Tag Archives: treatments

Abbie – Chronic Low Back Pain


On January of 1991, at the age of 24, I was in a car accident that changed my life. A few months after the accident a MRI showed I had a L5-S1 herniated disc with a displacement of the S1 nerve root. I had a lot of pain in my back and down my left leg. Chiropractic treatments and rest did very little to alleviate my pain. Because of leg pain and weakness I had a microscopic laminectomy and discectomy. A few days after that operation the pain that had subsided came back and even worsened. I tried physical therapy for months with no improvement and finally a CT confirmed that the disc herniated again.

At this point I had to move back to my father’s home in Israel (at the age of seven [1974] my parents moved us all to a Kibbutz in Israel). I was hospitalized for three weeks for conservative treatment that included steroid injections (not in the back but IM), confinement to bed, PT, and traction. It was a horrible experience. I felt completely helpless because I could not really move, so any thing I wanted or needed had to be brought to me I could no longer be an independent person. The hospital was terrible I shared a room with two other women and I shared a bathroom and shower with five other patients. There was no toilet paper in the bathroom I had to bring my own. On a good days, I got up early to take a shower right after it was cleaned and before anyone else used it.

The conservative treatments did not work and I had my second laminectomy discectomy in June of 92. I was pain free for a few months when slowly the symptoms came back. The orthopedic surgeon could not determine from a new CT whether scar tissue was the culprit or new or old disc tissue was causing all the symptoms. I was in and out of the emergency room a lot for the pain, since my doctors never gave me adequate painkillers.

My orthopedic surgeon gave me a treatment of several trigger point injections once a week for three weeks that gave me minimal relief. I went to another hospital for acupuncture. The treatments were done in the hospital basement, and along with 7 to 10 other patients the doctor went from each one and inserted the needles. After 15 or 20 minutes you would hear patients beg the nurse to come and take the needles out because they were hurting. It was ridiculous and no wonder it never worked.

I started to look for a really good doctor, one that I chose and not one that would be assigned to me. I made appointments with doctors in their private practice (Israel has socialized medicine in which doctors are assigned patients based on availability). I saw one doctor in his office and he suggested another operation maybe even fusion once I told him that I have no money to do it privately and needed to go through the ‘system’ he changed his tune. I tried to see him at the hospital clinic (he was recommended to me as the best neurosurgeon in the area) and he put me in a ridiculous ‘walking’ body cast. This cast started under my arms and ended at my knees, and I was supposed to walk around in it for 10 days. They put me in this body cast in July (93) one of the hottest months in Israel. I still canít believe I agreed to this I was still naive and with each new treatment I believed that I was going to get better. When the ten days were up I could not walk and I was ready to kill myself because of the pain.

During these years my family physician and the nurse practitioner only gave me 1 percodan a day, 10 percodan at a time, and I had to come back every ten days to get some more. I remember waiting all day dieing of pain until it was time to take the percodan. I still cannot believe I got through those years like that. I guess that because of the poor pain management I was unable to do any thing else but lie in bed and read books all day long.

After the body cast I never went back to that doctor (big surprise). I had another 2 CTs, a mylogram, 2 more MRIs, and two bone scans and still no one could tell me what was wrong. Of course since after the second operation the doctors insinuated that it was all in my head. I had no support from most of my family. My sister and twin brother were angry that I was so dependent on my father and believed that I was faking so that I could keep on living with him. And my stepsister and brother could not understand what I was going through and believed that I need to ignore the pain (as if I could) and get up and get on with your life and everything will be fine. My mother did not know what to believe. My father, despite everyone in the family telling him otherwise, was always there for me. It was hard to be dependent at 24 (and the next 5 years) on my 68-year-old father. It was very humiliating to endure people’s stares when he tied my shoes or carried the groceries and so on. But finally we got a break.

We found a very good orthopedic surgeon about two hours away. My uncle in Miami recommended him to us, since the doctor worked for the Miami Dolphins and now moved back to Israel. He preformed a L4-S1 fusion with 4 screws and 3 rods. At my request a neurosurgeon (a colleague of the ortho dr) decompressed the S1 nerve root.

Waking up from this operation was hard to say the least. The pain hit me like a freight train, and I could hardly breath. I was hooked up to a PCA unit but that was not enough, and I got supplemental morphine and phenergen. I pushed the PCA button every 5 minutes because if I didn’t my back would spasm up and the pain would be too much to bear. At 4 in the morning the unit ran out of morphine.

