I’ve talked off and on here about my diagnosis of chronic myofascial pain, provided some thoughts about surviving this disease and the treatment process, and most recently, discussed the trigger-point injection therapy I began a couple of weeks ago.

Here’s a little addendum to the story that I’ll now share with you…

During the first appointment at the doctor’s office where we performed trigger-point injections , skittish-(around-needles)-person that I am, I allowed only four injections. The second time, a few days later, was a session with 19 injections. That extremely-intense ordeal was on a Monday morning, and, as it followed a weekend of suffering through some intense back and foot pain, I experienced some much-needed relief during the course of that day. However, by that evening, I had pretty much returned to “normal.” (This was not a good thing, of course…the pain had returned!) In fact, by the end of the week (on that Friday), I was hurting so much that I made and kept an appointment with my chiropractor in Eugene, where I obtained some pain abatement with the (for me, usual) treatment modes of ultrasound, light massage, and a small chiropractic adjustment.

My injection-therapy doc was going to be out of town for a bit, so the first chance I had to return to him was Monday morning of this week. While there, I reported on my status, including the few-hours-only relief I obtained as a result of the 19 injections last time.

Of course, I had been discouraged at not experiencing more relief as a result of that previous visit, but, still, was rather unprepared for the assessment that injections were not going to be the preferred treatment for me. The “typical patient” tends to respond much more positively than I did, apparently.

I had been warned that this (injection) path might be more problematic for me than others, though. In reporting my medical history, I of course had disclosed that I had been taking lorazepam (“Ativan”) during the last several months in an attempt to cope with the anxiety-factors of my life (job loss, interviewing, moving…that kind of stuff). As it turns out, and as I had been informed, taking a drug in the bezodiazepine class can sometimes (oftentimes) seriously get in the way of having a successful outcome from trigger-point injections. And this doctor, while having treated only a few individuals who were taking (or had taken) this type of drug, had first-hand experience in seeing such cases as mine “fail.” I had been off the drug for a full three weeks at the time of my injections (and, now, as I write this, it’s been over five weeks), but the effect that the drug can have on the body (at least as far as trigger-point injections go) can be much longer lasting than would typically be predicted from the elimination half-life .

So, what to do now? (was the question) I had been studying the Trigger Point Therapy Workbook and doing my own self-massage of trigger points (with the help of a variety of massage “tools” that I now own). But this approach seems to have yielded little progress, especially regarding my back pain. (It’s possible that the condition in my left leg and foot is somewhat improved.)

I asked the doc what we could to do to pursue an alternative treatment path. Fortunately, he had some ideas (several of them, actually). One possible approach that emerged was to take small doses of a drug, naltrexone , once a day (at bedtime) for thirty days. Naltrexone is an “anti-narcotic” usually prescribed to manage alcohol and opiate addiction. However, in low doses (3 mg vs. the typical 50 mg), the drug has been found to be advantageous for a variety of ailments. The hypothesis regarding this drug’s biochemical mechanism (magic?) is that it produces an increase in endorphin levels in the body, which positively impact muscle tissue (and myofascial trigger points, in my case). In people with diseases that are partially or largely triggered by a deficiency of endorphins ( CMP and fibromyalgia are thought to be in this category), or are accelerated by a deficiency of endorphins, restoration of the body’s normal production of endorphins is believed to be the major therapeutic action of (low-dose) naltrexone.

Now, I had never heard of this drug prior to two days ago. But, I admit, this theory and approach are fairly attractive: a low dose of a drug purported to have “no side effects” and that does not involve frequent, multiple and painful needles in my body. Further, the success rate of this approach for individuals with my condition is supposedly quite high (the pharmacist said that, in his experience, this approach works “about 90% of the time”).

I took the first dose last night at bedtime, after discovering that “low-dose naltrexone” (LDN) has its own website and listserv on yahoogroups . I have started to do the reading and the research, though it may be several days before I have any “results” of this experiment to talk about.

Stay tuned for further updates on my naltrexone experience...

Here is a mildly disturbing development in my life...

I drove into town to run an errand during the noon hour today. While there, I decided to have lunch at the Subway shop closest to my apartment. As I was at the register to pay for my turkey sandwich and chips, the young man said, “that’ll be $4.70...or do you do the senior discount?” To which I stammered, “ excuse me ? Uh. No .”

