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evidence based medicine, Lasso of truth, pain

Going back to work with neck pain, a doctor takes her own advice

IMG_2706I hurt my neck a while back. I was in the operating room and, in retrospect, I wonder if my neck was contorted in an odd way for a long time as it was a lengthy case. In addition, it was during what I call my emotional low point of the year, the 4 days between when I ruptured my membranes prematurely and the death of my son. Anniversaries, emotions, and stress have a huge impact on pain.

Regardless, that night my neck started to hurt. I put it out of my mind and managed to get to sleep only to be woken up at 2 am in excruciating pain. The only other time in my life that I couldn’t sleep because of pain was when I ruptured my spleen, so yeah, my neck hurt. I couldn’t turn my head to the right and my muscles had seized up so much they were cement-like. I found some not expired acetaminophen, got an ice pack, and reminded myself that in 40 minutes I would start to feel better. I distracted myself by reading gossip magazines while I waited for the medicine to kick in, a trick I use with my kids. Whether you’re waiting for a fever to come down or pain to go away, it takes at least 40 minutes to start to feel better so the best thing to do is not to get worked up about feeling shitty, because it’s only going to give you a steeper hill to climb.

I managed a few more hours of sleep, but by morning my neck was a mess again.  Every time I tried to turn my head I felt nauseous. I lay on the couch, in abject misery, and thought how can I possibly work like this? I am in agony at rest, what will it be like when I actually have to do stuff?! And then I started to panic, what if I develop chronic neck pain, oh my God…

And therein lay the rub. I am a pain doctor and the mantra I have preached for more than 15 years is that time off work doesn’t improve pain. Study after study (and a Cochrane review) indicates that with low back pain there is no difference, and possibly even a worse outcome, with bed rest over prompt return to work. I didn’t have low back pain, but it was muscle pain so essentially the same thing (I had no red flags of nerve impingement. I also know that catastrophizing (giving greater weight to the worst possible outcome) is a negative prognostic sign.

So I acknowledged this was a stressful time in my life, resolved to think positive, grabbed the Tylenol, put on my big girl panties, and drove to work. I even packed my work out clothes for boot camp.

And this is what happened.

When I was talking with patients and engaged, I had significantly less pain than laying on the couch. If fact, there were times I even forgot about the pain. However, when I had down time, my pain was the same as it was when I was on the couch only thinking about how much my neck hurt.

So I went to boot camp. I didn’t go full court press, but I did everything except burpees (because I hate them and I was worried they might be too hard on my neck, but mostly because I hate them. If you don’t know what a burpee is, click the link and then you will see why I hate them). After I had been exercising for about 10 minutes my neck felt the best that it had all day, not 100% but better. I’m not sure if it was distraction, increased blood flow, or adrenaline, all I know is that it helped.

The worst parts of my day were the drive in and the drive home, probably a combination of immobility and the stress of commuting.

By the next day my neck was 80% better. The ice wasn’t helping so I switched to heat, kept active, and 3 days later it was a memory.

Being off work might seem like the only answer. I get how it can hurt so much that it can seem impossible to do anything but rest, but the reality is that remaining active with many kinds of pain is actually the best thing. Immobility is the consort of pain, and the less you do, well, the less you become able to do. It is a downwards spiral that I see all too often.

If you hurt your back or your neck and you think you possibly can’t work, remember that as long as your doctor doesn’t think there is a warning sign that something more serious is going on, your doctor isn’t sending you back to work because they’re a jerk, it’s because they are practicing evidence based medicine and because they care.

 

 

*remember, this post is not direct medical advice

 

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Discussion

8 thoughts on “Going back to work with neck pain, a doctor takes her own advice

  1. I have a multi-level fusion in my neck; it has been over 20 years since the last surgery. Recurrent neck and shoulder pain is common; but I have generally believed in keeping active and reclaiming former activities, also in spite of a diagnosis of fibromyalgia. I use every trick in the book to stay up and at the world…and as you say, it works much better than doing an Elizabeth Barrett Browning on the sofa!

    Posted by syrbal | February 8, 2013, 11:21 am
  2. Cervical Rib Syndrome ? 2 extra ribs in the neck and the nerves get caught under the ribs .

    Posted by Jim | February 8, 2013, 11:37 am
  3. You do a fantastic job explaining your internal thought process and reasoning. But, patients don’t often have the luxury of knowing what is happening in the mind of their physician. I wonder if patients that are upset their doctor is sending them back to work might have better outcomes if they were aware of that reasoning.

    Posted by Med School Odyssey | February 8, 2013, 3:40 pm
  4. Last year I was experiencing intense shoulder/arm pain for several weeks (Age and family history raised cardiac concerns, but these were ruled out). As an avid runner, I get antsy after several days of not running, but still I was hesitant to run for fear of aggravating this pain. After a few days I tried running, and found the pain abated after about a mile or so. The pain returned within a half hour of my run, but I was able to resume my running. Similar to lower back pains I have experienced, this shoulder/arm pain cleared up after a few weeks.

    Posted by Ken | February 8, 2013, 5:43 pm
  5. Nice article, something that really helped me with my neck pain was changing the way I sleep.

    Don’t sleep on your stomach. While a favorite position for many, this sleep position can twist your neck and put pressure on your lower pack. A better option – sleep on your back or your side. It also helps to purchase a pillow that provides maximum neck support.

    Also, multiple pillows may provide immediate comfort at night, but cause neck pain in the mornings. Your head, neck and spine should stay aligned throughout the night to reduce pressure.

    Posted by St Louis physical therapy | February 12, 2013, 9:14 am
  6. It took 6 months for me to be diagnosed with neurogenic thoracic outlet syndrome. As long as I maintain great posture and modify some daily behaviors, I have a normal life. There’s nothing better than returning to the realm of the living from that of the couch potato.

    Posted by ahyesplans | February 13, 2013, 11:43 am
  7. I once sprained my lower back really, rally bad. It was hard to even walk. As a poor college student with no health insurance, all I could do was go to the student health center and get ice packs. It was horrible. The pain slowly subsided and I felt better, but it was still there. That all ended when I went to play soccer. I ran around for two hours and felt great afterward. The pain came back only days later and at a very low level compared to right before the game. Yes, sometimes it helps to get out and do stuff.

    Posted by Ren | February 13, 2013, 12:16 pm
  8. Going to work with neck pain.. hmm.. that rings a bell with me! I barely sleep at night.. down to the fact that I always have an ear out for the kiddies who right now are in the same room as us… I usually get 4-5 hours a night if lucky.. but when I wake up.. and I have had a coffee my neck seems to seize i bought all sorts of OTC medicines but to be honest they rarely work.. Sometimes when you least expect it something pops on the horizon that can help.

    I will keep an out of for your future posts and see how your getting on.

    William

    Posted by William O'Toole | July 27, 2014, 3:09 am

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