bits by luke

I’m recovering from a herniated disc in the L4-L5 region. Spinal cord pain is some of the worst I’ve ever experienced. At the time of injury it’s all hot pokers and unavoidable spasms paired with inconsolable throbbing and paralyzing panic. I’m learning that the recovery process is another kind of pain in itself– slow, full of regressions, and depressing. There’s a mental anguish which grows from a pattern of happy pain-free days followed by sad pain-full days. Just when you think the back is starting to heal, and the inflammation subsides, and the herniation shrinks, you can re-tweak the injury in the most innocent of ways. Rising too quickly after bending over to tie your shoe can ruin your day. Reaching a leg into the car just a little too far before siting down can result in spending the weekend on the couch. The up-and-down nature of the injury toys with my emotional stability.

A physical therapy office asked me to fill out a pain scale. The scale starts at 0 and ends at 10. Each number is assigned a short description to distinguish the levels of pain: “disabling, you can’t perform your normal day-to-day activities”, or “moderate, throbbing that subsides with rest”. During my visit I found it difficult to fill out this pain questionnaire. The scale and its descriptors seemed to skew heavily toward the lower numbers and the higher numbers, ignoring the middle. How can you distinguish between a 4, 5, 6, or 7 when their brief descriptions all include the word “painful”? Putting aside the devious origins of the pain scale (have a read up on the Sackler family and Purdue pharma) I thought it would be an interesting exercise to write my own personalized pain scale as described by my life experiences.

0 - I am pain free.

1 - I have a paper cut on my hand. The pain isn’t consistent, and it’s extremely mild. Nothing about my day-to-day is interrupted, and only certain activities even remind me about the pain.

2 - I stub my toe. While quite painful in the brief moment after the stubbing, the intensity and duration of the pain is negligible. I have a dull ache for the rest of the day, but only when I’m walking around. The pain doesn’t weigh on my mind at all.

3 - I sunburn myself badly after refusing to reapply sunscreen every few hours at the lake. The pain is constant, but mild. Remedies like aloe or a cold beer in the shade provide relief. Rest is generally not interrupted. While constantly uncomfortable, the pain is tolerable.

4 - I aggravate my shoulder while swimming. Too many laps leads to muscle tightening and inflammation around the capsule. The pain is intermittent, but it’s a noticeable ache. Medication and manual therapy alleviate most of the discomfort, and I can rest assured that the pain will subside in a few days at most. My daily activities mostly aren’t impacted, though I won’t swim again for a few days. I don’t linger on the pain throughout the day.

5 - I slice my thumb to the bone with a knife while cutting frozen bread. The pain is immediate and intense enough to trigger a fight or flight response. When the adrenaline wears off, the throbbing stitches are a constant bother throughout the day. The mental weight of near-constant pain is bearable, however, because I’m still able to get through my normal day largely unhindered.

6 - I sprain my ankle playing soccer. The injury is painful in the moment, and worsens over time as swelling takes over. Medication helps a little, but there’s a constant level of unavoidable discomfort. The mental taxation starts to take its toll because my daily activities are limited. I’m unable to continue playing sports or get much exercise at all due to the severity of the pain.

7 - I fall off a mountain bike at speed and hit my head, hard. I don’t break any bones or tear any muscles, but the immediate and future consequences are measurable. Most of my body aches for many days following the event, even at rest. Pain medication is almost a necessity to enable basic daily activities. The pain is quite distracting and makes it difficult to engage in even restful activities like reading or television. The mental burden starts to approach the level of physical discomfort. How long am I going to be stuck immobile on this couch? When will I be able to move comfortably again, if at all?

8 - I herniate a disc. The pain is paralyzing in the moment, and barely subsides after the immediate injury. It requires a concerning amount of dangerous pain medication to take the edge off. Performing even the most mundane activities such as going to the bathroom, or laying down on the couch is extremely uncomfortable. Every movement requires thorough planning and execution, or the pain worsens. In addition to the physical pain, there is a substantial amount of mental torment. Nothing I do will make the pain go away and I cannot do anything without causing pain, so there is nothing to distract from the pain, so I cannot think of much else besides the pain, so I go around and around in a mental down spiral of pain.

9 - I am actively dying. To be clear, I have never experienced this level of pain, but I imagine the following might fit the category: consider a compound fracture that slices skin and exposes bone and other internals, or an unbroken fall from height that ruptures organs. The pain is all-encompassing, and you can do nothing but agonize about the current circumstances. No amount of pain medication will resolve the problem, and you have to seek medical attention immediately or risk death.

10 - I hold my dog in my arms and look her in the eyes as she takes her last breath.

Rest in peace, Ruby.