Disclaimer
I'm no expert. I'm just some guy who's screwed up a nerve in his neck and is trying to cope. That said, if this stuff helps you, great. If it doesn't, well, do your own research. And if you find something that helps, let me know.
Pain Management
A week or two in to this experience, one thing is apparent to me: pain elimination isn't going to be happening any time soon, which leaves me with pain management. Given that I'm going to have relatively constant pain for what appears to be an extended period of time, one goal is to be able to minimize the perception of the pain so that it doesn't interfere with things I'd rather do than mope. So, some notes on what I know so far. This will likely expand as time goes on.
Drugs
Ah, drugs. Take a pill and make it all go away. Well, not yet.
- NSAIDs - I self medicated with aspirin and naproxen before seeing the physician. I'm currently allowed ibuprofen along with the steroids. As thing have progressed, ibuprofen has turned out to be a reasonably effective bulwark against the worst pain, but I'm having to take large doses - 1500 to 2500mg per day - which needs to stop before it gives me an ulcer.
- NSAIDs part II - Sunday night the pain ramped up to the 9-10 level and stayed there. I ended up calling our insurance company's phone consultation physician to discuss dosages, and ended up taking 800mg of ibuprofen and 1000mg of acetaminophen in one go. This did tamp things down to about a 4 in 90 minutes, but it also left me feeling worse in other ways, including some mild tinnitus. Clearly that's the end of the road in this particular direction.
- Dexamethasone - This is the heavy-duty steroid I was prescribed after initially seeing a physician, with the goal of reducing the inflammation inside the spinal column. I suspect it's been fairly helpful on the pain front, since I definitely noticed extra pain when I was late taking a dose. But it's of limited use since it's a declining one-shot punch, not something to take continuously.
- Metaxalone - This is the muscle relaxant that's supposed to get the muscles out of spasm so they won't secondarily injure themselves. It's not doing that 100%, but I don't know how life would be without it. It does not seem to have a lot of pain-killing effect. It's also fabulously expensive (over $3 per pill, 3 times a day).
- Tramadol (Ultram) - Prescribed by the pain management clinic for relief as needed. This is a drug related to codeine, and supposedly less addictive than things like hydrocodone. I went up to 50mg four times a day, and then tapered back to 50mg once a day.. It does seem to cut the pain somewhat, though it certainly doesn't eliminate the pain. It has some side effects - makes me jittery and itchy - but they're manageable. One thing I discovered belatedly is that it does build up a physical dependency; trying to quit using tramadol cold turkey, instead of tapering it off, will give you nasty withdrawal symptoms.
- Amitriptylne (Elavil) - Also prescribed by the pain management clinic, because it combines pain blocking with sedation and may help me sleep a bit more soundly. For a few weeks I was having one 25mg dose a couple hours before bed, and it does seem to be knocking me out for 4 or 5 hours. This had the drawback of giving me more time to toss into a painful position while I was asleep, but I needed the sleep. When the pain went down a bit, I quit taking this one.
- Caffeine - Yep, it's a drug. It has seemed to me that the one cup of coffee I allow myself in the morning is actually providing some relief. Not much, but I'll take what I can get, especially since I'd be drinking it anyhow.
- Alcohol - A beer before bedtime (or what's passing for bedtime right now) does bring down the pain and tension enough that I can doze a bit. And yes, I checked, it's safe to have one beer on top of the other meds.
- Other People's Meds - As with talking about any other medical issue on the net, mention back pain and you'll hear from people who swear by some particular miracle. So far I've had Robax Platinum and Elavil recommended in this regard. As when I was dealing with migraines, it appears that the potential pharmacopeia for back pain is huge; when I end up with a steady long-term physician this is an area I expect to talk about.
Distraction
The pain is going to be there, as far as I can tell, but I don't have to be in the pain. Some things help me pay less attention to it. Getting "into the zone" of writing computer code is one thing that actually helps (and one reason why I'm spending lots of time at my desk rather than flat on my back). When I'm tired but hurt too much to sleep, putting on headphones and watching some reasonably immersive movie is helpful as well.
I also intend to spend some time exploring self-hypnosis here. I'm already (well, I was already) able to get myself dropped off to sleep inside of five minutes under normal circumstances thanks to practicing some induction techniques. It seems reasonable to assume that I can do something about pain in this regard as well.
TENS
That's "Transcutaneous Electrical Nerve Stimulation" if you're allergic to acronyms. Basically, you slap a couple of electrodes on the skin, crank up the battery, and see if you can confuse the nerves and get them to do something other than just whine at you. I've had a couple of sessions on a professional grade TENS unit at the physical therapists' now, and they do offer me substantial relief while they're going on. I chatted with the PT about home units, and her guidance was that they could be safe and effective for some people, and that there was no need to worry about overuse. Her recommendation, though, was to use one that they have available via prescription rather than buying a consumer TENS box, so I tried to close the loop with the MD on this one.
