If you happen to read this while you are in a moment of acute back pain, then I have a few steps that will get you on your feet, maybe get you ambulatory enough to make it to a hospital.
First, get out of bed. Lying in bed is not good for you. Your muscles are spasming due to an inflammation, and lying on the area of inflammation won't help it any. Won't necessarily hurt it, either. But you need to get the muscles to quit freaking out. There are two ways to do this: drugs and exercise. If you don't have any flexiril on you, then use exercise. Don't worry, it's not tough.
If you can't get out of bed, then roll over. If you can, then lay down on your stomach. Now, lying as flat as possible, slowly raise your upper body up using your forearms in a classic Sphinx position. Pull your head slightly back, keep your head and neck aligned with your spine, which will be all fucked up and crooked but do your best.
Do this ten, fifteen times. Hold the Sphinx pose for 5 to 30 seconds, whatever feels good.
Now, relax. Next, do the same move except prop yourself up on your hands...keep your pelvis glued to the floor, and do a press-up. Hold this for no more than 5 seconds.
Finally, get back up. Do you know how to get up?
Learning How To Sit, Stand, Move, and Sleep.
You don't know how to get up. Some of us do. There are folks who have cages and screws and bolts holding their spines together, and they know how to get out of bed so well, they don't even think about it. Here's what you do: roll to the side that has less pain. If the pain is right down the middle, then roll to either side. Next, use your arms to press your upper body into the air. ONLY your arms and shoulders should be holding you. If you are in bed, swing your legs down to help lever your body out of bed. If you are on the ground, tuck them underneath you and stand to press up with your thighs.
You'll be standing in no time, but you need to work your upper body, upper thighs, and abs to do so. If your back has moved at all, you'll know. You'll drop like a sack of rocks if the pain is right.
OK, now re-learn everything else. Walking: your ass pushes you, you do not pull your feet. Arms: they move from the middle of your back way back by the shoulder blades, and not pendulum-ing from the shoulders. Sleeping: cage yourself in with pillows. Sleep on your back or your stomach, whichever is most comfortable. Do not move. Especially don't twist your lower half away from your upper half. Sitting: posture! Use a lumbar roll. Ensure that your back has the right curves, but is relaxed...don't tighten it into this posture! Breath from your navel. Don't crane your neck. Never bend at the waist.
The Pain Will Still Kick Your Ass.
The worst part about back pain is how completely it takes you. It consumes everything. Every breath, every second is colored by it. There isn't a single motion the human body makes that doesn't amplify the pain. The worst part about back pain at it's worst is the humiliation you feel when you realize you can't get off the toilet. You can't get out of bed. You can't tie your shoes. You can't wash yourself. You can't cough or sneeze without graying out. You can't drive, walk, run, or involve the body in any sort of unplanned activity.
You are tethered to your nerves. If the pain is both acute and chronic, you're not going anywhere for a while.
The pain is most likely due to an inflammation or some other mechanical interference on a nerve root. A tear or strain can be the cause, as can a herniated disk. It might be a tumor. It could just be a mild muscle strain. In my case, it's a couple of disks.
Traditionally, the pain means the drugs. And boy oh boy oh boy, do they have the drugs.
When you go see a doctor these days (post-Rush Limbaugh OxyContin Scandal), he / she will be reluctant to give you an Olde Fashioned Narcotic. There's a set of really good reasons for this. However, if you've ever been in the sort of pain that requires an opiate, you know that there is simply no substitute. There's a really good reason for that, too. Opiates work. Your brain has receptors that are made to snarf those little suckers up. You were designed to be pleased by them. And they're field tested, having been out there in the known world for about a brazilian years. The side effects are well known. The only downside is the side effects. Addiction isn't one you have to worry about if you take them for real pain. If the pain isn't real, all consuming firey scary goddamn pain, then, yeah, you can get addicted. They are highly addictive.
If you do get narcotics (in the U.S.) for acute pain, you normally get one of the Big Three (Vicodin, Codeine, or OxyContin)plus a "muscle relaxant." Muscle relaxants aren't muscle relaxers per se. They just jam the signal that tells the brain "ouch! spasm!" The muscle itself is still doing it for a bit, but after a while the brain isn't telling it to freak out anymore. The inflammation is still there, the nerve still irritated. To treat the inflammation, you need an anti-inflammatory. The best anti-inflammatories in the world are steroids. They're great! They increase production of a whole sled of chemicals that help the body beat back infection and inflammation. They also make you crazy and make boys grow boobs.
So the Industry created Non-Steroidal Anti-Inflammatory drugs, NSAIDs. Tylenol. Aspirin. Acetomenaphine. And all the other drugs that, when taken, try to destroy the liver and / or kidneys as well as relieve inflammation.
None of this "kills" the pain. It takes a while to get inflammation to go away. So the Industry gave us what it gave us in battlefields: opiates.
Vicodin. Codeine. OxyContin. The big boys, Morphine, Fentanyl. The muscle relaxants, Soma, Flexiril. There are many others. You will most likely encounter Vicodin (hydrocodone) or codeine (tylenol with codeine). Note that these drugs combine NSAIDs and "pain killers."
