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Pain and Meaning

Slipped Discs and Pain Scales.

A BLOG by Jacqueline Christodoulou

It's been six months now since I suffered a 'slipped disc'. The searing initial pain has faded now, replaced by an uncomfortable tugging on my sciatic nerve. One thing I have noticed is that almost everyone I know claims to have had a 'slipped disc' at one time or another.

They mostly tell me this when they are carrying very heavy boxes or running for a bus, balancing on one leg or leaning forward. Sadly, these are all movements that I cannot, and will never be able to, manage. When I enquire about leg numbness and walking problems, I am met by blank stares - their own 'slipped disc' did not endow the weird feeling of body dissociation on them.

So I decided that I would research what, exactly, 'slipped disc' meant. Damage to a disc in the lower back falls into several categories. A bulging disc is where the disc between the vertebrae pokes out and touches the sciatic nerve, causing intermittent pain. A herniated, or prolapsed, disc, is where the jelly in the disc squeezes out and makes a lump between the disc and the sciatic nerve. This causes damage to the sciatic nerve and affects areas of the leg relating to the position of the damaged disc. My herniated disc at L4/L5 (as above) caused numbness of my right lower leg and my right foot. A bulging disc is not the same as a herniated/prolapsed disc.

The pain associated with a herniated disc is severe. However, because the generic name of 'slipped disc' is given to all these disc conditions, it is sometimes interpreted as a twinge to the sciatic nerve, which is more likely to be a bulging disc. So, not only are you in severe pain, but many people are relating your condition as something that is associated with less pain.

This generic terminology comes from generalisation of pain. Whilst we need some kind of generalisation in order to develop medicine, some data sets that tell us that a condition is common to many people and needs attention, this is at odds with the human experience of pain. The individual expression of pain is an important communication tool, an vital part of us telling another person that we are injured. Whilst some pain scaling tools tell us that someone is in pain, a scaling of 1 - 5 does not tell us anything about their experience, how this affects their lives.

The question 'is it hurting?' from a doctor, answered in the affirmative, or even from 1 - 5, elicits a prescription for pain medication; it does not tell him that one morning four months ago I woke up crying at having to endure this for another day, or felt desperately sorry for whoever had to put my socks on for me.

The meaning of pain is not 1 - 5. High or low. Good or bad. Severe or minor. It is woven into our everyday experiences as we try, in a world that is very different from our pain-free world, it makes meaning of the new difficulties faced by our health.

I went back to my doctor for my six month check up yesterday and asked when the pain would go completely. He told me that it wouldn't. He asked me how bad it was, high or low, 1 - 5, and prescribed me painkillers. He said that what I have is a lifelong condition. I nodded and smiled and swallowed back the tears until I got outside the surgery.

He didn't ask me about the difficulty I have walking and how this affects my job, or how I can't bend to lift my baby granddaughter, or how I'm so exhausted after a day at work that I can't visit my family. That's what pain really means.

I've got a set of exercises, the McKenzie Stretches, that a physiotherapist taught me and, for the time being, these are keeping severe pain at bay, along with the TENS machine; I'm feeling a whole lot better as my back heals and I improve my posture and strengthen my core. I actually feel lucky, because at the beginning of this I was told I might not walk again; I'm beginning to smile again now and my life is back on track.

Writing it down has helped, writing all these experiences in a note book that, now, I can put away and hopefully never have to go back to. And in the future, if anyone every asks me how much my 'slipped disc' hurts, I'll give it them to read and hope that, instead of making an assumption based on a medical stereotype, they will understand how I and my life were affected, and what this meant to me.

Jacqueline Christodoulou is a psychologist and writer from Manchester, England. Her doctorate in identity construction led her to the explore the links between science and storytelling, and to write novels. Her book 'Identity, Health and Women' was published by Palgrave Macmillan in 2010. She enjoys thinking, writing, helping people and telling stories.

Notes On A Lower Back Herniated Slipped Disc.

A PAIN DIARY OF SORTS by Jacqueline Christodoulou

I just walked upstairs with a cup of tea in one hand and a vacuum cleaner in the other. This time last year I couldn't even walk, let alone get upstairs, because I had a herniated disc, more commonly known as a slipped disc. This is the story of my recovery.

