Pain Hurts
Pain hurts. Not exactly breaking the brain with that statement I know. Pain is how we know something is wrong with our body’s, it teaches (example - it only takes one touch of a stove while on to know hot is bad), and it is how we can better understand and appreciate pleasure. As much as we don’t want to admit too it, pain is a fundamental part of life.
Enter chronic pain. Believe it or not, but there is a big difference between chronic and acute pain. Acute pain is a condition for which there is some combination of medicine, physical therapy, ice packs, float therapy, or many other treatment options that can cure it. Whether it is for 2 weeks or 2 months, acute pain will go away. Chronic pain does not have any treatment option or time limit before it will go away. It never goes away. At best, chronic pain can be only managed. What does managed mean, that even if a treatment for chronic pain works perfectly, the patient will still be in pain, only less than before. One should not measure chronic pain with the traditional 1-10 pain scale, chronic pain should be measured in terms of quality of life.
Since Thanksgiving, my neck has been causing my quality of life to be lower than it could be. I’m not sure what happened or why, but by the end of the night I could not turn my head without being in severe pain. To give you some idea of what I mean by severe pain, I could not turn my head to the right in order to talk to mom while she was in the passenger seat of my car. I had to turn my shoulders in order to carry on a conversation with her that night. Not being able to turn ones head to talk to your mom is a symptom of a low quality of life.
On Thanksgiving I had a small hope that whatever was causing this pain would be temporary. Temporary meaning maybe a week. Like a good patient I spent the week stretching, icing, trying to stay on top of my pain through the use of my meds, and generally trying to keep my stress levels lower (both at work and at home). As I’m sure you have figured out by now, my good patient procedure did not work. By the following weekend I was starting to believe that I was in trouble.
For a chronic pain patient like me, what does “in trouble” mean? First, the brain fog was horrible. For example, While driving home from a coffee shop the week after Thanksgiving, I came across a construction site which required me to take a different road. I remember reading the sign that said deter ahead but it did not register. Next thing I knew I was stopped at the hole in the road that was causing traffic to be deterred. Completely missed the turn for the deter. At work that week I was having the hard time processing more than one item at a time, my job is based being able to do multiple items at once…even on “slow” days. I would go to type something like my name but on the screen it would say “rocky road ice cream” or something completely irrelevant to the subject at hand. As any chronic patient will tell you, brain fog is a common symptom which means I have had practice living in the fog. This practice is probably the only thing that kept from from causing a car wreck or getting fired.
One of the benefits of living with chronic pain is we become pretty good at identifying the cause of each pain we experience. For example, a “flare” is an extreme ache feeling, similar to a bad case of the flue. A sharper pain in one joint is going to be something osteoarthritis related. A sharp pain in both knees, along with stiffness, is most likely rheumatoid arthritis. A sharp achey pain in both hands can also be rheumatoid arthritis related. That said, new pain (either location and/or how it feels) can mean something is developing that could be related to a multitude of reasons.
For me, my neck pain felt new. It was in a new place on my neck and it did not feel like my other neck pain (if you don’t know I have 2 plates and 8 screws in my neck right now). In the interest of fairness, I will fully admit that any neck pain for me registers in my head as the world is ending. I can be in so much pain in my knees that I require a cane but it barely registers in my mental health, I get a slight grinding noise from scare tissue popping (not a uncommon occurrence with how damaged my neck is) and I’m in tears. Needless to say, with my increased brain fog and this pain having a “new” feeling, I was hurting mentally as well as physically. Kind of hard to maintain a job and life while experiencing pain like this, let alone having a high quality of life.
Every doctor, nurse, and physical therapist has their own opinion on how long one should wait with a new pain before doing something about it. That determination becomes even harder for someone like me because I have so much damage to my body from different causes. It is hard to determine if something is related to my rock climbing fall, 5ish car wrecks, my rheumatoid arthritis, degenerative disk disease, severe osteoarthritis, bilateral hip dysplasia, severe facet joint syndrome, or any of the other conditions on my diagnosis list. In addition, one condition can cause new conditions. Cassie, a previous physical therapist who I greatly admired and respected, always told me to wait at least a week after new symptoms appear before going to a doctor. Her logic was that ones body can usually begin healing in a weeks time so it was important to let my body do its thing. I was ok with coping through a week of new pain, however, that meant chances are I would be seeing a doctor on my birthday (not exactly the birthday present I was hoping for).
Good news, I didn’t have to see the doctor on my birthday. My appointment for my pain management doctor was on December 9th.
Going into the appointment I was convinced they would want to order X-rays or an MRI, I was wrong. After an examine the doctor thought my pain was coming from C2/C3 due to my facet joint syndrome (which if you are not familiar with your neck that is about 2 inches below where your neck meets the base of your head). Our ability to turn our head comes from C2/C3 so basically every time I was moving was aggravating the issue. I’m still convinced there is something new going on but the doctor wasn’t. The recommendation, a radio frequency ablation on both sides of my neck from C2 to C4.
