Over Labor Day weekend in 1990, my wife and I were in Martha’s Vineyard to celebrate my birthday. Judy’s gift to me was a “special” massage that she’d thoughtfully scheduled, with the idea that it would help ease my chronic low back pain. But this wasn’t the usual massage rooted in the simple pleasures of Swedish wisdom. This was going to be an experience that had the masseuse gently walking all over my back. As I made myself comfortable on the cushioned table, I pictured a petite lady kneading my back muscles with her dainty feet. Instead, I met a rather robust, Teutonic-looking woman who proceeded to stomp across my back as I moaned and groaned in silence. I really didn’t want to appear wimpy, but I finally had to stop the massage because the pain had taken hold of me and began to sear down my leg.
I soon learned that all the narcotics on the island did little to interrupt the connection between my brain and my back pain. If I had to describe the pain, I’d say that it felt like electrical shocks shooting down my right leg. Though it came on gradually, over several hours, I reached a point where I couldn’t move or even find a comfortable position. I knew I was in trouble when the doctor in the ER offered to call the Steamship Authority and arrange for an emergency spot on the ferry to get me off the island. Luckily, we had taken our station wagon, so I had a reasonably comfortable ride home with the seat in the maximally reclined position. I never before appreciated Percocet and Valium so much!
Judy had called ahead to one of my colleagues, an anesthesiologist, who specialized in pain management so that by the time she dropped me off at the hospital, I had a team waiting to perform an MRI. Going by the images, they were prepared to perform a relatively quick and easy procedure. I had already diagnosed myself as having a disrupted lumbar facet joint, something you’ll read about shortly. This procedure involved what’s called a facet block, and I went home about an hour later, pain-free. I was fortunate to have such amazing access to proper medical care, and the knowledge to quickly figure out my problem. I know that millions of people are not as privileged when something goes so terribly wrong. This is in large part the reason why I wrote my book and opened a second opinion service.
Without a doubt, that experience deepened my understanding of what many of my patients endure, and made me a more empathetic physician. It has allowed me to better understand their plight and have a profound appreciation for the mysterious and sometimes elusive nature of pain. It also has further empowered me to listen to and learn from them, for if I had to say what has influenced me the most throughout my career, it has been my patients. They have been my greatest teachers. Although we experience pain that is unique to each of us, there are patterns of pain—patterns that allow me to better understand the source of pain and enable me to venture a diagnosis and suggest a treatment plan based on how others with the same pattern found relief. In this respect, the diagnosis and treatment of back pain are no different from those for any other disease. They require a thorough history and physical exam; they also usually call for laboratory and/or imaging studies to confirm a diagnosis and identify a course of action that has been shown to be effective.
That said, what makes the treatment of back pain dramatically different from that of most other medical problems is of course the “pain” part. My patients have also taught me that pain, especially if it goes undiagnosed or is improperly treated, frequently takes on psychological and social ramifications, all of which can change a person’s life forever. At that point, pain becomes virtually surreal. Those of you reading this might want to consider the following: how much of your pain is real and how much is surreal? My hope is that you’re with a treating physician who can help you figure that out.