Life Is Stressful

Life Is Stressful

From Chicken Soup for the Soul: Say Goodbye to Back Pain!

Life Is Stressful

One day a woman came to see me with low back and neck pain due to injuries from a car accident. This woman was obviously in physical pain, but there was more to her story than back pain. She and her husband had been trying to conceive a child for years. Finally, the fertility treatments worked. She was five months pregnant when the accident occurred, and her unborn baby didn’t survive.

This is a particularly heartbreaking story, but even when a life isn’t lost, it is very common for people to be dealing with a lot more than just back pain. Mandy describes how she began to cry at one of her physical therapy appointments. All healthcare providers see patients when they are vulnerable. Physically vulnerable but also emotionally discouraged, frustrated, scared, angry, annoyed or heartbroken. Life can be complicated and extremely stressful. It would be nice to not have other problems to deal with when you are injured and in pain. But, very often it’s precisely when you are physically vulnerable that you are also not at your usual emotional baseline.

Cluster Busters

Pain often presents with other symptoms, including difficulty with sleep that causes fatigue, worry that leads to anxiety, frustration that may become depression, and so on. Doctors who treat a lot of pain often look for “cluster symptoms” because they know that treating all of the symptoms at once tends to lead to better outcomes. For example, an 85-year-old-woman who I’ll call Joan began to experience pain in her legs when she walked. Prior to having pain, she was very active, though she lived in an assisted living facility. An MRI revealed that her pain was due to lumbar spinal stenosis, a narrowing of the canal at the end of the spine that causes “pinching” of the nerves. Joan tried many different treatments including medications, physical therapy and spinal injections. Nothing was working very well, and she really needed surgery. But I was very hesitant to recommend surgery due to her advanced age.

One day, Joan came in for an appointment, and I changed her medications to try and give her more pain relief. She left and seemed discouraged, but willing to try the change in prescriptions. A few minutes after Joan left, I went to lunch. On my way to lunch, I spotted her sitting alone with her head in her hands weeping. I felt so sad for her and realized that I needed to do more to help her. I went over to her and for the first time she told me about symptoms that she hadn’t admitted to me in the office. Joan said that she wasn’t sleeping well, because she was stressed and worrying at night. In fact, her anxiety was getting out of control, and she was afraid to leave her room. When she did leave, she worried that she’d have pain and need to find a place to sit down right away. Coupled with insomnia and anxiety, Joan said that she was crying a lot and feeling hopeless — signs of depression. Between her mood problems and lack of sleep, she wasn’t concentrating well. Though she was mentally sharp, Joan began to think that she was developing Alzheimer’s.

Joan was experiencing cluster symptoms, and each one was making the others worse. They worked together to significantly decrease her quality of life, and her physical and emotional health was spiraling downward. Right then I decided that despite Joan’s age, she really needed a surgical consultation. She also would benefit from consulting with her primary care physician about her mood and sleep issues. Ultimately, I talked to her doctors and we worked out a plan where Joan would take a mild sedative at night to help her sleep and then undergo surgery for her back. She began to sleep better, and with a plan in place to help with her pain, Joan’s mood improved. Surgery did solve her pain problems, and within a few weeks, she told me that she was “feeling like I did when I was seventy!”

Although I had asked Joan about possible cluster symptoms, she had consistently told me that her back and leg pain was her primary problem. I wish she had told me about her other symptoms, but I know that many patients “tough it out” when it comes to problems with sleep and mood. It’s important to recognize how these symptoms work together to make you feel really bad, or alternately if treated appropriately, really good!

Strained Backs, Strained Relationships

The story about Eddie doing one project a year highlights an important strategy that a lot of people with chronic pain use. Instead of giving up what they love to do, they figure out ways to do what they want but still manage their pain. A patient of mine who struggles with pain calls herself the “One A Day Girl.” She books one fun thing to do every day. If she tries to do too much, she suffers. So, when a friend calls and invites her to the movies, if she’s already scheduled something for that day, she asks if it’s possible to see the film on a day when she doesn’t have anything else to do. This way, every day my patient has something to look forward to but doesn’t overdo it.

Of course, when you have a lot of people counting on you — family and friends — telling them that you can’t do things because of pain can put a lot of stress on those relationships. It’s not always easy to balance nurturing yourself and others. And, while there may not be an easy solution to either your back pain or the strain it causes on your relationship, there are some strategies that might work to help you and those you care about feel better:

• Start a “choice diet.” We all have many opportunities to say “yes” or “no” to things. What is it that you want to do (or not do)? Be selective and not reactive when someone asks you to do something. Is this a good choice for you? Keep in mind that saying “yes” to one thing means saying “no” to whatever else you might do with that time and energy.

