Last week I told you about my six year journey through Workers Comp hell, precipitated by a broken leg and resulting in a 100% disability rating based primarily on a long-undiagnosed back injury with subsequent nerve damage. Almost as an aside I mentioned a future diary in which I would discuss the arsenal of non-pharmaceutical techniques I've learned to reduce my level of chronic pain. Based on your comments, it appears many of you "share my pain".
I do not mean to imply I am opposed to prescription pain medications. I take prescription strength naproxen twice a day and a muscle relaxant in the evening. If my pain level gets high enough to make it difficult or impossible for me to live my life, I add something else. There are several meds you can try: some are anti-seizure medications, some beta blockers, and, of course, various forms of oxycodone. If pain is controlling your life and you are not under the care of a board certified physiatrist, please consider seeing one.
Pain can be described with terms that include its onset, duration, intensity, type and nature, as well as what makes it worse and what makes it better. I have found that grading its intensity - on a scale from zero to ten - is most useful for chronic back pain. My goal is not to eliminate pain; that's not a reasonable goal, at least in my case. My lower back hurts all the time and I have sciatica once in a while, as well as two bad sacroiliac (SI) joints. My goal is to have an acceptable quality of life with the fewest medications possible.
Here are some non-pharmaceutical techniques I've found to be useful in reducing chronic back pain.
Conscious, progressive relaxation: Whatever the source of your back pain, your back muscles are part of the problem. The first response most of us have to pain is muscle tension around the area that hurts. We move wrong or bend wrong or pick up something too heavy, triggering pain. We freeze and tense up. Our back muscles spasm, pulling injured discs or degenerating vertebrae further out of place. Pain increases, tension increases, and muscle spasm worsens. It often becomes a vicious cycle. A HUGE part of the solution, for me, has been learning to do two things. First, on an ongoing basis, I keep my back as free of tension as possible by doing progressive relaxation exercises. Second, whenever I get hit with a sudden jab of intense pain, I do just the opposite of what my body wants to do; I relax instead of tensing up. It can take two or three days of conscious effort to stop the spasm completely, but - and here's the important part - I haven't had to seek drastic medical intervention since I learned to do this.
Slow, deep belly breathing: If you breathe properly, particularly when in pain, the intensity of your pain will decrease. Proper breathing provides your blood with better oxygenation and may even reduce your heart rate. To check your breathing, place your hand on your belly while you're lying down. Take a deep breath, pushing your belly up as far as you can while inhaling through your nose. Exhale slowly through your mouth. Repeat. Relax. Do some progressive relaxation exercises.
Heat, maybe cold: Heat does more to decrease the intensity of my pain than anything. I have extra-long heating pads everywhere I sit at home, positioned so they're applying heat to both my lower back and my butt. Computer chair? Heat. Couch? Heat. Recliner? Heat. Before I bought my current car, which has heated seats, I found an inexpensive seat heater for cars on Amazon. An unexpected benefit of the heating pads is I can set the thermostat lower during the winter. The downside? Every time I get up, I find a cat in my place when I return.
Some people get better results with cold therapy, or they alternate the two. Use what works for you.
Topicals - salves, patches, ointments, etc.: I think I've tried them all. If something helps you, use it. Although I confess to smelling like Tiger Balm from time to time, the only topical that significantly reduces my pain is an expensive prescription-only transdermal patch infused with lidocaine. I'd like to know what works for you.
Acupuncture: This was a big surprise for me. A few years ago, one of the large nerve roots in my lower back became so impinged that I couldn't walk. I developed a contracture of my right leg muscles from the severe pain. The doctor who normally did my steroid injections was on vacation and Workers Comp wouldn't let me see someone else. A friend insisted I try acupuncture because, after all, what did I have to lose? I came to the acupuncturist's office for the first visit supported by my friend and a cane, bent over at the waist. Two days later I returned, this time alone and standing upright, although I still needed the cane. After the third visit I was back to normal.
Stretching: Start every day with a few minutes of stretching (or yoga or pilates) and I think you will find over time that your back has less pain and stiffness. When I say "start every day", I don't mean you should go straight from the bed to the floor. Take your meds, drink your coffee, kiss your partner, feed your pets, and put some heat on your back while you read the front page. After an hour or so, when that early morning stiffness is better, stand up and do some neck rolls and shoulder rolls. Next, do some leg and calf stretches. Then get on the floor (if you can; if you can't, invest in a long bench) and do a series of long, slow stretches or yoga poses that will, over time, make your major joints more flexible, your core stronger, and your back more stable.