My mother who was at my side told the nurse that it was empty, and she replied that it was the anesthesiologistís, on call, responsibility to replenish the unit. However, the anesthesiologist was in surgery and would not be out for a long time. My mother then asked if the doctor could prescribe something instead of the PAC for now. The nurse replied that she was not going to wake up the doctor for something like that. I had to wait until 8 for one of the anasthiologits to come and refill the unit. I was in agony tears were poring down my face I begged for someone to help me. I was weak and disoriented from the anesthesiology and because of the operation I could not scream so my pleads went unnoticed.

I was release on my 28th birthday. An ambulance took me to the kibbutz rehabilitation unit. There I met the male nurse on duty, little did either of us know that we would be married a year later!! I was confined to bed and was allowed to get up twice a day this lasted for three months. I got through it with a lot of support from friend, my father of course and this kind male nurse (Neal) who kept asking me if I want a cup of tea and I always said yes. When I was released we started dating, and married in 1995. I always wanted to return the States and we moved two years later.

After the third operation I needed very little pain medication such as vicodin, but gradually over the years my pain became stronger and I needed to take percocet once the twice then three and four times a day. I kept hearing reports about chronic pain and I read an article in the Times about chronic pain and realized that that was I. But I still looked for a treatment that would cure me, and went through the typical injections, PT, and medications. During this time I went back to college part time and worked teaching Hebrew two hours a day twice a week. Once I realized that the CP was not going away I started searching for a PM doctor.

I started treatment at a PM clinic last November. The doctor said that they had many different medications and treatments we could try. I started to take neurontin 300mgs x3 a day then we gradually increased the dosage until I got to 1200mg 3x a day. I was ordered to stop taking the percocet, and I gradually did. At the next visit I got a nerve block injection and pamalor 75 mg to add to the regime. I was in a lot of pain and nothing was working I called their service many times and all they did was up the Pamalor, and when I told them that that is not enough I need a stronger medication to help me the doctor on call replied that if I was in that much pain I should go to the ER. So I jumped through their hoops and went to the ER and spent half a day there.

At my next appointment we talked to our doctor and explained to her that the medications I am taking help with the burning but not the rest of my pain, which is considerably stronger. She replied that she does not practice that kind of PM that she does not prescribe narcotics. So my husband stated, “so you don’t really care about my wife’s pain” the doctor contorted “yes I care, I would not be working in PM if I did not care” so again we tried to explain what I needed. At one point my husband asked if she was only going to treat only a part of the pain and not all of it. And that convinced her to put me on 20mg oxycontin 3x a day. She made me sign a contract with two terms that I see an orthopedic surgeon (about removal or the hardware that she thinks is pressing on the S1 nerve) and another pain management doctor to consult with about the Spinal Cord Stimulator and make an appointment with her in two weeks.

At our last scheduled appointment I was late because I was coming from the other PM doctorís office she wanted mo to see. As I was coming into her office I met her in the hallway and she told me not to bother going in because she will not see me. I begged her to understand why I was late since both her clinic and the other PM clinic were over 1.5 ñ 2 hours away from my house and I wasnít very mobile as it is. But she just stood there drunk with her power and in a bitchy way said no.

I was in tears as my husband drove us home. Instead of going home I asked that he take me to my PCP. I told her what had happened (mind you I did not have an appointment and it was 4:30 when I got there) she could not believe it and we decided that I would not go back to that PM doctor. Now my PCP wants me to find a new PM doctor while she continues to prescribe the medications I was given.

I have decided that I am not going to have another operation even though it might be true that the S1 nerve is compressed (this is dangerous since one might loose urinary control ect.). I canít deal with another operation. For now I will continue with what I have with some adjustments perhaps.

59-year-old grandmother had been pummelled by pain in her whole body for years.

By the time Marilyn Bard finished telling her story at Montreal’s MUHC Pain Centre, the desk before her was littered with wet tissues. The 59-year-old grandmother had been pummelled by pain in her whole body for years. Simple tasks such as hanging the wash caused sharp pain to run along her arms. Her neck and head throbbed with an intense pain she never thought possible. When she visited her doctor, he told her there was nothing wrong. But the day she couldn’t even hold her newborn grandson in her arms, she knew there was.

