Decrepit Old Fool

For me the only effective way to manage it is carefully modulated exercise.

No obvious physical morbidity causes the pain.  One doctor said it was ‘acute chronic migratory fascitis’; another said ‘fibromyalgia’.  I think both terms are doctor-speak for ‘We actually have no idea”, or alternatively, “You are crazy”.  A chiropractor said; “I believe you, and you need a long series of expensive ‘adjustments’” (during which time I got considerably worse).

This is pretty boring stuff unless you live with it, or with someone who has it.  So on the outside chance that any of my readers live with a similar condition, the long version is below the fold …

I have always had a ‘loud’ sense of touch.  While there are many fabrics I cannot wear, on the plus side I can actually feel the inner workings of mechanical things even if I can’t see them (I probably would have been a good safecracker).  But about 15 years ago, following several bouts of kidney stones and a few surgeries, my pain-circuits just seemed to kick into overdrive and stayed there.  Pain invaded my dreams, and my waking hours became a grim contest between human interaction and the noise of pain.  My energy level was, and is, unpredictable.

Finally I saw a muscle specialist who had seen this syndrome before, and he introduced me to the field of ‘pain management’.  About the same time I began to study Buddhist philosophy, which gave me a more constructive perspective on pain.  (I am not a religious Buddhist; it’s just a very helpful way of looking at things.)

The specialist told me; “There’s no cure.  You can either have weak muscles that hurt, or strong muscles that hurt.”  With that I began a round of muscle inventory with a physical therapist, and learned how to design my own exercise/PT programs. 

I visit Gold’s Gym 3 or 4 times a week and follow a carefully created program.  First, light stretching (with cold muscles you have to go real easy) and then a 25-minute warmup on the stairmaster.  This is when I will know how the rest of the workout will go.  If I can only ascend 75 to 85 ‘stories’ in that time, I finish up with a cool-down cycle on the stationary bike and 10 minutes of careful stretching.  This is enough to reduce pain for 24 to 48 hours.

If I can go 90 to 105 stories, my energy will continue right on through the workout.  Then I do a partial cool-down, stretching, upper-body strength-training, more stretching, and final cool-down.  A workout like that will reduce pain for 3 days or more.  On good weekends I get one on Saturday, and one on Sunday.

Skip any one of the steps – the stretching, warmup, cool-down, post-stretch, anything, and the results are particularly unpleasant; a return of the “pain dreams” and staggering gait.  So I’m pretty careful to do it right.  Over 4 years at the gym I have slowly realized rather impressive strength gains, and with them a corresponding reduction in pain.

I also exercise in daily life.  My mountain bike is my daily transportation.  I don’t use the elevator for anything under 5 stories.  I keep barbells at my desk and use them.  Sometimes I do situps while watching TV.

But sometimes due to stress or illness, pain begins to build up.  My muscles tremor and cramp, I stagger a bit when I walk (four years ago I was having trouble stepping over curbs or climbing stairs), and sleep becomes nearly impossible.  When this happens I need to take time off from work and go to the gym several days in a row.  Which I did, during my recent vacation.

In 9 days I tracked my work at the gym.  I like to figure rough, real-world equivalents to my PT sessions.  On the Stairmaster, I climbed the Petronas towers in Kuala Lampur, Malaysia, ten times.  I sat up from a reclining position 235 times.  I overhead-pulled a Ford Explorer two feet off the ground.  I did a bunch of assorted range-of-motion exercises and also rowed a boat approximately across the Illinois river at Peoria a couple times.  Each session mixed in the requisite warm-up, stretching, cool-down, and stretching.

For the effort I am rewarded with increased range of motion, less pain, and occasional nights of sound sleep.  My bike goes much faster.  My balance (while less than it used to be) is improved.

I have tried most of the narcotic pain relievers, and surprisingly they really don’t help (but they do make me feel crappy in the bargain, as does alcohol).  Ibuprofen helps quite a bit because of its anti-imflammatory and muscle-relaxant properties, so I use it a few nights a week.  But both it and Aspirin have other side-effects.  Acetaminophen doesn’t do diddly. 

So ‘management’ it is.  There is no pill, no silver bullet, but what I am doing seems to be very effective for me. 

Need I say that what works for me, may not work for you?  If anyone else with a chronic pain condition wants to try it, you should consult with a physical therapist first.  Just unguided exercise (or with an unqualified trainer who hasn’t specifically studied pain management and physical therapy) can cause you a lot more pain than it will prevent.  Your program will have to be designed for you individually, and you will need to adjust it as you go. Don’t rush – for the first three months all I did was walk back and forth in the pool and stretch.

Chronic pain is actually very common and can result from illness, injury, hereditary conditions, and some people experience depression as physical pain.  This is why you will need to take a guided-experimental approach.  Feel free to leave questions or discuss in the comments. I’ll update this post if I think of anything else.

Updates:

• The best description I have heard of fibromyalgia is that it makes you feel old.  You’re inexplicably tired and pain seems to come out of nowhere.  But it does not show on the outside, and people with fm often hear; ‘You can’t be sick – you look so good!’

• Age is hardly a factor, though.  I was only about 35 when the condition really started to manifest itself, and despite my witty and ironic pseudonym I’m a very young-looking 49 now.  There are teenagers and even children who experience chronic pain.
• The US Army is actually at the, uh, cutting edge in injury-related chronic pain research.  Seems the pain of some battlefield injuries – and anaesthesia doesn’t seem to prevent this – damages the pain pathways in the brain somehow.  They are experimenting with spinal blocks at medical stations so the pain signals don’t reach the brain.
• I don’t mean to say medications are of no value.  Many people do routinely use pain relievers to treat chronic pain with considerable success.