‘There is absolutely nothing I can do to help you’ I said.
The patient had lived through 3 months of sciatic pain so severe that she had barely slept in that time – let alone worked, exercised or smiled. If you know back pain and sciatic pain patients you can spot the ones with true sciatic pain before they even finish filling out their forms. People with true sciatica sit differently, talk differently, move differently and are often not even the same colour as regular pain patients. They tend to look slightly grey. All this is because true sciatic nerve pain is severe beyond belief.
For every 50 people who say they have some sciatic pain along with their back pain – only 1 or 2 actually have true sciatic nerve pain – thankfully!!!
This particular lady had true sciatic pain – I could see that from the other end of the waiting room. She had spent 3 months with sciatic pain so bad that she literally felt like there was a reduced hot knife in her hamstring muscle – 24 hours a day. It was true blue neurological pain – caused by a large nerve being compressed. Not only that – she had an MRI scan to prove it – and you didn’t need to have any medical training to see what was the biggest central disc prolapse I have personally seen in 20 years of practice. All this is why I was telling her there was nothing I could do for her. I am not a surgeon.
The lady had met with a surgeon previously – who ordered the MRI and he on reading it clearly instructed her that she must have immediate surgery to decompress the spinal cord. She had the worst case scenario whereby the actual spinal cord itself was being pressed upon by a disc. Not only was her immediate sciatic pain bad – the potential was that she could suffer longer term harm to her spinal cord which her symptoms clearly indicated was under huge pressure. I could not have agreed more with the surgeons assessment – which is why I was telling her I couldn’t help her – and that she should agree to the surgery immediately.
She had sought a second opinion (mine) and it was the same as the surgeons, we both felt strongly that the only possible solution to her sciatic pain was surgery. There was a however a complication that made the situation even more sticky than it might have been.
The lady had seen her husband go through 15 years of severely disabling back pain that he attributed to failed back surgery!!! She lived with someone who felt back surgery had ruined his life – a life that she herself had lived intimately with him. And as you might imagine this had left her with the most extreme fear of spinal surgery imaginable.
This lady, who was apparently in desperate need of spinal surgery for the worst back pain and sciatic pain imaginable – was more scared of the surgery than the life of searing and crippling agony she was currently living. Tricky to say the least! I spent quite some time trying to convince her that while there are always risks with surgery for sciatic pain – she really didn’t have any other choice if she wanted her life back in tact. But she wasn’t interested in what I had to say. She just kept begging me to try some form of treatment because she wasn’t getting sugery.
I sent her away and went home to sleep on it but the following day her answer was the same. So then I slept on it, and by the next morning I had figured out what I sensed was the best way I could serve this poor woman.
My plan was to offer her some safe treatments that wouldn’t aggravate the disc over a few weeks – not for pain relief though – just to prove to her that I couldn’t relieve her sciatic pain in any meaningful way. My hope was that this would act as proof that I couldn’t help her – and she would finally concede that surgery was the only option.
So we started treating her with acupuncture every second day – I felt like a bit of a fraud but I planned to refund her at the end of my sham treatment protocol to ease my guilt about deceiving her. What happened next was completely unplanned however.
When I was examining her and figuring out how to put some acupuncture needles in her back with the minimum risk of aggravating her sciatica I discovered that she had the worst muscle spasm I had ever felt in a lower back. Not surprising really, nor was it surprising that the spasm appeared to centre around her L5 0x disc.
When you have been treating pain for 20 years you can become quite compulsive about trying to ease whatever you can ease – it becomes a habit to try and ‘tidy up’ anything you think you can ‘tidy up’ – like a professional cleaner who reflexively does dishes at their friends house perhaps. So once I found this muscle spasm I thought that I might as well try and ease it off a bit for her – it wouldn’t effect the leg pain but at least she would have a bit of blood flow in her spinal tissues. No bad thing when your body is constantly trying to heal an uhealable wound UI thought.
So I used some fairly long acupuncture needles and went as deep into the muscles around her L5 0x disc as I knew I could with stirring it up – which is actually pretty deep fyi – there is a lot off muscle in the lower back. And as part of my compulsion to help I thought while I was there I would put double the normal amount of needles i normally would – there was double the normal amount of spasm after all.
And this is where things got weird.
After my first attempt at relieving the spasm she came back the next morning and said she has slept better than she had done in months because the sciatic pain was a little less. I figured this was almost certainly a wisp of placebo, and there was no harm in her getting a little sleep – she would need whatever rest she could get with surgery on the horizon. But when I felt her back the spasm was a little less and she was moving better. So feeling happy for her to have slept better on the second day (again compulsively) I put double the amount of needles in her lower back – so she had quadruple the normal number of needles I would normally put in the lower back of a patient. And this is where things got weirder.