Holy craperino, Batman! This is the first time such a thing has happened to me, and it caught me completely off guard. What, I wondered, about my appearance today , merited this promotion to senior status?!?

Yeah, yeah…I know. I’m 59. I’m an AARP member. I have some gray hair. But, geezzzz. He had to SAY IT OUT LOUD?

Now, I hadn’t had a bad day to that point, and the rest of day went mostly ok too. There is just this one little blip that sticks with me.

Senior discount? Moi?

The popular TV show Grey’s Anatomy is filmed in Seattle, and maybe its Pacific Northwest roots are part of the appeal for me. (This season the show made a move to 9:00 p.m. on Thursdays, so it is on ABC an hour before ER airs at 10:00 p.m. on NBC; I tape them both and watch them on the weekend). Aside from its obvious (and frequent) quirkiness, the show has real and touching moments that occasionally tend to unearth some truths about life and relationships.
 
Last Thursday’s Sometimes a Fantasy really caught my attention. Most episodes are filled with several different story lines, with some, not uncommonly, continuing from week-to-week. And the story of Izzie’s loss resumed this time. She had fallen in love with a heart-transplant patient who had asked her to marry him. However, shortly after he popped the question (and after Izzie had made an ethically-questionable call about his care), he died. Izzie’s story was juxtaposed with one about Megan, a young girl who came to the emergency room with multiple injuries. Although she was bruised, beaten, scarred and had stapled a wound on her arm with an office stapler, she claimed to feel no pain. The ultimate diagnosis for her was “chronic insensitivity to pain.” (Who knew there was such a thing!?)

So, he we had: Megan, dramatically physically damaged, who claimed to “feel no pain.” And Izzie, who stood immobilized outside the hospital, unable to motivate herself to return to work, when asked where it hurt, said “everywhere .”

The array of possible human experiences always tends to amaze me. In this dramatization, one person feels immense, debilitating, chronic, paralyzing pain, and the other, none at all.

During the operation on Megan, the surgeon observes that “everybody wants a life without pain. What does it get you? She needs to be on a poster somewhere to remind people that pain’s there for a reason.”

I know, I know. This is a TV show. But the writing this week seemed incredibly good…and provided a degree of wisdom than one typically does not encounter during prime time.

Of course, these observations extend my previous commentaries. You know that I think about pain a lot ; and an episode of a medical drama focusing on the topic is bound to attract my attention and dwell in my thoughts. Six days ago, in an attempt to address my chronic myofascial pain issues (including my long-standing chronic lower-back pain), I allowed a doctor to inject me 19 times with small amounts of Marcaine in my first major attempt at trigger-point injection therapy. Although I experienced some short-term relief that day, by the evening I was back to “normal.” And, as my back pain has been the predominant factor in my existence the last couple weeks, I drove to Eugene to see my chiropractor on Friday.

If “pain’s there for a reason,” I ask, “what is it ?”

I struggle with this question.

I suggested yesterday that the pace I kept leading up to the start of classes was an energy-depleting one. For me, of course, it’s not only the job that tends to wear me down, it’s the entire rest of my life. For example, in addition to commencing the school year this last week, I had two doctor appointments. The anxiety resulting from this schedule contributed to my fatigue, I’m sure.

The first of these appointments was with my urologist. As I’ve aged (I’m now almost done with my fifties), I have had to increasingly struggle with BPH; this is a condition I monitor carefully. Consequently, I have blood drawn for a PSA test every six months to assist in this process and to rule out prostate cancer (as my PSA level continues to slowly rise). About four years ago, my PSA number was of sufficient concern that I underwent a prostate biopsy. The rigors of this every-six-months examination, as well as the ever-present specter of cancer (or, simply, another invasive biopsy), probably are the reasons my blood pressure was up slightly for this appointment. Luckily, my PSA was more-or-less unchanged from last time and there are no obvious indicators, from the physical part of the exam, that I have cancer. This kind of news is always such a relief!

The second appointment of the week was the follow-up to my CMP diagnosis of last month. The blood work that I’d had done came back with an array of acceptable numbers, including my cholesterol and triglycerides. My HDL (“good cholesterol”) result was especially encouraging to me (I must be doing something right!). And my blood pressure at the beginning of this appointment was much better news than a couple days earlier.

