The pain of pain relief

The physiotherapist tells me we’re going to try something new today after I tell him that I’m still experiencing a lot of pain in my back.

“Have you ever tried spinal traction?” he asks.

“I don’t think so.”

“Follow me…Hop up onto the table and we’ll get you strapped in.”

“Is it going to hurt?”

“It might, but it’s normal.”

I lay down on a table that has a gap in it just beneath my shoulder blades, essentially a table split in two. The straps seemed elaborate, as if I was being held down to endure some punishment using a medieval torture device. One set of straps wrapped tightly around my hips with two small straps running between my legs to secure to the base of the table. The other set wrapped just as tight around my torso with two small straps each running across the top of a shoulder to secure to the top of the table.

“OK, so the table is going to slowly pull apart and stretch out your spine. This will take a lot of strain off your back. I’ll come back to check on you in a bit.”

He walks away and the machine starts up. It moves slowly, pulling apart a small amount then retracting back to the original position. The first pull feels alright. Sort of like taking a big deep stretch in the morning, stretching your arms way over head while straightening your legs and pointing your toes. Aaaahhhh, goooood morning!

This doesn’t feel right

The machine continues though, and the distance increases. This doesn’t feel right, I think to myself. But he thinks it will help, and he did say it might hurt. My body starts to react to the traction. It protests fiercely by tensing up the muscles in my back, trying in vain to hold itself together as the machine tries to pull it apart.

Eventually a young assistant comes to check on me. She says, “Doing OK?” while already half way out the curtained room, as if not really wanting a response other than “yes”. I say it’s uncomfortable and ask how much longer. She tells me not too long and I struggle through the rest of the treatment, hoping the pain is worth it.

Though I felt more sore after the treatment than before it, I still went back for one more try. It must have been me, I didn’t do it right. I need to relax. The second time, my body went into full revolt. Angry with me for not listening to its protest the first time. I had to yell for someone to come stop the machine before the time was up. The assistant arrived first to deactivate the modern day rack torture table. The physiotherapist made his way over and said it was too bad I didn’t like it. It’s helped lots of his other clients.

I left feeling once again like it was somehow my fault that the treatment didn’t work. There was no ownership on the physiotherapist’s end for perhaps giving me the wrong treatment for my complaints of decades long persistent pain.

I never went back to that physiotherapist, or any for that matter. Prior to the traction experience he frequently wanted to crack my spine like a chiropractor would. Contorting my body into a twist then putting his entire weight (which was significant) onto my twisted body to get a crack out of my spine. On one occasion I begged him not to crack the one side, telling him that I thought my back was too tense to get any benefit. He assured me it would release the tension and did it anyway. I felt sick to my stomach from the ripping, crinkling, faint pop sound that he generated.

Different kinds of pain

Breaking old habits

I like to think that the practitioners that have caused me bad pain in the past were not doing it maliciously. Most of them likely don’t understand the complexities of persistent pain or how to treat them. It’s been a large gap in how our medical practitioners are taught about pain. They expect you to come in with a problem to fix, and some get frustrated when you keep coming back saying it hasn’t worked. I myself believed very strongly that I had a problem to fix and would get frustrated right along with them.

Perhaps we need to get more aggressive? What else you got?

I have to take ownership as well. Now that I better understand the pain I feel and the gaps in the medical system I can see that my practitioners and I have been fighting a battle that can’t be won. For decades I’ve been trying to get rid of the pain rather than manage it. There have been times when I’d contemplate using sewing needles to give myself needling treatments, thinking If I can just hit the right spot, I’ll make it stop.

My body has endured enough torture. It’s made that very clear to me. During a recent psilocybin treatment (ie. magic mushrooms – more to come on this in a future article) I sat with my ankle in hand stroking and massaging around my scar. I was sobbing a steady flow of tears that originated from somewhere deep inside me. I realized that it was my ankle crying, expressing itself through my tears. The words “stop hurting me” came to me over and over again, as if my ankle was reaching out to me in a moment of desperation.

Sticking to the good pain

The pain is necessary at times, and not all treatments that cause some pain are bad. Perhaps a better word to use for the “good” pain is discomfort. The difference between discomfort and pain is different for every individual. I believe that it depends on your relationship with and understand of pain, the trust you have with your practitioners, and your personal readiness to try new interventions. If you have no mental capacity to deal with something new and perhaps a little scary, then chances are it will not be a good experience.

For me, the discomfort I’m willing to endure for pain relief looks like the feeling of a needle piercing my skin and gripping my muscle or facia triggering it to release or relax. Or the pressure of a deep tissue massage that feels like it helps get my blood flowing again.

I’ve compiled a few ways that I’m learning about how to stick to the good pain, the discomfort, when trying new treatments. I’m still in the process of practicing a lot of these and I’m still struggling with a few specific ones, namely the one about speaking up. Like any skill the only way to get good at these is to practice, and fail, and modify, and try again, until you find what works best for you.

• Speaking Up. Something I struggle with a lot. My practitioner will never know if what they’re doing is hurting me if I don’t say anything. The fear of a negative reaction is often unfounded, but if they do react negatively, I have to ask myself whether or not they are the person who should be treating me at this point in my journey.
• Knowing My Limits. If we don’t know our own boundaries, we can’t express them to our practitioners. I’m making time to get to know my body’s, and my mind’s, limits before I put myself in the care of someone else.
• Building Trust. This one takes time and is easier said than done with the reality of extended health care costs. When I’m financially able, I start slow with a new practitioner. I’ll ask lots of questions when we first meet (some even offer free consultations before committing to an appointment). I’ll get to know their strategy, their understanding of my kind of pain, and gauge whether I’d feel comfortable expressing my needs with this person.
• Paying Attention to My Inner Voice. Our bodies are communicating with us all the time, but we’re often not paying attention until it’s too late. When I’m with my practitioner, I’m paying attention to how my body feels. Do I tense up or relax when I see them? Do I drag my feet or arrive early to my appointment? Do I quiet the chatter in my mind or hear sounds of ahhhh, yeaaa while they’re treating me?
• Doing My Research. This includes on myself and on potential treatment options. I’m getting to know my community and what’s available to me. For example, I found a nurse practitioner, not mine, within the clinic I go to who specializes in chronic pain. I’ve also discovered that the Native Friendship Center offers free counselling services. My primary doctor only knows what they were taught. They can’t know everything. Most are unaware of all the services available to persistent pain sufferers, especially in the era of the internet.
• Diversifying My Treatment. Persistent pain is not simply a body issue. Many argue that it’s a brain issue. The signals in my body being misinterpreted by the brain. It’s different for everyone. I’m remembering to address the mental side of chronic pain as well. Being in pain for long periods of time does affect your ability to cope, it changes your brain! I’ve often received more pain relief from mental supports than from physical interventions. There is no one cure. It must be holistic.

We don’t need to be fixed

The reality of finding a new practitioner can be a stopping point for many to bring up concerns with an existing practitioner. It can be insanely hard to give up a medical professional in some instances knowing that you may not find another one. Why rock the boat? At the very least, it’s important to know what you’re working with so that you don’t put yourself in a vulnerable situation. If you know what your docs limits are then you can work to fill that void with another service while maintaining your primary care practitioner.

All pain is not the same. And those of us with persistent pain are not broken, meaning we don’t need to be “fixed”. It’s taken me a long time to figure out that I’ve been on the wrong path to pain relief, and it will take me a while longer to break old habits. What’s important is that I know more than I knew yesterday. All that matters now is what I do with that information today.