these points causing them to release. When this takes place the tense, tight muscles relax as well. This can take pressure and compression away from a nerve, releasing it. I have seen real results with this technique for sciatic pain, carpal tunnel syndrome, thoracic outlet syndrome and other issues.

Acupressure Massage-This type of massage works with the Chinese acupuncture points and instead of putting needles into the points, places pressure on the points for a number of seconds until you feel a release of the points and pressure. This in the Chinese tradition releases Qi or the life giving energy and allows the body to heal itself. This type of massage is very beneficial to relieving pain and it also gives the person a feeling of well being and energizes them as well.


Deep Tissue Massage- This type of massage concentrates on working on deep tissues and releasing any strictures that exists in the muscles. They also work on scar tissue and fibrous tissues that can cause friction or restricted motion between the muscles, tendons and joints.

Image courtesy of stockxpert.com

All three of these types of therapy can be very beneficial for anyone who is experiencing acute or chronic back pain, neck, shoulder, or leg pain. It can be used for other problems as well.

And The Beat Goes On............

By this time, it was late October 2005. I was physically,mentally and emotionally exhausted. I did not know what to do or where to turn. The only options that I had at the time were to give in to the surgeons here and have a 2 level lumbar fusion or pay out of pocket $53,000 to have a 2 level ADR done since insurance would not cover it.
My pain was constant I was seeing a pain management doctor trying one protocol after another. All the injections, pain medications, steroids and aggravation just seemed to be like trying to put a band aid on an arterial bleed. I would get a bit of relief usually temporary but nothing seemed to work for long. In the meantime the chronic back pain and sciatica plus the leg and foot pain was really taxing on me!
I think I got almost as much relief from some alternative therapies such as using moist heat and ice alternating them, neuromuscular and deep tissue massage, acupressure and acupuncture, herbal therapy and MSM. These things were all a big part of my life at that time and again today!
For people who are not familiar with some of the terms above, I am going to explain several of the alternative methods in detail in my blog tomorrow. So stay tuned!

Spinning My Wheels!

So I visit my new spine surgeon in Texas and I learn that I am a good candidate for the new ADR procedure! Hooray, right? Well yes until my insurance company decides that they indeed do not cover it now due to the fact they consider it "investigational" at that time. Now try to get them to explain what this means and the difference between that term and experimental is like trying to pull hen's teeth and my grandma would say!
I spent the next four to five months in constant severe back pain working on legal appeals to get my surgery approved. Even though the device was FDA approved at that time, insurance companies were still reluctant to cover it. This made no sense to me as from a financial standpoint, ADR cost half what the two level lumbar fusion cost. From a physical standpoint, most people were back to work within six to eight weeks as opposed to a three to six month wait for normal function after a fusion. The chance of causing further damage to the spine was a huge concern for me as well!
I researched, sent truckloads of paperwork to the insurance company and spent hours on end calling their representatives and my medical case manager which was a huge joke! What I found out is this. The first appeal is judged worthy or not by the in house medical director at the insurance company. This can be any kind of doctor. In my case it was an OB/GYN. Now how can someone in that field decide if I need this surgery or not? Well they tell me the "next" appeal level will be "independent". Yeah, right! The insurance company decides who does this appeal and "pays" the doctor that does the assessment. In my case this was a orthopedic doctor. His report had several errors and I was furious when I got it. I found out, through an oooops at the insurance company that this doctor was local to me.
I politely got on the phone and called his office to see what his field of expertise was. I figured well if he knew better how to take care of me than the other 8 surgeons I had seen and consulted with, I would give him a whirl. I asked about an appointment for my low back issues and was told he does shoulder surgery! HUH??? I then said well I am confused he did an evaluation on me for my insurance company and I thought he was an "expert" in this area. You are telling me he doesn't even treat spine patients? So, so much for an "independent" evaluation! Personally I cannot believe that anyone who is paid by the insurance company will be particularly sympathetic to my plight as they would like to get further referrals. I also found out later insurance executives get HUGE bonuses for saving the company money by denying procedures such as this.
My third and final appeal was sent with a letter describing all the "travesties" that they had put me through and that I was appalled that someone who had no knowledge of up to date procedures or treatment in this field could evaluate my situation thoroughly. This time after another 30 days, the cut off for them to approve or deny appeals, I was denied again by a neurosurgeon.
By this time I was exhausted both physically and mentally. I contacted the representative at my husband's employer to see if anything else could be done since our policy is self paid by the company. I was told I could appeal to them to get the funds for the surgery even though the insurance had denied it. I had 30 days to do this. I received all the forms to turn in for this on the 31st day so that was a bust!
Chronic pain takes its toll on your physically and mentally to say the least. Fighting with insurance to get medical treatment just adds to the frustration and angst that I had to go through. My life revolved around this issue and it was sad to say the least that I could not live or enjoy my family due to all this!

More tomorrow!

