Let me tell you all about about my disease…

Spoiler alert: this is a change of tack from recent serious philosophical posts. The only real conclusion will be, “What an interesting world we live in”, with a slight flavour of that old Chinese curse, “May you live in interesting times.”

I may have mentioned before that in the last two years of my general practice career, I also ran a district NHS back-pain clinic for a couple of afternoons a week. I applied for this because I’d learned spinal manipulation back in the early 1980s, and had somehow become the go-to guy in the practice for all things back-related over the decades.

Always get bass-players to carry their own amps…

This was something of an irony since a good deal of what I learned came from the personal experience of a disc-injury, from foolishly lifting a heavy bass-amplifier down some narrow stairs, in 1986. The course of this was that the initial injury settled, as most disc lesions do, in a few unpleasant weeks, but that from time to time thereafter quite minor indiscretions would lead to recurrences of similar back pain for a few days, centred on the same spinal level (L1 left, if you’re interested).

These attacks became less frequent over the years, though at one interesting stage I would get sudden, and transient, episodes of unprovoked sciatic pain. These usually seemed to strike whilst I was sympathising with patients’ bereavements or breaking bad news to them, necessitating disguising my paroxysms as compassionate expressions of support.

Here’s one I did earlier

My back-clinic experience, working with pain-consultants on chronic back pain, changed my perspective radically, from a crude idea of back pain as a biomechanical phenomenon (something must be bust if it still hurts) to that of a neuropathological phenomenon. Old injuries (like mine) not uncommonly set up abnormal central nervous system pathways, that are repeatedly or chronically triggered by minor incidences of the original strains. The effective solutions are much more to do with re-programming than repair… and in fact, inappropriate surgical repair not uncommonly exascerbates the problems rather than solving them.

Retiring to a less deskbound life helped my own issues, but this summer I’ve noticed some recurrence of that disembodied sciatic pain associated with the physical effort needed to mow and rake 2 acres of wildflower meadow on a steep slope – hey, you can’t save the planet without some pain (and the sciatica’s masked a bit by the arthritis in the opposite hip, the tennis elbow and the achilles tendonitis…). I should add that (as in many cases of referred leg pain) all the clinical signs of physical entrapment are absent. So no MRI scans for me, at this point!

It wasn’t fieldwork, though, that triggered this weekend’s problem, but (probably) changing a wheel on the car after a puncture on Friday, though at the time it seemed a routine enough job. That night, I began to get quite severe bouts of sciatica again, lasting just 10-20 seconds, but coming every few minutes. This did not make for a good night’s sleep, but I was able to experiment with the effects of changing every possible combination of postures in bed, then on the sofa, then on the floor. And all without waking my wife – I rather hope I never get something really serious, as she’s bound to sleep through it.

The problem was not only that it hadn’t settled by morning, but that my band also had a gig at the local Arts Centre on Saturday morning. The car was, fortunately, already loaded with the band gear from before my puncture, for providential reasons, though I had to get the big PA speakers from my church even though it didn’t seem very wise. Anyway, at that stage I noticed that the bouts seemed surprisingly regular – though the pain still came on over perhaps five seconds, and turned off entirely, like a tap, after maybe 20 seconds. So I thought to check my watch every time it came (whilst the band did most of the unloading and heavier setting up).

I was surprised to find that, within the limits of a biological system, the bouts came with clockwork regularity every five minutes (occasionally a few seconds less, or rarely up to a couple of minutes late), and that this pattern was completely unaffected by what I was doing at the time…

…except that, when we began to prepare to go on stage, the bouts eased off, and I had no pain at all during either of the two hour-long sets in which I was playing guitar, singing and generally prancing about like the aging idiot I am.

Sciatica Cure

The clockwork ground into action again as soon as we finished, leading me to suggest to the band that since my contractions were now 1 in 5, I should get to the labour ward with all speed. The same regular pattern continued when I rested at home for the rest of the day. The severity had eased enough, thank the Lord, for a decent night’s sleep, but the overall pattern has continued up to now.

Interestingly (to me, at least) I note that as the severity has eased, the length of the attacks has become somewhat longer, but the five minute cycle, when I bother to time it, is unchanged. If it had started off like this, I probably wouldn’t have noticed what a surpisingly clock-like pattern it had.

Now the thing about predictable events, as we’ve been discussing here for a long time now, is that they (and they alone) are amenable to scientific investigation, or they would be if I had more resources and skills than a mere propensity to get sciatica. The question is, what kind of bodily pain operates on a pretty regular five-minute cycle, and switches off entirely in between?

To me, the contingent nature of an injury is extremely unlikely: injuries hurt because damage persists, or they they ease when the immediate cause eases, for example by movement to a different position. But my long night of investigation showed that movement and position are largely irrelevant to my problem, and the whole thing smacks of physiology, albeit disordered physiology.

The phenomenon reminds me most of something like the Japanese shishi odoshi, or deer-scarer – spend a zen moment or two experiencing one here:

One can easily envisage something in the nervous system slowly summing action-potentials from the stimulation of a low-level pain pathway until a critical point is reached, the system discharges, yours truly winces, and the whole system is then reset.

The central-nervous origin of the pain is indicated not only by this  machine-like pattern of evidently complex causation, but by the complete lack of response to somatic pain-killers (more’s the pity), and even more remarkably by its complete suppression, apparently, by my going on stage to play rock music – proving either the power of stressed mind over matter, or that Spinal Tap describes the literal physical source of rock music . Watching the Singapore grand prix on TV, or writing this, has had no such beneficial effect on the pain as playing music live.

