to sound the alarm and doesn’t respond completely to an anti-inflammatory or local anesthetic, you have to be careful not to ignore that pestering warning signal. If we fail to shut the pain alarm off with conservative therapy, it is possible that our body is desperately trying to indicate that there is a serious issue at hand (as is the case with appendicitis).
And so, once more we have discovered that the body has a way of fighting back to keep sending you the pain alarm when it senses something is wrong. When these rare, but serious events occur in our lives, I believe that we actually want to let our bodies continue to sound the alarm (i.e., continue to send the warning signal of pain). If we switch off the pain completely, through over-medication, we risk missing the serious problem that is occurring. Here again, I have observed that over-medicating patients rarely results in 100 percent pain relief. Again, this is the body’s natural intelligence preserving our ability to feel pain in the setting of a major systemic problem.
The Body’s Protective Warning
One patient, David, saw me for pain control after spine surgery. He was managing his pain with high doses of opiates but he was still clearly uncomfortable.
“Is this how I am going to be for the rest of my life?” he asked. “I was expecting to be fixed by now.”
I simply couldn’t find an effective way to control his pain, so David went back to see his surgeon, who subsequently diagnosed an infection in David’s spine. Another surgery removed the new infection and after that the pain completely resolved. If I’d simply turned off his pain at his request, that infection would have spread.
Another similar case comes to mind. A friend, Nancy, was training for a marathon when she developed severe hip pain. At first, she thought it was a strain. She kept running under the assumption that the pain was muscular and that the best thing to do was just push through it. Unfortunately, it didn’t get better.
Nancy’s X-rays came back normal so an MRI was ordered, and that revealed a stress fracture. Nancy had to pull out of training and spend four weeks on crutches. Without that diagnosis, she might have run the marathon with painkillers, causing a more severe injury, perhaps even a displaced hip fracture.
A spine surgeon colleague once referred a patient with a disc herniation to me, requesting a nerve root block. This is a procedure where a local anesthetic and a steroid are delivered directly to the patient’s spine to temporarily decrease the perception of pain and decrease the inflammation along the nerve.
We use nerve root blocks when we suspect inflammation or compression of the spinal nerve by a herniated disc. The nerve block serves diagnostic and therapeutic purposes: If the patient sees a significant benefit, the surgeon can perform highly localized surgery to free the compressed nerve and alleviate the pain with the smallest possible intervention. In other cases there may be multiple compressed nerves, in which case the nerve root block will not provide the same complete relief.
In this case, we performed the nerve block and the patient did well, finding complete relief while the local anesthetic was working. This established the diagnosis and I planned to send her back to the spine surgeon for a procedure to permanently solve the problem. Given the severe compression, we were both certain she would require surgery.
The funny thing was, her pain never returned. This experience taught me that, on occasion, simply abolishing the pain temporarily can have a lasting effect. Perhaps the injection interrupts pain just long enough to stop the wind-up phenomenon from spiraling out of control. Perhaps the nerve pathway simply stops sending off the alarm that something is wrong. Perhaps the finely tuned inflammatory response receives a signal to turn off for a while because the communication with the sensory nerves is turned off. This is sometimes the case when there is no serious problem present, but simply nerve irritation, which once treated results in extended pain relief. The reprieve from pain can help turn off the alarm, as long as there is no serious problem lingering. It also helps us as physicians differentiate what is a mechanical compression problem of the nerve versus simple inflammation. The spine surgeon who referred me the patient was somewhat perplexed as well. He wondered whether I’d used steroids in the injection, but I hadn’t.
Конец ознакомительного фрагмента.
Текст предоставлен ООО «ЛитРес».
Прочитайте эту книгу целиком, купив полную легальную версию на ЛитРес.
Безопасно оплатить книгу можно банковской картой Visa, MasterCard, Maestro, со счета мобильного телефона, с платежного терминала, в салоне МТС или Связной, через PayPal, WebMoney, Яндекс.Деньги, QIWI Кошелек, бонусными картами или другим удобным Вам способом.