A radio frequency ablation basically burns the nerves so I can’t feel pain anymore. I’ve had multiple ablations before with success, however, there was one ablation that didn’t go well. Any guesses where on my neck that was, yup C2/C3. Before I can receive this procedure, I need to have a couple of weeks of diagnostic nerve blocks. Obviously, before I can get the nerve blocks my insurance needs to approve.
The clinic received approval to begin the diagnostic nerve blocks on Dec. 13th. Things might be looking up, yeah not so much. Due to the holidays, the first appointment available was not until January 9th, 2023 at 9;45am. Just to recap, this new pain began on Thanksgiving and I went to the doctor on December 9th, 2022. Even if the diagnostic tests proved beneficial, that meant it probably wouldn’t be until the first of February before I could have the radio frequency ablation. I was in trouble.
Luckily, I had some vacation time to burn so I applied to take December 23rd off and the first week of January off. Under normal circumstances, those would be ski days. It wouldn’t matter if there was deep powder or rocks, I would be in the mountains making turns. However, since the start of this latest round of severe pain I can’t sleep much past midnight before needing another pain pill, have almost hit multiple people and cars because the pain has limited my range of motion even more than it is already, have had to stop whatever I was doing for a significant pain flare up, have needed a pain pill after drying my hair with a towel, have had horrible pain chewing small bites of food, and have ended conversations due to pain so I didn’t think skiing would be possible or wise, even if it would help me mentally. Basically, I spent my time off either on my couch or bed not moving. Not exactly the dream quality of life.
Side note, part of the reason I started this blog was because I wanted to improve my articulation skills. I need to work on being vulnerable. However, in this case I simply don’t have the words or skill to describe what I’m going through right now. That is why I’m relying so much on specific examples. My goal is to provide you with a chance to walk in my shoes for a few minutes in order to better understand. Hopefully this helps!
With the help of my opiate medication (yes I said medication), patience, stretching, ice packs, time off, and pure strength and will, I made it to January 9th without needing a ER visit. Please understand that doesn’t mean I won’t need an ER visit tomorrow, this is just a humble brag basically.
Its finally January 9th, diagnostic nerve block time. The plan, numb the nerves at C2, C3, and C4 on both sides of my neck with an ultrasound. Success is defined as for the 24 hours after the nerve block my pain is reduced by at least 80%.
Execution of the nerve block. Due to the nature of the test, the doctor can’t using a numbing agent for the skin. In the textbook’s opinion, the needle used in the nerve block is small enough that the patient shouldn’t be in that much pain. Notice I say textbook. My doctor injects what is basically a guide into C2, C3, C4 for the dye and nerve numbing agent. Once the guide is inserted, he injects the dye so he can see the joint on the ultrasound, then injects the nerve numbing agent. Remember, this happened on both sides of my neck.
To say the injections on my left side hurt would be an insult to the word hurt. I easily hit 9 out of 10 (my 10 being the night I fell rock climbing and required 10 screws and a plate in my left wrist). C3 was insanely painful, I felt it all the way down left arm. The right side was not as bad, maybe a 7 or 8 out of 10. I didn’t feel any pain down my right arm. I’m still not sure how best to describe the pain, the best I can do is a severe ache combined with a burning feeling. It physically and mentally hurt. When I say mentally hurt, it both sucked the life out of me and I don’t want anyone touching me. This would include the barista that I have a huge crush on, I need some recovery time. For the record, the 9th of January was a Monday and I went back to work after the block and worked the rest of the week. Chronic patients like me don’t take time off from work for fun, its because we are in enough pain to bring most of you to the ER, we just need a day or two to get it back to manageable.
I have my follow up appointment tomorrow. Based on my experience with this nerve block, I’m guessing my doctor and insurance company will approve round 2. If I’m perfectly honest, I’m only at 50.2% hoping to get approval, 49.8% of me is convinced that I can’t go through that again without some kind of major side effect. Personal experience has taught me that the 49.8% doesn’t really matter, if I want a legit chance at reducing my neck pain in the long term I need to “suck it up” and just do it. That “legit chance” is the .2%, that is the energy for which I continue to fight for my quality of life right now.
I’m going to end this post for now. My heart is hoping for some fried bison for dinner so I’m off to the grocery store. Stay tuned, I am planning to update this after my second diagnostic nerve block and hopefully after the radio frequency ablation.
If you have any questions about this procedure, or are scheduled to have it yourself and would like to talk please feel free to reach out to me. My socials and email are available in my contact info or you can leave a comment and I’ll reach out to you.