At the previous appointment, I had been advised that I should stop the anti-anxiety medication I had been taking (to help with sleeping) if we were going to make progress on the chronic myofascial pain issues. I have since weaned myself from this drug successfully, and am now able, apparently, to pursue a treatment path. The treatment recommended is trigger-point injections, as this physician has been doing such therapy with his patients for about 15 years and reports many stunning successes.

So, I have now started down this road. Typically, he states, about 18 trigger points are injected during a session. I allowed him to do only 4 injections during my appointment (and only after a one-hour talking consultation), however, as I’m not totally convinced, after doing my research, that this is the best route to go. But, I got modest, temporary symptom relief on Friday and I’m going back tomorrow for the next step. We’ll see how this all works out.

I guess the last thing to report (for this entry anyway) about current experiences contributing to my anxiety and fatigue, is the noise element in my life (and the resulting, somewhat-tenuous relationship with my neighbor in this apartment complex). The bass vibes from the stereo keep coming through my living-room wall. The kids keep screaming as they run up and down the stairs. The adults keep slamming their door. And I keep feeling like I need to run away.

After a few weeks now of talking to my neighbor as frequently as once a week, when I handed in my rent check yesterday to the office, I mentioned my uncomfortable living situation to the manager on duty. Unfortunately, I did not get the sympathetic, good-listener ear I was hoping for. I was told, though, that they would give the neighbor a written notice about the complaint. I’m betting that this has happened already, as the reception I received on the stairs this morning was quite a cool one.

For now, though, I’m sure I can live with an unfriendly neighbor as long as she’s a quiet one.
Work, health, pain, doctors, needles, noise, neighbors. My life. And anxiety.

A recent article in Time magazine addresses The Mystery of Pain. (Of course, we’re talking physical pain here, although, I believe, emotional and psychic wounds can lead to just as much distress as physical ailments do.) This piece was of interest to me because physical pain has been an ongoing nemesis in my life…for almost all my life. For the timespan of most of my twenties (about seven and a half years), for example, I experienced daily, often-times debilitating, headaches. And, it was during these years that I began to cope with periodic lower-back pain as well. I ultimately interpreted both of these physical conditions as reactions to the overwhelming stress in my life at the time, namely finding myself in a marriage that was the completely wrong place for me to be. When I left that relationship at about age 30, I was able to turn around the crippling nature of these physical conditions, get myself off the medication (Valium) I was using to cope, and make some progress in the areas of physical health and emotional growth. (The obvious smack-in-the-face exception is the fact that I moved directly from being addicted to Valium to a lifestyle of alcohol use and abuse, and that subsequently took a few more years to overcome.)

There have been some small portions of my life where I have lived relatively head- and back-ache free, but those times seem rather a dim memory. I continue to cope, the best I can, with daily pains in these parts of my body, and succeed pretty well most of the time. They have become, simply, conditions I have learned to live with.

But, I have aged. And I’ve not acquired the ability to get rid of chronic conditions, but, rather, seem to be an unwilling “collector.” I am not one of the people identified in the Time article who has a deteriorating body and is asymptomatic. Nope. When something is “off” with my system, I feel it, often times, it seems, with a higher degree of intensity when compared to others. I have recently written, for example, about my diagnosis of Chronic Myofascial Pain. This is a condition that dominates my awareness in terms of the feelings (or lack thereof) in my lower extremities all-day, every-day. I’ve apparently not yet made significant-enough progress in my learning curve about this condition, given that my attempts at self-treatment have yielded virtually no change. The bottom line is: I live with these chronic pain conditions everyday AND try to be as functional a human being I possibly can at the same time. I find this pretty challenging.

The writer for Time asks “why does the same problem hurt one person and not the next?” Good question! I often wonder this myself. He suggests that we consider three factors: the “pain-inflammation connection;” “neural blockades;” & “depression and hormones.” Although I’m sure that the inflammation connection is a large part of my physical stuff, the relationship of depression to pain, of course, intrigues me. That has to be part of my dynamic as well, given my propensity to perpetually struggle with my emotional health. I’m convinced, in fact, that if I could find the right something (drug? herb? sleep potion?) to help me with chronic depression, then these other ailments would not loom as large for me as they currently do.

The article concludes with the statement that “today pain remains a tantalizing mystery.” (Duh. You think?) For now, we are advised to “cheer up, pop an Advil, keep working, go to the gym, eat something and buy your spouse a present.”

Ohmygod. I certainly feel reassured about handling my pain now. Thanks, Time.