Unfortunately, the original physician I dealt with with did not think it appropriate for her to prescribe the TENS unit; apparently she keeps from getting involved in power struggles over narcotics by simply not being willing to do anything for pain beyond OTC drugs and referrals. And TENS units in the medical supply places are by prescription. However, armed with a credit card and Amazon, I now have one of these little units. It takes a nine volt battery, comes with four electrodes, and has far too many settings to play with.
It does definitely help. I've been experimenting with where and how to stimulate with it, but it will block the trapezius pain (and to a lesser extent the triceps pain) while it's running. The drawback is that there's no lasting relief at all; five minutes after I take it off, the pain is back. But at this point, I'll take whatever respite I can get.
Physical Therapy
PT has so far had no effect for me in managing the pain - rather the reverse. That could change as the situation stabilizes. So right now it's wait-and-see.
Activity Modification
This is a tough one for me - I do not like to ask others to do for me, or admit that I cannot do things for myself. But, three things are evident. First, there are some activities that are more painful than others. Second, the duration of activity matters, and it's not a linear scale; twice as much standing might be four times the pain. Third, I pay because the more I ramp the pain up the longer it takes to ramp back down.
At the moment (in November), there are some things that I simply cannot do, like lay flat on my back (I am not sure I could do that at gunpoint). There is a wider range that I can do with pain: getting things off a top shelf, putting on a sweatshirt, washing my hair. From there it grades down, but even things like walking up the stairs or getting a bowl out of the cupboard have the potential to make me hurt, depending on just how I perform them; the pain seems extraordinarily sensitive to the precise alignment of bones in my spine and shoulders and the amount of jolting my body undergoes.
So, reluctantly, I am doing far less than I used to. Some things I ask for help with, some I don't do at all, some I limit. I'm spending a lot of time in my (fortunately very comfortable) desk chair. This is another area I need to explore with a patient physician if things go on; I need to understand to what extent toughing through the pain might extend or retard the healing process, and to what extent it's just my choice about what I want to put up with.
I'm also having to learn the biomechanics of what works and what doesn't, or at least keep track of problems. For example, I tried to sit down in a wooden chair at the dining table last night so I could have dinner with the family. I don't know whether the problem was the hard seat or the hard back or the inability to lean back, but within five minutes the pain had skyrocketed (from about 5 to 9 on the 1-10 scale). So, I won't be trying that again in the near future.
So how much does it hurt?
Describing pain is tough. The traditional scale is "where is it on one to ten, with one being very light and ten being the worst pain imaginable?" I have some trouble with that, because my imagination is pretty good - I can still imagine worse pain than I've had with this thing, though I certainly don't want to. But I can wave my arms around a bit to get to an answer (which amounts to "it's the worse pain I've had to deal with in my life").
Two other types of pain I have all too much experience with are migraine headaches and toothaches. The migraines were a constant presence a few years ago (and they cleared up when we moved, leaving me to assume an environmental component) that were eventually medicated away. Compared to even a bad migraine, the neural pain from the herniated disk is worse: sharper, harder to ignore. The migraine pain tended to be steadier, while the nerve pain can rise or fall dramatically in short order.
The toothache pains are somewhat similar to the nerve pain, except that they were more localized (and I find it easier to ignore a pain that covers less of the body) and had a different quality..."colder" is the term that best approximates it for me. Toothache is intensely unpleasant and made it hard to sleep, but at least in my experience it never rose to the intensity of the current pain.
So, back to the 1-10 scale. The way I have it calibrated at the moment is that from 1-5 it's pain I can set aside and function, 6-10 is constantly present even when I'm distracted by writing code or watching a movie. From 8 up it's getting increasingly hard to even do anything else at the same time. 10 is tears in my eyes and breaking out in a sweat. That's where I stand today; if things get even worse, I guess I'll have to recalibrate. Or else tell the doc that this pain goes to eleven.
And on that scale, currently (late December) I'm spending most of my time in the 1-4 range. That's a damn sight better than the 5-8 I was routinely clocking in November, and I'm happy for the improvement. I don't have pain-free moments, but I have pain I can ignore much of the time. I also have steady pins and needles all down my right arm about 90% of the time.
A Pain Heuristic
One thing that I find surprisingly hard to judge is how much the pain is affecting my mental abilities. It's tough to introspect and know how clearly you're thinking. Fortunately, I seem to have hit on a rough-and-ready way to make a judgment on this. I've always kept a computer game or two around for quick relaxation breaks, going all the way back to the original Tetris. These days Lux Delux is my choice in this arena.
Ordinarly it's a game I'm pretty good at; I win something like 70% of the games I play. But I've discovered that when I'm mentally checking out, my average goes way down - or else I just stare at the game board and can't form any sort of coherent strategy, or even interest in finishing the game. When it gets to that point, I know that I'm too far gone to be trying to write code, and it's time to break out a movie and just pass the time.