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Point of View

Pain's price

By Nancy Price Graff

For some people, back pain begins with tying a shoelace. Mine began almost 25 years ago on an outing to find the perfect Christmas tree. My husband, two-year-old son, and I were descending a hill at a local tree farm when I tripped in the deep snow. Pain ripped through my back. I inched down the hill, lifted my legs into the car with both hands, and grabbed for the handle above the door to take some weight off my back and buttocks. After that I held on. It's what I've done ever since.

Every life has pivotal moments that alter the trajectory of all the days and nights that follow. That hunt for the perfect tree became such a pivot in my life. Before that day, I had a bottle of Advil in the upstairs bathroom cabinet; in the years that followed, I had prescription painkillers upstairs, downstairs, and in my purse. I didn't need the pills all the time, but I needed to have them handy. Before my fall, my watch paced my life; ever since that day, my back has. It tells me when to stand, when to sit, when to walk, when to lie down.

My 10-year-old Merriam-Webster's Collegiate Dictionary defines pain as "localized physical suffering . . . induced by a noxious stimulus." In my experience, "localized physical suffering" does not begin to give due weight to pain's potential to undo a life—physically, yes, but also mentally and emotionally. Fortunately, some newer dictionaries acknowledge pain's broader impact, but black ink on a white page still seems inadequate to describe pain's impact. As my pain became unending, it ceased to be linear. It took on amplitude and a character of its own. It manifested itself in ways I could never have imagined.

Miasma: It was evident in my voice, which took on a permanent hoarseness, as if my vocal cords were rasps and language the articulation of thought sanded to a rough edge. Pain also became unassuageable restlessness, conveying through constant movement my frustrated hope that the next position, the next adjustment of an arm or a leg might finally bring respite from the torment. Pain sapped my thinking, until ideas could no longer navigate through the miasma and find coherence. I cried in my bedroom not just for the pain I was suffering, but for the pain I was inflicting on those around me.

I mourned the loss of my previously active life and the geographic limitations of my new life. I mourned pain's capacity to isolate. Unable to sit or stand for any length of time, I was forced to give up concerts, plays, lectures, parties—the kinds of social events that give life its gloss. I came to see pain not as a wedge that drives people away, but more like a moat that separates those who can from those who can't.

My pain even became visible. During a checkup, my dentist found four loose teeth—caused by my constantly clenched jaw. It was inconceivable tome that I might lose teeth because of pain in my back, but there it was. Stress manifested itself in my face, too, blossoming as dark shadows under my eyes and furrows in my forehead. More than once I found myself in the drugstore in the section full of creams and concealers, studying their magical claims. I was looking futilely for anything that would restore animation and attractiveness to a face hardened by pain.

As the pain worsened, I saw a chiropractor, an osteopath, a physical therapist, and an acupuncturist. I gave each of them six months to a year to bring me some relief. Nothing helped. Three years ago, I finally saw a surgeon at DHMC. He thought a laminectomy and discectomy could put me back on my feet; nothing was assured, he warned, but he thought the odds were in my favor.

Nerves: I had the procedure, and my surgeon was pleased, but the pain did not let up. The surgeon had said it might take a while—perhaps months—for my previously compressed nerves to recover. A year later, with little change, the surgeon referred me to the DHMC Pain Clinic. I broke down; it sounded like a life sentence.

I did not know then but soon learned that the Pain Clinic rejects the narrow definition of pain as "localized physical suffering." Instead, it treats pain globally, hoping to ameliorate emotional and mental suffering, too. My pain doctor was less interested in my back's mechanics than in pain's effect on my life. Soft-spoken and kindly, he asked questions and performed a basic examination. Then he listened . . . for a long time. When I finally wound down, he explained my options. I had choices, it turned out—five of them, from steroid shots to cognitive therapy. Like the surgeon, the pain doctor impressed on me that no treatment was guaranteed to improvemy condition, but he believed a combination of therapies might help.

For six months, I followed his advice. Finally, my back began to respond to the surgery and to the other therapies. More important, the pain doctor teased apart the separate threads that had once been my back pain and my daily existence but that had, over time, become simply one Gordian knot representing my painful life.

Counsel: I last saw my pain doctor a year ago, but his caring counsel stays with me. I am vigilant about everything—from lifting heavy objects to standing for long periods. I take a narcotic painkiller a couple of times a month, sometimes preemptively. I am often stiff but am once again walking, skiing, biking, and swimming. I know my back will likely cause me some level of pain for the rest of my life, but I now see my pain and the rest of my life as separate entities. Even if I cannot fully eliminate the former, I can work on mending the latter.

Once again, the world seems full of possibilities.

The Point of View essay provides a personal perspective on some issue in medicine or science. Graff—a Vermont writer, editor, and historian—has written six children's books; several books on Vermont history; and numerous magazine articles, including two for Dartmouth Medicine about her struggle with chronic depression. She has also been a member of Dartmouth Medicine's Editorial Board since 2003.

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