A pain in the…

Plenty of eloquent and wise people have blogs for many fine reasons — to keep in contact with friends, to write their experiences for a larger audience, to give voice to various social issues, to make others laugh…lovely reasons, all, and probably reasons that I, too, have put my hat into the blogosphere ring.

But there is another reason one blogs, or at least if one is honest, one must admit that a blog provides a good forum for venting one’s spleen (and what the hell does that mean anyway?) about some of life’s stupidities, small and large.

So, heeeere’s my spleen.

Background: Since 2002, I have been plagued, on and off, with intractable low back pain. I have had practically every “procedure” and such known to man to help with said pain: physical therapy, water therapy, epidural steroids, facet injections, trigger point injections, 2 separate disc decompression procedures…the second of these disc procedures actually helped me tremendously for nearly three years before I started to have, once again, the constant and steady pain with which I now live every day. And in the course of this time I have taken narcotics. A whole variety of narcotics. Baggies and baggies of…no, wait. Not really that.

But you see, here’s where perception and reality conflict with one another. The perception of someone who takes regular opioid medication is that said person is a junkie. An addict. A malingerer. This is the perception of society at large, and it is unfortunately perpetuated in all sorts of ways. One that comes to mind right now is the Fox TV show House, which incidentally, I love. On the show, Dr. House has sustained an injury to his leg that causes him to be in excruciating pain all the time, and a conceit of his character is that he’s constantly popping vicodan. Don’t get me wrong, House is a complete ass who is hardly a paragon for emotional stability, and he goes about procuring his pain medication in inappropriate and sometimes illegal ways. But hear this too: the man is in pain, and to function in his position as “Ridiculously Brilliant Doctor,” the man needs narcotic pain medication. Just because he’s developed a physical tolerance for said medicine, it doesn’t make him a junkie. It doesn’t make the needing of that medicine a weakness, any more than a diabetic’s need for insulin should be viewed as weakness.

But the crux of the issue comes down to this perception of drugs as evil in and of themselves, which by extension tarnishes those who need them. I have countless stories in my own experience of being treated poorly and inadequately with regard to pain medication, and all of these stories go back to the central assumption that those who claim to be in pain may not actually be in pain and may be seeking pain medication for other recreational uses. But let me tell you: I’ve sat in a couple of local pain clinics at various times in the last several years, and what I see doesn’t even begin to bear out that assumption. I have seen elderly people clearly dying and in pain. I have seen young people clearly dying and in pain. I have seen people in wheelchairs and with canes. I have never failed to be humbled, sitting in the waiting room, at the incredible level of pain that some people suffer. Yeah, my back hurts, I mean it really hurts, but wow. Lots and lots of people suffer in far greater ways than I do.

But you see, it’s not about the patients. It’s about protecting the doctors from liability and government regulations. It’s about providing half-ass cared to the above patients and passing the hot potato of medication so no one medical person or practice gets left holding the bag labeled, “I prescribed this guy too much percocet and I am now being investigated and could lose my licence.” It’s about patients, many of them elderly as I said, jumping through ridiculous hoop after hoop to prove their fitness to have their pain treated.

And here’s where it gets personal. I’m in pain right this minute, less than I have been some days, more than I have been others. In the coming months I will have to make some difficult decisions regarding surgery for my back, when surgery has a substantial risk of either not helping or making things worse. If doctors can’t fix my back surgically, they frankly may not be able to fix my back. My family physician, a competent and kind woman, referred me to a “pain specialist” (Okay, the quotes are a little snarky. I’ve been watching too much House.) who wants me have (yet another) injection in my back that he freely admits may or may not help and a discogram (Which no, isn’t John Travolta coming to your house and singing and dancing, as I had wondered previously. It’s actually a really bitchy procedure involving a needle and a doctor trying to poke your back in the exact place to reproduce the most pain, for the purpose of figuring out that exact location. I’ve had two discograms to date — good, good times). In the meantime, I’m in pain medication no man’s land. The family physician isn’t comfortable prescribing me anything (though I’m pushing that point), and the pain specialist doesn’t prescribe anything until…and this is awesome….I have a psych. evaluation.

I don’t begrudge these folks taking a gander at my psychological makeup. Have at it. But somehow, my ability to have my pain treated is dependent upon this evaluation, which I just discovered in making the appointment, involves 90 minutes with the psychologist and another 90 minutes of personality testing. I could tell you now that my personality is well and truly fucked, but I guess that’s another story. Do I think that the doctors requiring the evaluation have a deep concern for my mental and emotional states? Really no. I think that it’s part of the giant ass-covering game that needs to be played. And did I mention that I’m in pain? Like kind of a lot of pain? And that now I have to beseech my family physician to please, please, please, and I’m sorry, so sorry, please, help me out until I’ve completed the hours long psych. evaluation, and that information gets faxed back to the pain specialist, who then can determine whether I’m worth the malpractice insurance and regulatory agency risk to actually, you know, treat my damn pain?

Man, I’m tired. I hate fighting battles that shouldn’t have to be waged in the first place. And I’m not going to apologize for hurting.

Edited to add:

My family physician stepped up to the proverbial plate today and prescribed me enough pain medication until the whole psych. evaluation, etc. is resolved.  I’m grateful.  I really am.  Sadly, choosing to prescribe pain meds is, in fact, probably a professional risk for her.  But she believes me.  And I’m grateful for that.  I had my injection today, and mighty heavens, it was unpleasant.  But here’s hoping that it provides some benefit in the long run.  And I must add that the pain specialist was incredibly kind to me today, as were all the nurses with whom I came into contact.  Kindness does indeed make crappy situations slightly less crappy.