“My back doesn’t hurt anymore. Thank you.” she said, “But I’ve still got this pain in the ass," and gestured at her husband. He turned red in the cheeks and sagged in his chair.
Mrs. George (names changed for privacy) was here to follow up on her outcome from a back procedure I did for her two weeks earlier. I’d just walked in when she launched into telling me of all the housework she’s been doing and how exhausting it is. She knew she was to rest but said, “There’s just too much to do. I can’t rest.”
Her husband had made the first appointment for her. “She’s been complaining about her aching back for years and I’m sick of it!” He declared. “Can you amputate or something?!”
Three weeks earlier she told me of how her back ached intensely. She couldn’t even stand up. She would be willing to do anything to be free of it. She had just a few streaks of gray in her heavy brown hair held back by a straining metal headband that squeezed her head. I wondered if it was too tight. A moist herbal tea scent hovered around her plump five feet four inch frame. She still had that headband on.
"Excuse me, Mrs. George." I said. "I want to know what happened with your back after the treatment." She had a Radiofrequency Ablation, a procedure with needles that burn sensory nerves to painful joints in the back.
"Oh, I didn't feel a thing," she said. “I don’t understand it but the back pain is still gone.”
That's not the typical response. Usually it’s more like, “It was easier than I thought and feels much better now.” I looked closely at her eyes and face and thought, “She misses the back pain just a bit.”
“You know, Dr. Johnson,” she said, “I raised four kids and kept house without ever complaining of back pain. Oh, I had it! Now I’m supposed to enjoy the golden years?! Ha!"
You might think that the Georges, married almost 40 years, would fit together like a hand-in-glove but it was more like a hand-on-cactus. Mr. George the hand and she the cactus. Mr. George complained of her incessant complaining about housework while she complained about his messes and lack of appreciation. Now I'm an Interventional Spine Pain doctor, not a marriage counselor. It appeared the spine issue was resolved but there was no joy. What's with that!
WHAT THIS BLOG IS ABOUT
In this blog I’m going to share some of the anecdotes and pearls I’ve gleaned from over 70,000 cases. There are three parts to each post:
1. What people tell me vs. the real issue.
2. A comment on the neuroscience of the case.
3. My observations and philosophy on pain and suffering.
If we as humans could just say what the real problem was and what we really wanted, and if doctors would not waste hot air pontificating in neurolinguistic jargon, it would be a lot easier.
But since I'm a doctor with a lot of hot air I'll talk first about what was said. Her back ache was incapacitating. Yet she kept busy around the house. The main driving force for her coming in was her husband who thought this would free him of her complaining. Thus the lack of joy even though she got relief. The absence of the pain was disorienting to her because it had become part of her martyr identity, dying of work for an unappreciative husband.
It's clear that she presented with a nociceptive component of pain. That is a physical sensory receptor signaling pain from a body part. Injured facet joints in the back of the spine tend to hurt when we straighten up and may be relieved with bending forward. She reported pain with leaning back on the facets and injection of anesthetic to the facets temporarily took away her pain. Burning the sensory nerves to those joints caused lasting relief. The nerves usually grow back in less than a year. No function is lost.
The facet joints in the back of the spine are not designed for weight bearing. They are like interlocking incisor teeth that stop the vertebra from slipping. When the front disc collapses and the bone shifts down the facets get crushed.
In some ways modern medical treatments have made it harder to be a career martyr. Pain is still a basic part of it but suffering is the key. Nobody can take away your suffering if you don’t want to let it go. In this case, a simple word of appreciation from Mr. George would have worked better than an operation
“You gotta love livin', baby, 'cause dyin' is a pain in the ass.” Frank Sinatra