Images courtesy of Pocheco at stockxpert.com

Feeling Like A Hamster On A Wheel

For the next several months, I felt like a hamster on a wheel. I was prescribed one medication after another, tried physical therapy which made my problem worse, and as each week went by, my life changed more and more. Chronic pain takes its toll on your not just physically, but mentally and emotionally as well. Each day I would wake up and wonder if I had the energy to get through the day. I never knew from one day to the next if my back pain would be such that I could not work or take care of my family. To say I was frustrated and angry is an understatement! I had worked in nursing for over 15 years prior to becoming a massage therapist and I was truly saddened to see how medical care had become what I considered a farce in most cases. Doctors want to pat you on the head, tell you it will be OK and hand you a pill, hoping you will not come back! When you do, its lets try this test or that, only to be told there is no hope for you other than major back surgery that you do not want to have. And, who could blame me after my previous experience? Chronic pain management seems to be almost nonexistent here in the U.S. and even the programs that are available are not the best.
I did hours and hours of research to find that there are more people in the same situation. Many suffering with chronic back pain, more than I would have ever dreamed of. I found support groups and information on new treatments that I would have never found if I had not taken a proactive approach to my own medical care!
One of the most important and absolutely fantastic support groups for people with chronic back pain and considering surgery is The ADR Support Group. I met many people there who were just like me. Sick and tired of crappy treatment at the hands of surgeons who either were not knowledgable of the new treatments for spine care or just did not care. Unfortunately, most surgeons seem to have the bedside manner of a toad so if you are looking for someone to be caring, this is not the place to find it!!!
I also found out about a new surgery that looked very promising for those suffering chronic back pain called Artificial Disk Replacement. This type of surgery had been done for over 20 years in Europe with very promising results. The beauty behind this type of surgery was that it required much less recuperation time than a lumbar fusion did. Lumbar fusion is the "standard" here in the US for problems like mine.
ADR as it is called does not place stress on adjacent disc levels that can cause them to herniate or degenerate in the future like fusion can. ADR has been successful according to the studies done in Europe when doing multiple levels. The success rate of fusion goes from 80% at one level to a less than 25% success rate when doing multiple levels.
So, armed with this knowledge I approach my family physician about this new surgery. Luckily for me, her brother was an engineer and had actually worked with the artificial discs development in this country. She told me that if I wanted to pursue this she was OK with it.
I found a surgeon in a well known and reputable spine center in Texas that had worked in clinical studies doing over 100 of these procedures and made an appointment for consultation. Now I am in Tennessee, so we braved a 12 hour car ride to go see this surgeon. Before I went that far I had called my insurance company to be told this procedure was "covered". Otherwise I would have never made the trip!
Image courtesy of redbaron at Stockexchange.com

My journey continues tomorrow!

One Day At A Time

For most people including me, living with chronic pain means never knowing today what tomorrow will bring. This makes it very hard to make plans to do most things. This can be really frustrating especially in our hectic lives of today. So what can we do about this? Simply, I now live one day at a time. I take on what I can for that day and try not to worry too much about what I did not get accomplished.

A little background on me, I discovered in 2000 that I had a herniated disc in my lower back. I managed to get by with conservative therapy and exercise for some time. I would have some flare ups but by far I lived my life pretty much as I had in the past. In 2003, while walking from a parking area behind my workplace, I caught my toe in a broken piece of pavement and fell hard on my knees.

The jolt to my back was significant. I was in much more pain after that and the back and sciatic pain was constant. I tried what had worked before to calm down the situation but there was very little improvement from these methods. I had an MRI and found out that the herniation was much worse. It was impinging on the sciatic nerve. My family physician told me at that time that I needed to see a neurosurgeon quickly as the herniation could cause loss of bladder and bowel function or paralysis if it got any worse.

The surgeon recommended a laminectomy. I had that done and felt better for approximately 4 weeks. I then stood up one day felt something go pop in my back and was in horrible back pain. I called the surgeon and was seen the next day. It was so bad I could barely sit up or stand. I had to lie on my side with my legs bent at a 45 degree angle to get any kind of relief. Then I had to get further MRI's to be told they could not see a reason for my pain. I had not herniated again.

My pain levels were intense for about 2 more weeks. I was scheduled to go back to work as a massage therapist after two months post op. There was no way I could work full time in this pain. I had to cut my massage practice down to 2 days a week and hope and pray that I would be able to take care of my clients those days.

The medical mill as I called it continued for the next few months. I was sent to another surgeon for a second opinion concerning my chronic pain issues, after my original surgeon basically ignored my problems. My family physician was a major blessing for without her at that time I would have had a break down of some sort.
Several surgeons refused to see me outright as I had not been treated by them. I finally got the second opinion, and was only seen for that purpose. He basically said I can't see what is really wrong with you but I think it will be better in 2 months! What the heck??? How did he know I would be better if he could not even tell me what my problem was?

This started my journey to find a competent doctor to help me with my chronic pain issues as well as do a ton of research on back pain, back surgery, new methods of treatment including pain management, and the options that were open to me at that time.

I will continue my journey on my next blog post.