In many of my posts I have often advocated writing a diary all about your pain. What triggers make it worse, which foods irritate it, the weather, what you were doing when it started or flared up, and what medications you are taking and much more.
For any health professional to understand your health problem it really helps if they have this sort of diary so they can understand how you are on your worst days and how it all started. How many of you have been told to remember what your pain was like on your worst day when you go and visit your GP or Health Professional?
Recently I have been suffering more than usual and I must admit I did not keep a diary of where and when I was at my worst but I really wished I had done as it was something I always did before, especially after a flare up.
My memory is not just foggy through Fibromyalgia but something which has never been good. I have always said had we done course work as part of our GCSE’s back in the day I am sure I would have come away with more than a couple of them. I have always been a big writer and I would write and rewrite the work I needed to learn before my exams in the hope it would help me to remember it but to no avail. My mind would go completely blank and the same thing happens when I am asked how a certain pain feels. Had I written down what it feels like when the pain came on it would have been easy to explain it.
I recently saw a neurosurgeon who needed to know certain things that I could not remember from my previous surgeries. He had recent MRI’s of my spine but due to all the work I have had done on my spine he said it is quite hard to see what is really going on. As I have lumber and cervical problems it was decided that I would first have a diagnostic CT guided right C7 nerve root block, plus a appointment with an osteopath for help with my lumber pain which is coming from my sacroiliac joints, both of which have arthritis in them.
This week I went to see the osteopath and I definitely seemed to get mixed up with all the questions I was asked. When he sent me a transcript about what we had talked about I could see I must have got a few things wrong and wished I had kept a diary and also taped our meeting.
The osteopath explained that it seems most likely that I am suffering from a chronic facet syndrome, where the joints of my back and sacroiliac joints have become irritated and hence I get a reflexive muscle contraction in my spine and hip muscles. This becomes stuck in a negative feedback loop so that my muscles are unable to relax at night and so there is a build up of lactic acid, which causes a localised inflammation which hence wakes me from sleep. It could also explain why my hip muscles have become really dominant and are now out of sequence with the other muscles, especially as there seems to be no signs of a neurological reason for this. Facet syndrome is often associated with a loss of disc height due to dehydration, as this increases compression on the facet joint which could have been further exacerbated by my previous fusion at the lower levels of my spine. However as this has been going on for a while he thinks that it’s likely that things are a little more complex and there is an element of sensitisation and a persistent pain syndrome. This is also associated with high levels of stress, fear and anxiety around pain.
He does not see any reason why this should not settle well but this will probably require some treatment to relax my muscles and get stiff regions of my back working better to take the load away from the lower facet/sacroiliac joints. This can then be followed up with some better rehab to make sure that I can have a long term effect on this and I can manage the risk factors better. However, the osteopath said I can start by reducing the threat level and getting some relaxation into my muscular and nervous system immediately.
I understood all of the above but had he not sent me this transcript I only remembered part of it. Another thing we talked about was pacing which again I honestly thought I dealt with perfectly with a rest every day, regular breaks when going on long journeys and help when I needed it but I actually could not have been further away from the best way to pace myself.
I was told it is also important that I started pacing and not pushing through my pain but start working with it and breaking activity up into bite size chunks with adequate recovery in between.
He also wants me to decrease the level of threat within my nervous system and begin to turn down my flight or fight response as we know that stress hormones increase sensitivity to pain. The best way to start this is by belly breathing which was one of the exercises he gave me to do regularly plus a rocking technique on all 4s rocking to gently get my facet joints opened up a bit.
Finally, he explained that it would also be a good idea to reduce the loading on my lower facet joints by improving my sitting posture by:
- Sitting back on my pelvis
- Having adequate lumbar support (no space between spine and back of chair)
- Relaxing back into chair (so that you would fall off if the chair back was not there)
- getting up every 20-30 mins
As you can see from the above it was a lengthy first meeting and I do not think I would be alone in saying that most people would be able to remember all that had been discussed without a transcript afterwards. I have an injection booked for next Wednesday and will make sure I have all my up to date scan details and I will turn on my voice record app if they are allowed in the CT room.
The two most important things to remember when you are going to see any health professional about your problems is to make sure you have an up to date history of all your previous surgeries ( if necessary) and a diary of your pain. The second important thing to remember is to make sure your phone is fully charged and you have a voice record app which you can turn on as you go into see your consultant.