Forty-seven-year-old Kate went to see her primary care physician, complaining of low back pain.
“It’s been hurting for months,” she explained. “I’m not sure what caused it; it was just there one day and kept getting worse.”
“On a scale of 1 to 10, how would you rate it today?” the doctor asked.
“Six,” she replied. “But it’s not just the pain. I’m having trouble getting around, so I have to rely on my husband and daughter a lot. And it’s hard to sit all day at work.”
After examining her and looking through her previous medical records for any clue to the cause of the pain, the doctor ordered an X-ray and gave the Kate a referral to physical therapy, plus a prescription for an NSAID—a more powerful version of a popular pain pill available over the counter at drug stores.
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Physical therapy went well, with Kate’s pain rating dropping to a 4 while she was undergoing therapeutic massage and TENS. But shortly afer the therapy ended, her pain began to increase, so she returned to her primary care physician.
“It’s now a 5 or a 6,” she replied, in answer to his question about her pain level.
“I’m sorry the physical therapy didn’t do the trick,” he said. “Your X-ray showed a little disc degeneration, but nothing that would explain this level of pain. Tell you what. I’m going to give you a prescription for some stronger pain medicine. An opioid. It should do the trick. I’m also going to send you to an orthopedist to take a closer look at your back.”
Kate was relieved. Surely the stronger medicine would control her pain and the specialist would figure out what was wrong—then fix it!
The orthopedist performed his own examination of Kate, asking her questions, asking her to bend this way and that to see what triggered the pain, and more. Concerned, he ordered an MRI of her back, which showed degenerative disc disease and a bulging disc.
“It’s not huge,” he said as he pointed to an area on the MRI. “But you can see the bulge right here. And see how the spaces between these discs are narrow compared to the other discs? That’s degenerative disc disease. There’s inflammation in the area, and that causes pain. It’s what we call the ‘pain generator. ’ I’m going to refer you to an interventional pain specialist, an expert in dealing with problems like this.”
A few weeks later, Kate was lying on a table in an outpatient surgery center as the interventional pain specialist injected anti-inflammatory medication into her back. Working carefully, guided by a type of live X-ray called fluoroscopy, he injected the medicine in exactly the right spot.
“I’m glad we caught this when we did,” the pain specialist said, smiling. “You should be fine.”
Kate was indeed fine for a few days, but then the pain returned. Over the course of several months, she returned to the pain specialist several times, and each time he injected medicine into her back. Unfortunately, her pain grew more intense, not less.
“I can’t believe it got worse!” she said to her primary care physician. “It’s a 7 now, sometimes an 8, especially after I’ve been sitting all day at work. It’s hard to sleep; I have to take a pill every night. I don’t clean the house or shop anymore; my husband and daughter have to do all my chores. Isn’t there something else you can do?”
“Well,” the doctor replied, “I can send you to a different pain specialist. Maybe he’ll find something the first one missed.”
The second pain specialist agreed that the problem was the disc bulge and spinal degeneration, and injected a different medication into Kate’s back. But like the other medicines, it only helped for a while before wearing off. Meanwhile, the pain remained severe and Kate became depressed. She couldn’t get through the day without popping pain pills and antidepressants, and wouldn’t even think of trying to sleep without taking sleeping pills. The pain and depression kept her from doing anything other than dragging herself to and from work: no more visits with friends or relatives, no more brisk morning walks in the park, no more nights out with the girls.
A year after that first visit to her primary care physician, Kate was a wreck. She was in constant pain, depressed, withdrawn, and feeling guilty about “turning my back on my family.” Not only that, she had packed on 25 pounds and developed hypertension (elevated blood pressure). Her primary care physician put her on antihypertensive medicines and admonished her to eat better and exercise.
“Oh, great,” Kate sighed to her husband. “Another thing to feel guilty about.”
Desperately hoping to find relief, Kate saw a neurosurgeon referred by her primary care physician, and agreed to have spinal fusion surgery. Although the surgery seemed to go well, it took her an awfully long time to recover. Twelve months after the surgery, she was still taking large doses of opioid pain killers, as well as anti-depressants and medicines for anxiety and sleep. Because she wasn’t able to return to work following the surgery, and her health insurance didn’t cover all of her costs, the family budget was seriously strained. Family relations were also pushed to the breaking point.
“I don’t know when my husband and I last had sex,” Kate sighed. “I’d like to, but . . . and there’s another thing to feel guilty about.”
“My recliner chair is pretty much my life,” she continued. “I sleep there because it hurts too much to lie flat. And since I’m not at work, I sit there all day watching TV; my daughter even brings me my meals there. I used to try to keep up with my friends through Facebook, but I gave it up. Seeing what they’re doing just makes me cry. The surgeon said he wanted to put a spinal cord stimulator in my back. I said okay because I want this to end, but I really don’t have much hope.”