When pain takes over

By Deborah Pike Olsen

updated 8:37 a.m. ET Jan. 9, 2008

I always thought my body could do anything. At 28, I would routinely run four miles at a stretch. At 32, I gave birth to my first child. Maybe that’s why when a deliveryman showed up one day about six years ago with the new sliding patio doors I’d ordered, I thought I could surely help lug them inside.

Bad idea. A few hours later, I felt an extreme tightening in my lower back. During the next couple of weeks, the pain worsened, depending on my activity. My butt and thighs ached after I pushed my 7-month-old daughter in her stroller. And my entire left leg — from my thigh to big toe — burned whenever I tried to close those new patio doors. I finally saw a doctor, who recommended physical therapy. Although I was pretty fit and only in my early 30s, it took me five months to recover.

Then one night about two years later, my husband and I got into an argument. I stormed out of the house, slamming the front door behind me. In that instant, the pain returned and then continued to pop up in new places during the next six months. I had trouble turning my head, and my left arm became weak. Later, I developed a fiery sensation in the middle of my back, beneath my left shoulder blade.

Many doctor visits, two diagnoses of herniated disks and several more months of physical therapy later, my symptoms still plagued me. I could barely push a grocery cart without triggering a deep ache through my left leg. Even sleep didn’t come easily: Rolling over felt like a knife slicing across my back. Worst of all, I could no longer hold my two toddlers on my lap without throbbing pain.

Now I have a name for my condition: chronic pain, which is defined as discomfort that persists for three to six months or longer. Yet I still don’t have a satisfying explanation for it. When the results of magnetic resonance imaging scans of my back and neck indicated that I never actually had herniated disks, I was surprised, but my doctors weren’t: MRI findings don’t often reveal the cause of back pain. My neurological exams, which tested reflexes and strength to determine whether spinal nerves might be irritated or compressed, also turned up nothing.

Hurting? Here's how to find relief Where to begin If persistent pain is disrupting your life and seeing your primary care physician doesn’t deliver relief, visit a pain specialist who’s board-certified in both pain medicine and anesthesiology, neurology, physiatry (a type of rehabilitative medicine) or neurology. Or try a multidisciplinary pain center, where a team of specialists can devise a cohesive medical strategy. (Call the Commission on Accreditation of Rehabilitation Facilities at 888-281-6531 for a list of accredited pain-management facilities in your state, or contact a local major university medical center.) Research shows that the multifaceted approach to treatment is very effective. “I can do a nerve block,” which involves injecting anti-inflammatory meds, says Carmen R. Green, M.D., of the University of Michigan at Ann Arbor. “But if I don’t improve a patient’s ability to cope through psychotherapy, I haven’t done much.” Here are some of the treatments your pain-management team may prescribe (efficacy varies depending on the patient): Conventional treatments — Physical therapy — Over-the-counter pain relievers — Prescription drugs (such as opioids and antidepressants) — Psychological treatments (like relaxation training and biofeedback) — Interventional therapies — COMPLEMENTARY REMEDIES — Acupuncture — Massage — Yoga and/or tai chi

In my two-year odyssey to find a cause and a cure, I’ve learned that chronic pain frustrates doctors and patients alike. Because pain itself is invisible, and it’s often impossible to pinpoint a trigger, young, healthy patients are frequently dismissed, especially if they are female.

“Doctors don’t assess pain as well in women,” says Carmen R. Green, M.D., director of pain management research at the University of Michigan at Ann Arbor. “They may think, Can a mother really have pain if she’s able to take care of her kids?”

That attitude aside, one reason many doctors have trouble diagnosing and treating pain is that until recently, medical experts viewed pain as merely a symptom. Today, researchers know that chronic pain itself is a disease of the central nervous system because, as happened to me, it can persist indefinitely after an initial injury has healed. Sometimes there is no specific injury to blame, as in the case of fibromyalgia, the baffling disease marked by muscle pain, tenderness and fatigue.

Over time, prolonged discomfort can permanently damage your nervous system, diminishing your body’s ability to ease pain, so you experience it more intensely. According to one researcher, if you can’t treat the ache within a short window, it’s more likely to persist. “Central nervous system changes peak at three weeks of pain, and then they may become irreversible,” says Clifford Woolf, M.D., professor of anesthesia research at Harvard Medical School in Boston.

Unfortunately, most doctors and patients aren’t aware of how urgently treatment is needed. One survey conducted by the American Chronic Pain Association in Rocklin, California, found that 72 percent of people with chronic pain have lived with it for more than three years, and a third have dealt with discomfort for longer than a decade. Chronic pain interferes with a sufferer’s life, straining relationships, deep-sixing careers and leading to depression, even suicide. Thankfully, new discoveries in research are finally giving doctors a better understanding of how pain becomes persistent — and the best ways to ease suffering.

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