It is tempting to brush aside chronic pain advice from well meaning health professionals because they don’t understand your pain. The advice is often geared towards just coping and getting on with life – functioning despite the pain. It often comes at the end of a course of treatment where nothing has really made much difference.
When I reflect back now on my early clinical practice, I am guilty of this advice. I was very much a ‘suck it up princess’ sort of physio. I realise now why I did much better with treating acute injuries and not so well with those that were months or years down the track. ‘Suck it up’ doesn’t really work for persisting pain – I just didn’t know that.
Then I learned a valuable life lesson, thanks to chronic pain.
It was during my 3rd pregnancy that my back became really problematic. No specific reason…probably those pesky pregnancy hormones. It would, of course, just get better once I wasn’t pregnant. But it didn’t. It got worse. So in between worrying about how to run a private practice and look after 3 kids I went off to visit all the physio gurus. I tried all the new treatments and nothing seemed to work. They gave me the same advice I gave to clients. My immediate thought was ‘thanks, but you don’t understand my pain. It is different”. I became obsessed with trying to figure out why I had pain – because lets face it, if a physio can’t figure this out, perhaps they shouldn’t be a physio? I became extremely focused on every twinge and what it might mean as I tried to problem solve it all out. My pain didn’t make sense to me. I needed to be able to rationalise a mechanical reason for why the pain continued…some sneaky muscle / joint / ligament was weak / unstable / tight / in the wrong place. I went from being an aerobics addict to doing very little of anything active. I closed my private practice.
We moved to south coast and I started doing a small amount of consultancy work. Fortunately I had a forward thinking boss who wasn’t scared off by the potential Worker’s Comp risk and could see that I still had something to offer professionally. I couldn’t comprehend doing any sort of work where I might have to physically lift or manipulate a client. I constantly worried about the work I had booked in. Would I be OK to run that 2 hour training next week? What if my back was really bad? How do you explain a physio with a bad back doing manual handling training?
Ultimately I ended up in the office of a very lovely Sydney neurosurgeon. He went through my MRI results with me and said that his suggestion if I couldn’t live with my current level of pain was to have a disc replacement. As luck would have it, I wasn’t in a health fund, so his advice was to get in one and ponder my decision for the next year. A year came and went with no significant change to my level of pain or function, but it had given me time to build up a healthy level of anxiety that I could potentially be worse….and did I really want to roll that surgery dice? In retrospect I have real doubt as to how much this surgery would have helped me, because based on what I know now, most of the pain was due to a hypersensitive nervous system.
So, now what? My daughter and my pain were 8. I was as unfit as I had ever been. I second guessed every movement or activity that I needed to do. I didn’t participate in any ‘active’ family activity. I was capable of imagining that I had moved the wrong way and increasing my pain. I kid you not. And my pain grumbled along with intermittent flare ups. Not particularly great advertising for a physio.
And then I found explain pain. It re-conceptualised the way I understood pain and how to go about treating it. Turns out Lorimer Moseley who wrote it used to sit not too far from me in lectures back at Uni. I remember him turning up to lectures with no shoes on. He is now a professor. Go figure – you can never tell. I learned how to deal with my sensitised nervous system and how to upgrade my activity. I learned that what goes on in my head is just as important as what is going on in my body.
Now I am not going to tell you that it was a quick fix. I spent 8 years getting into this big black chronic pain hole. It took me probably a year to get back out to the point where my pain was only intermittent and I was far more active. The thing is that even a physio who really should know better still managed to get herself into a mess – so don’t feel hopeless about where you find yourself now. The encouraging thing is that with consistent effort, reduced pain and increased function is a realistic goal. Our nervous system is dynamic and adaptable. It responds to what you throw at it. If it currently responds with persistent pain, then you need to change what you are throwing at it.
Today I can swim 2.5kms or run 10kms or mountain bike 30kms or paddleboard for hours without pain. Any pain. I’d love to do a triathalon…..but I just can’t get past the whole shark thing. But I did run the City to Surf on Sunday in 75 mins and came in the top 10% of female finishers. Not bad for an old chick who wasted 8 years on chronic pain. [edit: And I ran the half marathon the following year with similar results. If you had told me a couple of years previously that I would be capable of this, I would have laughed at you and then cried].
I see a big need in Nowra and the Shoalhaven for a program that can adequately assist people with chronic pain. Something that gives you the right people to walk along side you as you journey, encourage you and give you the right information to start moving forward. The STEPP program is something that I have been tossing around for a year or so now, trying to come up with a way to help people in chronic pain that doesn’t require having to go to a Sydney inpatient clinic. Together with Felicity Slevin (psychologist), we think STEPP offers options to those that may feel they have none left.
We would be more than happy to hear from you.