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Office  Last Monday my lower back muscles when into a paroxysm of pain and they refuse to loosen up. Yesterday the left lower psoas muscle went into a spasm severe enough to make it near impossible to get up without evoking a vice-like grip in my lower back. It is not a sharp or radiating pain; it is not sciatica. All the same I have never been in so much pain other than the time I had  migraine headaches. I couldn’t do much last night. Even putting on and off my clothing was hellish and horrible. Taking massive amounts of Motrin and Ben-Gay have done little if any good.  My only comfort is the knowledge I’ve had this before and it passes – eventually.  Until then life is miserable and limited.  It effects my cognition and my moods.

I see a lot of patients with pain; theirs are far worse than mine. For such an important and ubiquitous topic pain is not much addressed in medical school. Doctors in general aren’t keen on treating patients with pain. I don’t disclose a secret to say patients with pain are not the types doctors like to deal with. Pain is subjective; pain makes people needy and wobegon. What patients want and what doctors are willing to do for pain are often at odds. A common complaint of my patients is their pain is not being taken seriously nor is it being addressed adequately. With the current national worry about opiate medication abuse, doctors are becoming less willing to prescribe such or even deal with pain, asking the patient to ‘see a specialist” which rivals getting an audience with The Pope.  When a patient is fortunate to find a physician willing to address their pain, they often feel they are looked upon as drug-seeking manipulative whining cranks.  By the way, data supports chronic pain is best treated NOT with opiate-based medication but with other Rx and non-pharmaceutical routes. Alas, these take time, energy, money, and explanation to do,  and patients often don’t ‘buy it’ – they want drugs – now – and effective ones. It is hard to think rationally when your mind is poisoned by pain. I my current status I would be willing to debase myself for something stronger than ibuprofen.

I know what I need to do for my pain: stay put, take regular Motrin, apply heat, and wait patiently. Perhaps get a massage and for goodness sake do some stretches. No valium  or hydrocodone is needed.  That’s a slippery slope.

But what about my patients, the ones who have active/chronic pain not being properly addressed? It is tough to treat depression/anxiety when pain is active. It’s like trying help a patient improve their sleep when they live in an apartment with the neighbor’s music  blaring all night.

Pain is a complex problem and the solution is likewise. The treatment is also complex. I wish I had a simple solution.

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