From back pain to depression, one woman’s agonizing journey
In my practice, I’ve worked with countless patients who were referred by their providers because their back pain had no physical cause. Exams, X-rays, and MRIs showed nothing abnormal. Those tests don’t show over-reactive, over-sensitized nerves! And when a physician doesn’t understand this stress-related condition, they prescribe the treatments they DO know. It can be physical therapy, more tests, steroid injections, and painkillers. But they are not an effective treatment for nerve sensitization.
Melissa’s story: The downward spiral from back pain
Thirty-four-year-old Melissa worked as a bartender at a dive bar in small-town Wisconsin. Standing a mere five-foot-two, Melissa had no problem putting a six-foot, 250-pound drunk and disorderly patron in their place.
Eventually, Melissa transitioned to a new line of work, quite different from the demands of being a bartender. She opened a makeup station, applying bridal and event makeup. Melissa spent hours each day standing and leaning slightly forward to apply eyeliner and blend eyeshadow. This position, although great for makeup application, is brutal on the back—heavily loading the back bones and discs and placing them at increased risk for injury.
Melissa began experiencing a persistent ache in her low back. The discomfort increased and she saw her doctor who assured her it was just a back strain. She tried sitting more at work but the pain persisted. Melissa’s doctor then referred her to physical therapy. Weeks later, the pain worsened and spread to a larger area. She tried over-the-counter anti-inflammatory medications with minimal relief.
Melissa’s exam was normal other than some sensitivity to touch and discomfort when bending forward and extending. Nothing in her medical tests offered a physical reason for her ongoing back pain. Melissa’s x-rays showed mild arthritis, which is not typically disabling. Her health declined, so Melissa’s doctor ordered an MRI. Again, the test showed mild arthritis. Nonetheless, she received a round of epidural spinal injections to reduce the pain, “just in case” they helped. They didn’t.
Melissa cut back her work hours. She couldn’t stand or sit all day anymore. She needed to change positions constantly. And she needed more rest. For the next two years, Melissa moved as little as possible because she was afraid the pain would get worse. Then the weight came on. Her depression worsened. She was without hope and feared this depressing situation was her new life.
Melissa’s repeated requests for help with her pain sparked another problem with her care. The clinic staff suggested she was seeking painkillers. After one particularly hard day when she called a clinic with a question, the staff’s response was, “Aren’t you on enough medicine? What else do you want?”
It took six doctor visits or more at a medical clinic before they trusted that she wasn’t just there for drugs. That she was searching for relief. Trying to understand why the standard treatments did not work for her. The struggle wasn’t just in the clinic, but also in the people around her. Coworkers, friends, and family were annoyed by Melissa’s ongoing pain issues. She was ridiculed, judged, and lectured because they didn’t think anything was wrong. She looked ok and her medical tests were mostly normal. Based on their understanding of pain, nothing was wrong.
Guilt, depression, and weight gain
Melissa couldn’t play with her kids because she didn’t have the energy. She felt guilty for how much her parents helped, since she no longer worked. She felt worthless, a burden to everyone around her, but unable to do anything about it.
Eventually, the only relief Melissa knew came from opioid pain medication. The amount of opioid she needed to dull the pain was that of a person dying of cancer and she became addicted. Despite the high dose of pain medication, she was still not functioning. She couldn’t work and struggled to take care of her kids.
The connection between pain and non-pain symptoms
After a couple of years, Melissa was referred to me because I understood stress-related conditions and central sensitization pain. It was clear to Melissa and me that her pain and disability were much greater than her physical exam and imaging findings had shown.
Her symptoms went beyond the chronic back pain. Melissa experienced brain fog and severe fatigue. Melissa struggled to sleep at night. She hadn’t mentioned these non-pain symptoms to her previous providers because she didn’t realize the non-pain symptoms could be related to her back pain.
In the beginning, Melissa had a mild back issue, maybe a muscle strain, maybe an arthritis flare. It caused moderate discomfort. Over time, sensitization developed in the nervous system. Sensitization amplified the pain signals, making every movement, every activity, hurt severely. There was now dysfunction in the nervous system, too.
The abnormality in Melissa’s nervous system could not be seen or measured on standard medical tests. Nerve sensitization required a different treatment approach. And that’s what we did!
Relief at last!
Becoming aware of sensitization’s effects on her body gave Melissa the power to improve her situation. Understanding the role sensitization played in her pain levels alleviated her fear of moving. The fear she would hurt her back more. Medication management shifted to nerve pain agents, a medication class that calms over-reactive nerves.
Melissa observed that stress worsened her back symptoms, which empowered her to reduce stress. She recognized the importance of self-care. She couldn’t take care of her kids if she was not well. She became ok with making her needs a priority, rather than something that could be ignored.
She joined a gym, which gave her a sense of community to support her wellness goals. Melissa surrounded herself with people vested in her getting healthy. She showed up for the workout training and her back felt better. She realized movement was the answer, not the enemy. She lost weight and felt good. She made like-minded friends of all ages.
Melissa’s mental health improved when she regained hope. She understood she wasn’t imagining her struggles, as all her coworkers, family, and many providers believed. At last, she had proof that she wasn’t just crazy or being overly dramatic. This validation rescued her from the depths of despair..
After twelve months of sticking to this program, Melissa regained her health, wellness, and happiness. Recovery is a process that takes time. She cares for her kids and has a part-time house painting business. She enjoys the movement and artistry that comes with painting.
Remember, with sensitization, it’s not in your head. It’s in your nerves! And judgment has no place in healing. If you suffer from chronic back pain, seek a provider with knowledge and experience treating central sensitization pain. Contact me at AskDrShana.com to learn more about stress-related disorders, like nerve sensitization.