I'm writing this story because most of the personal contributions on the Internet that I read when I was ill are less than positive, and I wanted to bring some hope to those who are have just suffered this condition. This is my story, not a generalisation, or a definite map of recovery, but I hope that it will help you to think positively.

My herniated disc finally occurred when I tripped over a carpet. I had suffered back pain for almost two years leading up to this, and taken paracetamol. In the weeks leading up to the herniation, the pain became worse. At the moment of injury I felt a 'ping' or 'snap' in my lower right back and fell to the floor. The pain was severe. I immediately thought that I should go to the hospital, but as it was Saturday I decided to wait until Monday to see my local doctor. I did not sleep or move around much for two days because of the pain. I also could not pass water sitting down.

On Monday I could not feel my lower leg or foot. I attempted to walk to my local doctors surgery, but my leg gave way and I fell to the pavement, unable to get up. I was very frightened and worried, and a passer by called an ambulance. When I got to hospital I was examined, given Tramadol and diazepan in the accident and emergency department and transferred to a ward for observation. I was in hospital, unable to move from my bed for five days. I had an allergic reaction to Tramadol, so was given ibuprofen 400mg only. During this time a physiotherapist visited me and explained the Mackenzie stretches. I was finally given a CT scan an it was confirmed that I had a disc herniation at L4/L5.

On my final day in hospital, I was given a pair of crutches and taught to walk up and down stairs with them. I was given a physiotherapy appointment for 1 weeks time. At this point the pain was still almost unbearable and I was discharged with paracetamol.

The day following my discharge I spoke to my local doctor and discussed pain relief with him. He prescribed co-codamol and ibuprofen 400mg, which went some way to controlling my pain, but only if I set my alarm and took them in the night. So. Two weeks after my disc herniation I was on 24 hour pain relief and could not walk without crutches. My foot was numb as was my lower right leg, and I could not sit down or bend forward. Lying in bed, if I moved slightly wrongly I felt severe sciatica in my right leg. At this point I was very upset and depressed as the pain was continuous.

The worst part of this was that the diagnosis of 'a slipped disc' made people roll their eyes and claim they had suffered this a carried shopping home the next day. I found out that there are three categories in the 'slipped disc' range of meaning:

Swollen disc - where the disc is swollen, causing local tissue pain. Bulging disc - where the soft disc tissue bulges and causes tissue pain/nerve pain. Herniated disc - where the soft matter from inside the disk leaks out and causes tissue pain/nerve pain/sciatica.

It is likely that those people who carried shopping home the next day did not have a herniated disc.

Week 4. My hospital appointment arrived. I went to a spinal unit to see if I could have disc surgery. This was the first time I had been outside my home since leaving hospital. I was given a sick note for 6 weeks and told to go to physiotherapy. The specialist was reluctant to operate and informed my that the numbness I felt in my leg would probably be permanent. He told me that I could never wear high heels again and would probably always have a limp. He suggested spinal injections and morphine implants, but I was so shocked that the injury was permanent that I could not make a decision.

Week 5. I walked outside on crutches. I went round the block, and further each day. I went to physiotherapy and became upset when I couldn't lift my leg off the physio table. I started regular Mackenzie stretches and attended physio twice a week.

Week 6. I was still in tremendous pain, but I managed to walk on crutches to the chemist and bought a TENS machine. I also bought a knee support for my left knee which was now painful because of the adjustment in walking. I went to physio twice this week. No improvement in my reflexes.

Week 7. I decided I would try to go back to work part time. I was still taking a lot of pain medication, but I needed to keep my mind off my injury and keep my job. I managed to walk without crutches, but my foot dragged along the floor and flopped. I discovered through googleing this that I now had a 'drop foot'. The sciatica was very bad, but under control with pain medication. I was about to go back to the surgeon and ask for an operation to fix it, when I came across a research paper that noted the optimum time for non surgical recovery to reach the level of surgical recovery is two years. Because of the risks involved in surgery, I decided to persevere.

