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Put a Lid on Pain

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Put a Lid on Pain

Customized remedies for back ailments.
Vijay  Vad M.D.
Vijay Vad M.D. More by this author
Aug 09, 2011 at 10:00 AM

When I met John, he was at his wits’ end, having all but given up hope of getting relief from what he experienced as “round the clock” pain. John runs several successful computer programming and Internet technology companies that require him to drive fairly long distances to work. When he first came to see me several years ago, the long drives were causing him considerable back pain.

John is now in his mid-40s, but the initial source of his pain was an injury that occurred when he was just 14. While competing in a karate tournament, he threw a roundhouse kick, also called a “720” because it requires two full revolutions of the leg and body to deliver the blow. His opponent had fallen against the ropes to get out of the way, however, so there was nothing to stop John’s leg and lower body from continuing to spin out of control. The whiplash left him a little sore, but he was able to finish the match. He didn’t feel bad that day, but the pain soon intensified.

“I woke up the second day after the tournament,” John said, “and I was absolutely screaming for my mother.” At the hospital, he was given traction and sent home the following day. John felt essentially normal for the next 10 years, with only an occasional backache.

He spent a decade laying tile and granite floors for a living, and even though he was on his knees most of the day, John felt little back pain, because his work forced him to maintain a strong body core and tight stomach. The problems developed after he stopped doing manual work and started his first computer job. He had been going to night school while laying tile, but once he began working at a computer station full time, he lost his core body tone, and after a few years his back pain started in earnest.

After examining John, I determined that he had a tear in the soft tissue in one of his spinal discs. When healthy, the discs separating the vertebrae in your spine are like jelly donuts: they have soft, gel-like centers surrounded by layers of fibrous tissues. Because of injury or aging, small tears can form in the outer layer of the disc (this is called an “annular tear”). When the gel-like center of the disc pushes through—like squeezing the jelly out of the donut—the result is a herniated disc. John had sustained a tear on the outside lining of a lumbar disc, located in the lower back. This caused inflammation of the nerve going down his left leg and resulted in severe back and leg pain.

I decided to approach his situation from all directions. The weight he had put on and the prolonged sitting he endured during his years of sedentary work had added enormously to the initial problem of his injury. So I started John on a weight loss regimen of aerobic exercises, including swimming, treadmill walking, and yoga-based stretching exercises (In my book, Stop Pain, I’ve include a selection of these stretching exercises) and an anti-inflammatory diet.

I also advised him to make other lifestyle changes, such as cutting down on his commute and heating his back for 15 minutes at bedtime and in the morning and icing it after work. I told John that if he did all these things, he would see a significant improvement within six months. In a very short time, John went from missing two or three days of work per week because of his pain to being able to work five days a week.

It’s not that John has no pain at all now. We are managing his pain in an ongoing way and keeping it at a minimum. I may still occasionally prescribe anti-inflammatories or pain meds, or suggest going to an osteopath, but only when absolutely necessary and only for short periods. I am usually able to get many patients to a pain-free stage pretty quickly, but others who have been seriously injured or have gone untreated for lengthy periods of time have to be willing to stay in it for the long haul.

John knows that if he maintains the regimen he’ll do all right most of the time. And that’s a big change from the way he felt when all he experienced was pain. As he once put it, “When I’m in so much pain, I feel like I’m in the middle of a crowded room screaming and no one hears me. When you’re in round-the-clock chronic pain, you feel lonely and isolated.”

Knowing that there is a way out of pain and that people care about you is a major source of comfort at times like that. My job as a physician was not to treat him and his various scans as numbers in a generic protocol, but to customize his treatment plan, because pain is personal.

About Author
Vijay  Vad M.D.
Vijay Vad, M.D., is a sports-medicine specialist at the Hospital for Special Surgery and a professor at Weill Medical College of Cornell University. He is the author of Back Rx and Arthritis Rx. In 2007, he created the Vad Foundation, dedicated to tw Continue reading