Bard sought a second and third opinion. The final diagnosis: rheumatoid arthritis, psoriatic arthritis, fibromyalgia and occipital neuralgia. The neuralgia required two separate surgeries to remove nerves from the back of her head. Doctors treated her arthritis with cortisone shots and painkillers. But the pain in her joints was never eradicated, and the neck pain returned.

Visibly, it took a heavy toll. “I looked like my grandmother!” Bard says. Worse, the chronic pain was threatening her 19-year marriage. Her husband believed she could conquer the pain if she tried hard enough and had to shoulder everyday chores.

Finally, in 1999, Bard’s neurologist convinced her to visit the MUHC Pain Centre, so called because of its affiliation with the McGill University Health Centre. Founded by doctors Ronald Melzack, Joseph Stratford and Mary Ellen Jeans, it has treated hundreds of patients successfully since opening its doors in 1974.

With low expectations, Bard joined the centre’s group-therapy class and for the first time talked to others who understood her pain and offered strategies to deal with it. To her surprise, she began feeling better right away—and it lasted. She learned how to relax by releasing tension in each part of her body, starting with her toes then progressing upward, and she was switched to more effective painkillers. Her pain was ranked nine out of ten—ten being the most painful—when she began at the centre. Now, on good days, it barely registers a one.

“When I visited my three grandchildren in Calgary not long ago,” says Bard, “I was lifting them up, swinging them around and running with them. I was doing things I’d never done before!” Chronic pain—any recurring or persistent pain—can last months or a lifetime. Surveys show about 2.5 million Canadians suffer moderate to severe chronic pain. In the United States it disables to some degree some 86 million people, at an annual cost of $90 billion to industry and business. “Persistent pain is so destructive,” says Melzack. “It causes damage to those who suffer from it and to everyone around them, too.”

Melzack’s fascination with pain began in his early 20s while working on his Ph.D. in psychology at McGill. Immediately after graduating, he spent three years at a multidisciplinary pain clinic in Oregon. There, he began work on a questionnaire based on the rich vocabulary of one of his early patients, whose left leg had been amputated but whose “phantom” limb caused her agony. Melzack’s pain questionnaire was devised to determine a patient’s perceptions of the intensity of pain, and is now used at the pain centre as well as at hospitals worldwide. Leaving Oregon, Melzack travelled to Europe for two years of research and was then invited to the Massachusetts Institute of Technology, where he met physiologist Patrick Wall. Together they developed a new theory of pain that overturned a 300-year-old understanding of how pain works.

“The Gate Control Theory,” which they published in 1965, describes how nerve gates at each level of the spine’s vertebrae either let pain pass through or damp it down. A person’s thoughts, expectations, outside stimuli such as rubbing a sore spot and even cultural conditioning, they suggested, can reduce the pain signal.

Back in Montreal, Melzack corralled experts from different disciplines—anesthesiology, psychology, neurosurgery and nursing—and cofounded the pain centre, basing its treatments on a multidisciplinary approach with specialists collaborating on a variety of aids and innovative treatments. All shared the common belief that the pain anyone feels is real.

For Catherine Berardinucci, 44, of St. Eustache, Que., the pain began after an accident on a water slide. As she readied her inner tube to head down the slide, a man behind her gave it an impatient shove. To her horror, she heard loud cracking noises from her neck as she landed, spinefirst, at the bottom of the chute. Rushed to hospital, she was diagnosed with severe whiplash.

Berardinucci was sent home in a neck brace. After two weeks the only reminder of the incident was tingling fingertips. Then, three years later, unbearable pain suddenly gripped both her arms. Tenosynovitis was diagnosed. Yet the more she read, the more certain Berardinucci was that she didn’t have the condition.

After months of pain and little progress, she was finally given a magnetic resonance imaging test.

It revealed permanent spinal-cord damage as a result of the accident. She learned that surgery to improve her range of movements could leave her a quadriplegic, but she decided to take the risk. Depressed, taking morphine and antidepressants, she didn’t want to go anywhere, do anything.

While she awaited surgery, her family doctor referred her to the MUHC Pain Centre, where she described the accident and her hitherto unsuccessful treatments. The centre decided it could help. Berardinucci was given nutritional information and relaxation techniques, and at group therapy she learned strategies to help manage her pain by getting out of bed and doing one activity—however small —each day. Doctors tried various medications, seeking the right fit. At every step, she was encouraged by the nurturing atmosphere that permeates the centre.

BY ALISON RAMSEY