Week 8. Christmas. Heavy snow meant I couldn't walk in the street, so off work for almost three weeks. I stopped taking co-codamol during the day, and changed to ibuprofen and and paracetamol. This stopped any drowsiness. I still could not sit on soft furniture, but could sit on a hard chair. I stared to read about lordosis and posture and upped my Mackenzie exercises. I had been visiting my physiotherapist every week, and now this changed to every two weeks. My walking was still abnormal with a severe limp. However, after discussion this with a colleague who had suffered a herniation and numbness, I began to intentionally roll my foot. This helped with the aesthetics of my walking. I was up and about and although I was still very upset, I was coming to terms with the fact that this was permanent.

Week 9. I still hadn't been able to bend my leg enough to lower myself into a bathtub. I had been taking showers and badly missed bubble baths. I had not been far from home until now, but now I had to plan travelling with work. This involved rail and air travel, and it filled me with terror. What if it happened again on a train, or worse, a plane? How would I get home?

Week 10. This week I was discharged by the physiotherapist with an exercise sheet. I was far from better, and I remember looking at an exercise where I would bend forward from a sitting position to touch the floor and laughing, I would never, ever be able to do this. I still could not lift my right leg to a right angle and I was still in pain when lying down. I was wearing boots to support the weakness in my foot, ankle and leg, and a knee support on my left knee.

Week 11. The lift broke at work and I had to walk up two flights of stairs. It took me 1 hour to do this, but I did it. Until now I had only really seen my family, friends and regular work colleagues, who had not really mentioned my appearance, but this week I had a national meeting at work, and people gasped and looked very shocked when they saw my gait. I resolved to practise rolling my foot and walking better.

Week 12. At this point, my life had stabilised a little. I was still taking ibrurofen400mg and paracetamol. I had noticed that I wasn't in so much constant pain, and I made a visit to my local doctor to talk about my recovery. He told me that I would not fully recover, that I had the numbness and the limp for life, and that I may get the same severe pain at some time in the future if the same, or another disc, herniates. Apparently, it is more likely to happen after the first time. I had worked out by now that this was not my first herniation, I had a similar episode ten years ago, but this has been diagnosed as a trapped nerve. My doctor told me he was sorry, but he could only give me pain killers or refer me for surgery. Surgery felt out of the question now, so I resolved to keep up with my physio and be sensible with pain relief. It was very hard to come to terms with this being a lifelong injury.

Month 4 February - More snow and difficulty walking, but my balance was getting better. Still unable to lift or bend forward. My main aim now is to raise my knee to a right angle without searing pain.

Month 5 March - Went on the train from Manchester to London. I was able to sit for 2 hours without getting up in pain. Getting on and off the train was difficult as was the Underground, but all the escalators were working so it was relatively easy. Managed to stay in a hotel bed without severe pain, something I had worried about. Saw a colleague I hadn't seen for a year, who was shocked at my limp. Later in the month, I noticed that my foot was swelling badly if I walked any distance. My doctor advised this was normal as the physiology of my body was still adjusting to the injury.

Month 6 April - I still cannot lie in bed without pain, particularly if I put pressure on my right leg to turn over or get up. Sleeping much better with no need for painkiller in the night, but sill taking co-codamol before bedtime. Lifted a small box at work. I was able to put my socks on without too much of a struggle, but not sure if this is just due to a new technique rather than improvement in movement range. I have started using my feet and legs a lot more to move things towards me instead of bending forward to get them. Major problem when buying shoes. I cannot wear boots in the summer and flat pumps do not support my ankle and foot, or stay on. I choose a pair of expensive leather pumps which are fairly enclosed, so as to let air to my foot in the summer. This is fairly successful, even though they keep falling off. Discover that right foot is much smaller than left foot now, and the shape of my big toe has changed. So I now have to pad out my right shoe.

Month 7 May - Fly to Aberdeen and attend posh dinner. No one asks me what is wrong or looks shocked. I have still not had a bath, sat on the floor or lay on the floor. I eventually find a piece of foam and lie on it in the bathtub after lowering myself down carefully. It works! I have three baths in two days. :-) I trap my foot in a door and it is bruised badly, but I don't really feel it. Bonus.