After some thought, I've decided not to be any more specific than that. We're all different, we all have different sources of pain, and what works for me might make you worse. Here's an example: exercise balls are supposed to be just the thing for improving core strength. In my case, however, any exercise that repeatedly hyperextends my spine has drastic consequences. See a physical therapist (or a qualified trainer) and tell them you want them to design a home exercise program for you. It's worth every cent.
Massage: Those muscle spasms I talked about? The right massage therapist can fix you up. I'm talking about deep tissue massage and if, say, your psoas muscle is a source of trouble, be prepared to holler.
Distraction: Unless my pain intensity is a six or higher, the right source of distraction can make an hour or more go by before I start noticing how much I'm hurting. This site is a terrific distraction for me, along with some TV shows, writing, reading, and playing with my pets.
Laughter: Laughter also qualifies as a distraction, but I think it's in a class by itself. A partner or friend or co-worker who has a great sense of humor and tries to crack you up as often as possible is a gift from the gods.
Sleep: Sleep is essential. If pain wakes you up, before reaching for the pill bottle consider your bed. I highly recommend a memory foam topper for your mattress, two or three inches thick. Invest in the best pillows you can afford. If you're a side sleeper, use something like a king-size pillow placed lengthwise under the covers and "cuddle" it, i.e., put one end between your knees and rest your free arm on top of it. Once I made several changes like these, I began sleeping through the night (eight hours!) and noticed the frequency and intensity of my pain crises had diminished.
Walking, other exercise: The worst thing you can do if your back hurts, experts say, is take to your bed. Move around. Go for a walk. Concentrate on relaxing your back muscles while doing so.
The backbone's connected to the hip bone: If you have back pain that radiates down your butt and the back of your leg (sciatica) or if you have sacroiliac (SI) joint dysfunction, good body mechanics are critical. Don't sit for prolonged periods. When standing, shift your weight to the unaffected side. Stand on a book or a stair and let the affected leg dangle weightless a few times a day. SI joint dysfunction is notorious for causing stabbing pain when bending or squatting or doing things like pushing a shopping cart into a turn. When you make movements that hurt your SI joint, let your unaffected side do most of the work.
Weight loss (sigh): You knew I was going to get around to this, didn't you? I can hear some of you yelling at your monitors right now: "How the hell am I supposed to lose weight when I can no longer __________!" [Insert favorite former activity: play golf, jog, etc.] I hear you. But let me tell you a story. When I was in nursing school I gained and lost twenty pounds in eight hours. I was observing in a cardiac cath lab and had to wear a twenty pound lead apron all day. Within two hours my back and knees were KILLING me and I was exhausted. All over twenty extra pounds. If you're carrying around extra weight - particularly if you're carrying it in your abdomen - losing weight will lower your pain intensity.
Posture: This tip can work miracles for some people, and it's easy. Sit up really, really straight. Stand tall. Imagine "lifting" the weight of your backbone and stretching it out, easing the pressure on bulging discs and degenerating vertebrae. You can spend several thousand dollars for "spinal decompression", which is nothing more than placing yourself on a torture rack ... or you can listen to your mother's voice in your head and stand up straight.
Chiropractic: If you have chronic back pain, you should know a good chiropractor. It's not the only answer to your pain, but - like acupuncture - it's a tool you should avail yourself of. In addition to skeletal manipulation, chiropractors offer treatment modalities that break up muscle spasms.
Supplements: Glucosamine and chondroitin reduce pain in some people. I, unfortunately, am not one of them, but I sure tried them. Vitamin D was a different story. I began taking 1000 mg every morning because my serum level was low and, to my surprise, my pain intensity dropped significantly. When I mentioned this finding to my physiatrist, he said about 25% of his patients have less pain when they begin taking vitamin D. Fish oil capsules are being studied for their effect on pain. I've always been a skeptic about homeopathy ... but I keep arnica montana in the cabinet, and I take it sometimes. Every single person reading this can probably add to the list: shark cartilage, certain herbs, etc. Here's my point: if you want to try something AND it isn't contraindicated because of a prescription med you're taking, go for it. Try it for a month or two. If it doesn't help you, save your money.
Nurse Kelley needs a moment on her soapbox. Folks, keep a list of everything you take. Prescription meds, over-the-counter meds, supplements, vitamins, herbal remedies and topicals. Show your list to a pharmacist in your area and ask him or her to look it over. You might find out that you shouldn't be taking two of them at the same time of day, or that you're taking too much acetaminophen, or that five things on your list are blood thinners. Print out a copy for your doctor or nurse practitioner.
Okay. Time for the fun part - let's talk!