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chronic pain

When the pain doctor has chronic pain

The title says it all.

I am a board certified pain medicine physician and on many days I wondered if my pain was worse than my patients. I had chronic low back pain, like 23% of the population.

I was stiff and in pain in the morning and as soon as I came home from work all I could think about was lying down, flat on my back. “Give me a few minutes kids, mommy need to rest her back.”

And then I decided to get off my ass and do something about it. I mean, here I was every day preaching to my patients about self care and, uh, you know, neglecting it on the home front.

What I didn’t do was get an MRI. Studies tell us the severity of the MRI findings are not predictive in any way of degree of pain or disability. What an MRI buys you (if there is an abnormality) is some kind of procedure or, even worse, a consult to an orthopedic surgeon. Now don’t get me wrong, if I break my femur, I want an orthopod. But the last thing I want with low back pain is back surgery. Study after study tells us that outcomes from multidisciplinary management are superior to surgery and I have seen enough people with failed back syndrome (multiple back surgeries, no better, and typically much worse) to last a lifetime. If I had a red flag concerning for spinal cord compression I’d have an MRI, but my pain was smack in the middle of my low back, radiating out equally on both sides. Unsexy, run of the mill, low back pain.

So I took my own advice. The same advice I’ve been giving for almost 15 years, so it’s not like I had to think about it. I just had to commit to it. Which is hard. Because it meant some major lifestyle changes and an even bigger reassessment of my life.

  • I lost 40 lbs. And oh my God, did that make a difference. I was carrying a 40 lb fat back pack since I had my kids (they are eight-years-old). Granted being pregnant with triplets is hard on your body and then having sick kids for a long time left precious little “me” time. However, at the end of the day I realized that taking care of myself WAS taking care of them. If I’m healthier I will A) live longer, B) not flake out at the end of the day because my back hurts, and C) set a positive example (because we can tell our kids anything, but it’s what they see that counts).
  • I strengthened my core. We are meant to be bipedal…up around on our feet, running from saber tooth tigers. We didn’t evolve to sit in a car, or at a desk, or on the couch in front of the TV. I’ve been tweeting about my boot camp experience, but having a strong core has really revolutionized the way I carry myself and the pay off is exponential. I am strong.
  • I managed my stress. If I can’t control it, I forget about it. Or at least I try. Best example: if I’m running late and traffic is a bear. Stressing over it will not make the cars in front of me magically part like the red sea. In those circumstances, you just have to let it go. A lot of chronic pain (probably 70%) is musculoskeletal. Stress starts to build up as muscle tension, and voila, low back pain (or headaches, or pelvic pain, or where ever you carry your stress). Oh yeah, and I got divorced, because I realized I was profoundly unhappy and it was in my power to change that. Living with someone who is making you miserable is the worse kind of pain imaginable. Fix what you can and let go of what you can’t.
  • I learned how to use a back roller. It’s just a cylinder of foam, but it offers a multitude of amazing ways to stretch and strengthen your lower back.

I suppose there are days when my back bothers me a little, but then I think back and realize I have had a little more stress lately or slept poorly, so I get myself back on the self-care band wagon. I haven’t felt this good in years, and if the situation were to ever present itself, I feel pretty confident that I would be the one leading the saber tooth tiger hunting party.

 

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Discussion

7 thoughts on “When the pain doctor has chronic pain

  1. My, My. I’ve never been to a Doctor that foxy, but you are right about the stress. It seems that days that I am stressed out my pain in my legs and hands are worse.

    Posted by Benny Stearns | October 27, 2011, 1:31 am
  2. I was *born* with lower back pain. Seriously. At least 1 pinched nerve, probably two: agonising pain in hip, loss of feeling in toes.

    Exercise kept it all at bay for years. Exercise is GOOD. Listen to the nice lady doctor. If you’ve got a posture problem, bite the bullet and treat it: orthopedic soles, special exercises, the works. Keep the weight under control. Wrap up well in draughts.

    Pro tip for reducing stress: get that special someone in your life to help massage away the contractions in your back and shoulders with a little warm, scented oil, maybe a few candles, make sure the children are in bed, etc ;)

    Posted by anarchic teapot | October 27, 2011, 9:14 am
  3. Jen,

    I also work in chronic pain management – could not agree more about no back surgery! Are seeing patients getting these pain stimulators placed? While I have only referred a couple, only because they asked. I have had a couple of patients have problems, would love your insight. I just started following you. Looking forward to reading.

    Brett – The NP Mom

    Posted by The NP Mom | October 30, 2011, 4:17 am
  4. Have you looked into Calmare for treating chronic pain? It’s FDA cleared and is noninvasive with no side effects. calmarett.com

    Posted by Thomas Kocherhans | October 30, 2011, 5:06 am
  5. Hi Jen,
    I am a chronic pain patient and I try to see my chiro at least once a month. I wish I could go more… I would never have sx period!
    That being said…could you follow up on the best core exercises to do? There are so many and some are advanced like the “Plank” in yoga very hard for chronic pain peeps.
    Exercise is good if you are not dying in pain! I find that chronic pain makes all pain worse even pain from exercise. I just got a 3 wheel bike to ride to my store and pharmacy & bank and will see how that goes. (I hope good and lose some weight)

    Posted by crystalwolflady | January 10, 2012, 10:06 am
  6. I started to notice severe lower back pain. Severe … and right smack in the middle of my back, non radiating .. and then I’d start my period .. after the 2nd day of my period it goes away. Obviously, after 8 months of this, it’s related since it’s the only time it happens … some day I’ll remember to mention it as a new problem to my doctor … maybe.

    Posted by student4now | April 29, 2012, 12:28 am
  7. Dr Sarno…

    Posted by Joe Christie | April 10, 2013, 1:50 pm

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