Month 8 June - I run a conference at work and feel more confident. I am feeling like my old self again. Go out for lots of walks, and even try to walk up steep hills and on uneven ground. Not very successful. I buy some multivitimins and keep up with physio. There is no improvement in the sensation in my leg and I finally realise that I don't know why I think there will be - it's permanent. I try to come to terms with this.

Month 9 July - I'm finding it more and more difficult to think about the future with my leg like this. My birthday is coming up in September and I want to go out socially and want to wear heels, but then I remember that I couldn't walk at first and how that felt. I go to see the Flaming Lips at Jodrell Bank, and suddenly the crowd decided to sit down on the floor, something I haven't done since my injury. I managed to half lie on the grass to avoid being the only person in thousands standing. I had to be helped up which was embarrassing. But I managed to get to the front of the crown and dance with my partner and felt normal again.

Month 10 August - I turn over in bed, pushing hard on my right leg, and there is no pain. I try it again, and there is still no pain. The numbness has not changed, and my leg is still weak, but the pain had lessened at last. There is no sudden nerve pain. I vacuum the carpet for the first time in ten months (my partner has been doing it for ten months!). One morning I am late for work and run for the bus. My leg feels like it is a stick on the end of my knee, and I am shocked again. It's a weird feeling of limb dissociation. My mother sees my swollen foot and remarks on it. I make a conscious decision to not hide my foot and leg and do the best I can under the circumstances. I am still either lying on the sofa or sitting on a hard chair in the evening. But I manage to pick up my baby grandaughter for the first time in nearly a year and babysit her on my own.

Month 11 September - It's my birthday and I go out in small heels. Unfortunately this doesn't really work as my shoe keeps slipping off - I can't grip it with my toes. I manage to dance in a nightclub and drink alcohol. No one comments on my walking and my partner notices that my limp is improving. For the first time since I had my injury I didn't feel like I was 'just coping'. I felt relaxed and hardly thought about my leg at all (may have been the vodka!)

Month 12 October - One year since I hurt my back and the only things I can't do are crouch down, sit on the floor easily and sit on soft furnishing. I can lift reasonably well, carry shopping bags, walk more than a mile, go upstairs on the bus, sit in the car for an hour or more. I changed the net curtains at my window and stepped form a window ledge with my left leg first. Three month ago this would have left me crying in searing pain as my right leg bent further than a right angle. It was a bit tingly, but I was OK!

Month 13 November - I decorated the kitchen! I went up a ladder! I still have twinges in my back and I can't feel the bottom of my leg or my foot properly. I've fully accepted now that my body won't ever be the same, but that needn't stop me for doing things I did before, it's more about using common sense. The main thing is that I can walk, something that at the beginning of this process seemed impossible.

Month 17 May 2012  I'm having weeks at a time now when I don't take painkillers or think about my back pain. My walking is still slightly problematic at times, and it's easy to overdo it, but I have traveled on planes and trains and in cars without much of a problem. Occasionally, I do get a tight feeling on my lower back, and my leg is still fairly numb. My affected foot is showing signs of nerve damage, but this is manageable. Remembering to sit and stand property, and doing appropriate stretches when I have been bending forward are all part of my daily routine now. The impact of this injury is slowly fading, both physically and mentally, and this summer I plan to attend a series of outdoor concerts and this will test me even further.  I am starting to realize that my body has slowly but surely done the best job it can do to heal me and, although this is taking a long time, working together with my physical body and a positive mental attitude is the way to recovery.

More updates to come, but these things helped me through:

  • Positive mental attitude
  • Appropriate regular use of painkillers
  • Regular physiotherapy - carry on at home. It's meant to hurt, take painkillers beforehand
  • Lots of walking
  • Understanding pain and how it affects me - owning my pain

This healing process wasn't without its problems and I've linked back to post I have written whilst I was ill where appropriate.

Jacqueline Christodoulou is a psychologist and writer from Manchester, England. Her doctorate in identity construction led her to the explore the links between science and storytelling, and to write novels. Her book 'Identity, Health and Women' was published by Palgrave Macmillan in 2010. She enjoys thinking, writing, helping people and telling stories.