• Build your social capital. Social capital is your “wealth” in human and other connections. In general, studies have shown that people who have a lot of social capital are happier and healthier. Think about ways that you can connect with others — via e-mail, phone, letters or face to face contact. One way that people improve their social capital is to get a pet. Dogs, especially, provide a lot of love and support to their owners. Plus, walking your dog gets you out and about, talking to people in your community.

• Pay a gratitude visit. Identify people who you would like to thank for their kindness. Pay it forward and thank them. If you can do this in person, that’s ideal. However, there are a lot of ways to communicate if you can’t meet. For the thank-you to be as meaningful as possible, try and be specific. What did this person do that you are grateful for and how did it make you feel? Gratitude visits and other positive psychology strategies have been shown to lessen feelings of sadness and worry.

Sex and Your Aching Back

It’s not uncommon for backaches to interfere with an individual’s lovemaking. Often, people are reluctant to talk with their doctor about how their back pain affects their sexual activity. But if you find that backaches — or fears of reinjuring your back — put a damper on your sex life, ask your doctor for advice.

Here are a few suggestions that might also be helpful:

• Talk openly with your partner about your concerns.

• Avoid arching your spine backward. Try to keep your spine straight or bent slightly forward.

• When bending forward, be sure to bend your knees. Bending forward while keeping your knees straight puts a lot of pressure on your lower back.

• Avoid lying on your stomach or your back with your legs flat on the bed and extended straight out. If you can, keep your hips flexed to take some pressure off your lower back.

• Try positions that are easier on your back, such as lying on your side with your hips and your knees slightly bent.

• Be judicious and gentle. If your back is bothering you, don’t aim for long, vigorous, gymnastic lovemaking.

• Making love in the water — in a pool or hot tub — can take some of the stress off your back, because water is buoyant and offers support.

• Be patient. Don’t try to resume sex too soon after having a backache. If you find that your back hurts when you resume sexual activity, wait a few days before trying again.

Reprinted with permission from the Harvard Health Publications Special Health Report: Low Back Pain (2010)

Get Ready, Set, Go — Ouch!!

Have you ever noticed that just when you are looking forward to something, you experience more pain? Sometimes, getting ready is the problem. For example, a relative or friend is coming to visit, and you want your house to shine a bit so you clean more than usual. Or, the holidays are approaching, and you do things that you don’t usually do, such as wrap presents, bake or get ready for guests to arrive. Winter can cause a lot of pain from shoveling snow or slips and falls on the ice, but so can spring and fall when people work out in the yard more than usual.

If you’ve noticed a pattern of having more pain just when you are looking forward to something, think about what you might be doing prior to the event that is contributing to your symptoms. Here are a few hints:

Avoid repetitive tasks that you are unaccustomed to performing. This is the main reason that I see people coming in with seasonal pain or soreness due to spring gardening or fall yard cleanup. Put simply, they do things that they are not used to doing, and in their rush to get tasks done, they push through the initial warning signs of pain until they become very uncomfortable. Keep in mind that the “big pain” may not come until hours after the task is completed (or even the next day or two), but you will usually get early warning signs that your body is becoming uncomfortable.

Listen to your body — or you may pay a price later. Of course you don’t have to completely avoid repetitive tasks, but sitting for hours wrapping presents, taking trays out of the oven, bending over to plant flowers, or raking can create the “perfect storm” to develop or worsen back pain. If you have repetitive tasks to do, be sure and take breaks and stretch. Do something else for a little while, then come back to your task later.

Ask your kids to help. If your kids are sitting around playing electronic games or watching TV, get them involved in helping. Not only will it help you avoid an injury, but it’s good for their health.

Get enough sleep. Cutting back on sleep when you are busy puts your body at risk for injuries. Be sure that you are getting enough sleep so that you can enjoy whatever it is that you are looking forward to.

Build fun into your schedule. Chores and “to do” lists should not be the sum total of your day — even before a big event. Be sure and add something fun to your “to do” list. Laugh and enjoy yourself. There is no better time than now!

Find ways to relax. Even when you have a lot to do, find ways to relax. You can meditate, pray, take a long walk, listen to soft music, take a hot bath or do whatever you enjoy that helps calm your mind and ease the stress on your body.

 

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