Why do I keep putting "pain killer" in quotes? Because they don't kill pain. What they do is make you feel so fucking great and fuzzy and warm and lovely that you forget the goddamn pain. It doesn't matter anymore, this pain. I can move without it. The muscles stop spasming. You start to move, and blood flows. Healing begins as the habit takes root....
Well, not necessarily habit. If you take these things for pain and only for pain, your brain handles them differently. It's proven. You're not taking them to satisfy an urge to get high, you are taking them to avoid screaming in agony. The brain seems to know the difference at a very small level, and thus your brain handles the drugs in a very different fashion. These are recent findings, and if this were a decent article, I'd cite the findings.
Just know that it is different. What happens, though, is that people often find fear of pain, and they keep taking the opiates for months after the pain is no longer acute. Then the brain starts to associate the drugs with something other than pain. Then you're fucked.
My advice with the drugs: it's up to you. No one is tougher than pain in the long term. Pain will fuck you up psychologically, it will sap your every will. Best to mitigate the pain with drugs when it's unbearable, but plan for the long term.
Unfortunately, there's no clear map for the long term. There's no one direction to go. Best I can do is show you what I know, and maybe you can find a path.
Surgery, Conservative Care, or Loony Party?
I am undergoing what is called "conservative treatment." This means no surgery, and it is viewed by many as a pocket-lining step to surgery. It is viewed by some as the destination for their pain. It is, to some, the answer and to others a continuation of effort that will culminate in Surgery. In other words: for some people it works, and for others it doesn't. Two people with identical (roughly) conditions can have radically different results from treatment. My current path is conservative, and has been for three years.
Surgery: back surgeries are normally not necessary. In the US, where 40 percent of the population has, at one time or another, reported acute back problems, back surgeries are as common as liposuction. The problems with this are many and varied. The biggest problems seem to be tied to treatment and surgical treatment, since both of these options make billions of dollars for everyone from my doctor to the guys who make the lighbulbs in his office. Specifically, there isn't a big rush to find a decent surgical "cure" using the resources available. The most recent microscopic techniques are hardly used, but seem to be the most effective for disk-related problems. Reconstructive techniques used in other parts of the body are whole generations past what is used in the back (which amounts to a latticework of screws, meshes, rods and wires). The approaches used are complex and horrifying, with certain vertebral surgeries requiring entrance through the abdomin. The more recent laproscopic and microscopic methods are underutilized and oftentimes uneffective.
Uneffective? Yes. While there are no solid numbers on the success rate of back surgery, you will hear that a statistically large number of surgeries either don't work, or cause more problems than they solve. Because the back is hugely complex. But what should scare you is: there are no solid numbers! Studies have been done but nothing near what needs to be done. I've heard the tinfoil beanie version: companies that supply medical equipment (some of which make 70 percent of their income from back sugery needs) will do everything to fight any bad press.
I know more than a few people who have had surgery. One, a guy who fell from a deck on a Navy ship, told me this: if you can still walk? Don't get surgery. Four out of five people who've had surgery have pleaded with me: do not get it done.
That leaves quackery. This covers a lot of ground, especially if you place chiropractic in the quakery field. Myself, I don't. Chiros have allowed me to better understand my back and my body, and I may actually avoid surgery with their help. But there are good and bad doctors, chiros, priests, and mechanics. There's always someone who'll tell you to avoid accupuncture, accupressure, massage, pilates, yoga, and osteopaths. But you don't have to buy into a religion to get mechanical relief. I'm a believer (you get this from the first paragraph if you know what to look for) in the McKenzie method. My chiros and doctors support it. It comes from Robin McKenzie's methods, and he has a book. He has a couple, actually, but "Treat Your Own Back" is cheap and effective, and it is the one referenced by doctors and chiros everywhere. Basically, McKenzie uses movements involving flexion and contraction to re-inforce the natural curves of the spine. The exercises push and pull the nucleous of the disks and help stretch and align muscles. They are easy, quick, and effective. But that's just one school of thought. There are literally thousands of methods, and any single one or combination of them can help or hurt you.
So, What To Do?
You have nothing but options, with no clear path. I can tell you that in the worst acute pain, McKenzie exercises provide me with relief. But my condition (two herniated disks at L4/L5 and S1/L5) is my own, and yours may be a fracture or a muscle or something insidious. I can tell you that no-one will be able to give you a definitive answer if the pain continues. I would caution against listening to anyone who recommends surgery as a first step. I would also caution against waiting too long, as I have, since now a lot of the less invasive methods won't work for me. Ultimately, I can only tell you this:
Pain hurts. You have options to eliminate it. But you may end up where a whole lot of us are, where our goal is literally to grit our teeth, bear down, and just fight through each day. Yes, sometimes with chemical help or electrical help (see TENS units) or with TISG or any number of voodoo magnetic oil-of-Rome nonsense. But always, always dealing with it, each day, until someone finds an answer we can apply.
So, It Is All Hopeless?
Depends on how you view it. I see it as being full of hope, but not full of data, answers, or reliable information. I do what I can do to make it through each day, and some days I just stop and cry and that works. Some days I feel 90 percent normal. Ultimately? Many many of us, millions of us, we deal with this the way addicts deal with their addictions: one day at a time, $god willing.
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