I don’t pretend for one moment that this strange pattern is an adaptive pain response (chronic pain is characterised by the fact that it doesn’t give any useful warning of a problem, but is itself the problem). But I get the impression that if one could understand just what is going on at spinal cord level here, one would also gain a pretty good idea of how chronic pain works and, perhaps, open up some new treatments for it.

Any medical researchers out there with ideas?

Jon Garvey

About Jon Garvey

Training in medicine (which was my career), social psychology and theology. Interests in most things, but especially the science-faith interface. The rest of my time, though, is spent writing, playing and recording music.
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5 Responses to Let me tell you all about about my disease…

  1. Robert Byers says:

    If your the GOP TO GUY then it means you do the best job by reputation!

    As A Christian I can’t believe pain is experienced by the soul EXCEPT by way of the memory.
    All pain/senes only are NOTICED because we READ our memory.
    so two options for you.
    It could be just a case of your memory being triggered by impressions on your nervous system that something is wrong. yet actually nothing is.
    Like when people lose limbs, phantom pain, but still have pain from them but no reason for it. or those , I forget the name, who have no pain at all and so threaten themselves.

    The other option is, I think you said this, that the nervous system DOES SEE som,e irritation and it just takes a while to become a greater sensation.

    The music performance simply might tell the body there will be NO more irratation on the back.
    OR, the memory being concentrated, the pain shows itself as a phantom.
    lord bless and heal you.
    My confidence in opining is based on my conviction pain is our soul observing our memory. So the memory can be deceived.

    • Jon Garvey Jon Garvey says:

      Robert

      Neurologically there is indeed a close parallel between chronic back pain (and, indeed, other kinds of chronic pain) and phantom limb pain. That’s an extreme, because the pain is very real, but the limb is non-existent.

      When I was working I attended a master-class where one of the speakers was a pain specialist who regularly took time out to visit a region where ethnic warfare had been waged by chopping off the hands of the “enemy” civilians with machetes. It (sadly) gave him a good opportunity to discover who got phantom limb pain, and why: what happened in the first few days was crucial.

      And yes, “memory” is involved, only primarily at the spinal rather than the mental level. Hence, i suppose, this weird “objective” cycling of the pain in my case, which only became obvious when I noticed and timed it.

      And yet the brain and mind are involved, as the music-making “exemption” shows. In fact research on chronic back pain shows that over time, there are measurable changes in the brain – the areas representing the affected part of the back actually increase in size at the expense of the other areas. So it’s not surprising that people become (apparently) fixated on their pain – and yet, much of the solution involves ones mental approach to it.

      But I’m glad to say I don’t have to start too much in the way of mental discipline, as it’s a lot better today!

      • Robert Byers says:

        i have different conclusions but won’t weary anyone with it.
        I said my points.
        Just to repeat WE DON’T FEEL PAIN. WE only OBSERVE the memory. Then we feel the pain. So a phantom limb pain in fact shows there is NO ACTUAL pain going from point to point b.
        it shows the memory simply thinks a limb SUDDENL:Y fell of OUCH.
        These cases are not aberrations but prove the true equation.
        We do not feel pain but only feel pain by observing the memory.
        If so it will occur in other ways.
        Possibly you are having some example of it. I don’t know.

        I don’t agree we have a brain or it matters. only a memory, including its place in our skull and probably distributed around.
        Anyways.
        i think healing could be better accomplished by a presumption in a soul exclusively reading the memory.
        then tweek the memory to fix problems. Any help is welcome in this direction please.

        • Jon Garvey Jon Garvey says:

          Robert, if you want to observe that “pain” is an immaterial experience that’s irreducible to physical phenomena, then that’s fine – the so-called “mind-body problem”.

          But to deny that there is anything going from point A to point B in phantom limb, or any other kind of pain, is simply wrong. The nerve pathways can be measured in action, mapped and, to an increasing degree, explained.

          The somatically-mapped areas of the brain are also completely unproblematic, and indisputible, as regards the connections they make with the spinal centres.

          The intractable mystery only really comes from how all that neurological activity (inlcuding that involved in memory) becomes conscious experience, and how conscious experience feeds back on the physical aspects (for example, the ability to ignore the pain of major trauma when extremely engaged, eg in battle).

          But as ever, it pays only to start theorising when you’ve studied the subject.

          • Robert Byers says:

            I have seen many youtube discussions on phantom pain by researchers.
            They do deny any pain is going as there is no source to the pain. its a ghost.
            I agree a message is sent that a limb is missing and then i suggest the memory reads it as pain but there is no pain sensations actually coming.

            i’m not saying pain immaterial but rather our soul only reads the memory. The pain sensations only go into the memory.
            IN FACT your case of ignoring trauma in battle makes the point. the BATTLE occcupys the memory so powerfully that the memory of the trauma/pain is not read. nO different in mechanism then phantom pain!
            the same simple equation.
            Our bodies are not that complicated. however complicated.

            I would argue the BRAIN is only a memory machine. pain just is another example that shows we only feel pain by observation of the memory. Interfere with the memory, one way or another, and one interferes with the pain relative to normal pain levels.

            If we were souls encased in bodies it could only be this way. Our souls do experience the pain.
            The aberrations show the equation i suggest.
            Possibly your music case is case inn point.
            Playing and performing before a audience occuys your memory and possibly reveals the pain is itself a false memory.
            if so it would not be a strange thing but logical.
            Just speculating on that point.

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