canklecat

Sounds very familiar. I have cervical spine stenosis, worsening pain for almost 20 years since it started after my car was t-boned when the driver of a full size SUV blasted through a red light at highway speed.

It got worse after I was hit by a car during a bike ride a few years ago. Reinjured the neck. Broke and dislocated my shoulder, with a winged scapula that took a year to sorta-heal.

Constant neck pain. Frequent headaches. The works. And referred pain, or adjunct pain caused by the poor posture and ergonomics resulting from permanent physical changes.

It's pretty rare when the usual perfunctory pain assessment questions at every medical visit are sincere. I tend to brush them off, figuring they're just checking off boxes in a list. I could tell them my pain is "Z-squared" and they'd just write that down, or ask for a number from 1-10 and shrug when I say 6, which is my usual answer.

Once a nurse stopped, looked at me and said "That's actually pretty uncomfortable."

I said, yeah, I know. But I haven't had a day with pain level lower than 4 or 5 in 20 years. After awhile it's background noise.

She seemed interested in details, such as "compared with what?"

So I pointed to my left index fingertip, which was nearly amputated by a machine more than 20 years ago. The entire distal phalanx was crushed into seven pieces and dangling by some connective tissue. Fortunately the blood vessels were intact. The ER just splinted it and sent me home. There wasn't much pain initially because of the nerve damage. It seemed okay the next few days, with some throbbing pain, but nothing bad enough to need more than ibuprofen. It eventually healed without medical intervention, with minor nerve damage (maybe 90% of original sensation) and the fingernail is permanently divided into two overlapping pieces.

In another shop injury a hammer handle split and wedged my little finger, splitting the flesh down to the periosteum. No blood, not much pain. I just cleaned it and wrapped it snugly with a couple of bandaids. It healed fine, just a barely visible and palpable scar.

I was an amateur boxer and, among other idiotic stunts, usually preferred to spar bigger guys. I boxed from lightweight to light middleweight, 132-156, and rarely sparred anyone my size. I usually sparred guys up to heavyweight size. I never learned to pull my punches properly and tended to knock down guys my own size or smaller, which isn't a good thing in sparring. Despite some myths about macho gym wars being as rough as actual competition, it's not a good practice, especially in the amateurs. Fortunately toward my final couple of years I got a better coach who worked with me on technique and restraint.

Anyway, I had plenty of black eyes, cuts around the eyes (actually skin splitting against the eye socket), cracked ribs, and a cracked sternum from sparring a state heavyweight Golden Gloves champ (and he really was taking it easy on me). Never saw a doctor for any of it. Just seemed like part of the process. If people are too sensitive to pain, they usually don't persist in martial arts.

I don't think it's a matter of willpower. Some people just have a different pain threshold. I've always had a delayed pain response, usually hours or days after an injury. And until the car wreck 20 years ago, never had a problem with chronic pain from old injuries. Once they healed that was it, no other problems. But that all changed in 2001.

Same with crashes from bicycle racing or just ordinary bicycle and motorcycle riding. Plenty of injuries. Never saw a doctor for any of them. During my first criterium in 1978, in the final sprint, the guy next to me pulled ahead slightly, swerved into my lane and took my front wheel out from under me. Road rash from ankle to shoulder. I was in the Navy at the time, a Hospital Corpsman working at the National Naval Medical Center in Bethesda. The petty officer in charge of our unit advised me to keep the injury to myself and not go to sick call because I didn't have authorization for off base activities such as bicycle racing and boxing. He said that base CO could very well recommend disciplinary action. So I patched myself up, making sure nothing bled through my white scrubs. And I went back to race again two or three weeks later.

When I was hit by a car in 2018, the ambulance crew saw my busted up shoulder and arm dangling loosely and asked if I wanted fentanyl for the pain. It's a fast acting, very short duration analgesic, and would last long enough to get through the waiting time at the ER. I said, nah, it doesn't hurt that bad so far. At the ER they offered morphine. Again, I said, nah, it doesn't hurt that bad yet. A hydrocodone or Tramadol will be enough (despite media hype, those are very mild opiates and not nearly as addictive for most people as the hysterical news stories would have you believe). Again, they seemed stunned that I wasn't in much pain. I said, "Ask me again tomorrow or this weekend at home. By then it'll be hurting."

And I've had severe headaches since I was a kid. Neurologists can't decide whether it's migraine, cluster headache or trigeminal neuralgia. Those are pretty well acknowledged as pain level 8-10, sometimes reaching an excruciating level that few people can tolerate for long. Now I just say "migraine" because otherwise they assume I'm self-diagnosing and mooching for opiates. But analgesics don't help with migraines or cluster headaches. They can help with trigeminal neuralgia, but in my experience a local injection of Xylocaine or something similar works great for trigeminal neuralgia. No need for opiates. Now I take a beta blocker as a preventive and it usually works pretty well.

So when I tell nurses or doctors now my pain level is usually around 6, but I'm not crying and begging for prescription pain meds, I can tell they don't believe me. But you really do learn to push it into background noise. You can't cope otherwise. Once the pain hits a 7 or 8, yeah, I want something stronger than Tylenol.

Anyway, I got tired of medical professionals who either disregard patients with genuine pain. Or, almost as bad, refer us to "pain mismanagement clinics" that turn out to be Medicare/insurance milking scams. Typically they'll set up as many appointments as possible, each six weeks apart, before actually doing any treatment. I watched my mom go through that mess years ago for her arthritis, scoliosis and deteriorating joints. They made an appointment, which accomplished absolutely nothing other than to give her another appointment for a nerve block. But when the next appointment came up six weeks later, it was just a consultation to *explain* the nerve block. Then another six week wait for the actual nerve block. Before her health care system switched to this Medicare milking scam, her regular ortho doc would do the nerve blocks at the same time, no delays or redundant appointments.

Unfortunately I was referred to just such a pain mismanagement clinic to be evaluated for cervical spine ablation. I was sent to them in 2018 and their soonest appointment was six months away. When I asked why the guy said "Take it or leave it" and hung up on me. This time my ortho doc, who's a good guy, said he could get me in within two weeks. But when I was contacted by the clinic, they pushed it back to nearly two months. So after this upcoming appointment I'll be looking for another ortho clinic.

There's a good reason many of us have switched to finding our own solutions for coping with chronic pain. For me, CBD was somewhat helpful but expensive for what it does. Kratom has been much more effective and I can continue to function and stay physically active. Some folks suggested alpha lipoic acid, which I've been taking for a month or so. It might help a little but not enough to justify the cost of yet another supplement. I can't take NSAIDs daily, especially ibuprofen -- it aggravates my psoriasis and psoriatic arthritis symptoms, which has recently been confirmed by studies. Tylenol does almost nothing for me. I get as much good from hot soaks in Epsom salts, a percussion massager and TENS unit.

So, yup, what you've described is too familiar. There's got to be some medical professionals out there who get it. But I haven't found one yet.