On day 3 she came back and her sciatic pain was 90% gone. She had slept like a baby and walked into my office with a huge smile on her face – a face which had gone from greyish to a healthy happy pink. There was however another part of her body which had changed colour too – her lower back. She showed me her lumbar spine and there was what looked like a huge bruise covering her ENTIRE lower back – her whole lower back was bluish green. Much of the muscle spasm was gone too and she was moving normally.
After another week passed all of her back pain and sciatic pain was gone and so was the ‘bruising’ on her lower back. She felt completely normal. Fast forward a year and she sent me a message from Africa – she had just climbed Mount Kilimanjaro in the middle of a round the world holiday and was living a completely pain free and normal life. Fast forward 6 years and I sat down and had a coffee with her – she was still completely pain free and had persisted with the core exercises I had taught her to maintain stability in her lower back.
You might say she was foolish to have refused surgery knowing that disc was no doubt still damaged. But you’d be overlooking the irrefutable fact that literally millions of people have silent disc prolapses that never cause them any problems. You might think I was irresponsible for opening a door that led her away from surgery – but that was the opposite of what I was trying to do – I resolved her pain completely by accident.
In terms of explaining what might seem a little miraculous I have what I believe is a pretty solid theory about what actually happened inside her lower back. She absolutely did have a disc prolapse (and probably still does) – but the real cause of the nerve pressure was a coffee mug worth of swelling (like a big fat sprained ankle perhaps) right around that disc. Somehow the needles triggered a release of the swelling and in an instant she became one of the millions of human beings living with a disc prolapse and no pain. The release of that swelling was so great that it showed up looking like a giant bruise that spread through the tissues of her entire lower back region.
For my part I already knew disc patients could live with no pain – it just never occurred to me that someone with severe sciatic pain and a disc prolapse as bad as hers could live without pain. I also believe that the core exercises helped bind the area and have helped prevent further damage occurring. We’ll probably never know for sure though – because she has refused to go near a hospital for her back since – even for a scan. Which is ultimately her choice.
Does it seem like an improbable event to you?
Perhaps this whole scenario isn’t as surprising and improbable as we might think… after all its not as if we know much about the science of back pain and sciatic pain yet… not in the same way understand dentistry for example.
Did you know that dental pain has not always been caused by tooth decay? It used to be caused by worms that burrow into your teeth, at least that’s what we thought up into the 1600’s anyway: and it makes a little more sense than you might think.
The little round holes in ships and furniture are made by worms. And it’s not as if we ever see those little critters doing their thing. We simply assumed that a worm wiggled into your mouth while you slept, and burrowed into the enamel.
If you know what worms do for a living, the hole in the tooth looks like a smoking gun. Then when you pull a tooth, there is a dangly little worm like structure (the root), seemingly the culprit!!
It seems a little silly to assume that the root of your tooth is a worm that burrowed in there, if you understand neurology and microbiology the way you do. But before the microscope we had to figure out things like tooth pain using ‘common sense’.
The worm theory is far more commonsensical than the actual ultra-weird truth about tooth decay. Hundreds of billions of tiny life forms clinging to the surface of your teeth, so small that even in those numbers they are completely invisible. Feed them too much sugar then their digestive juices melt your enamel? Compared to that bizarre fact of life, surely the worm was a perfectly sane and understandable theory?
So perhaps understandably, the myth of dental worms was a popular one for a long time. Theories on and treatments for tooth worms spanned many cultures and eras. It would appear trying to smoke the little monsters out was a popular strategy, as was tooth extraction.
Sometimes we are incredulous about an event because we have a genuinely deep knowledge base and the event was truly improbable/rare/miraculous. Other times we are incredulous simply because we just didn’t realise that it was possible -or simply because we had a lack of awareness and experience of that part of reality.
You may have a clear explanation for why my crazy sciatic pain story seems improbable. But where does your explanation come from? It’s not likely to be based on meaningful first hand knowledge of putting large numbers of very long needles into the lumbar spines. And it is just as unlikely that anyone you know, or have ever known has tried out that method with a group of ‘disc patients’.
So what specific knowledge base are you drawing from when we deem it an unlikely event? Maybe you simply assume if that type of thing worked then doctors and surgeons would be advertising it? If so I would definitely advise you against assuming your doctors know about every possibility worth considering… especially about pain.
I would argue that both you and I would tend to be a little incredulous about that lady’s recovery because we are ‘so knowledgeable about pain’. We are incredulous because we know very little about pain… yup even me the supposed expert.
If we went back to the 1600’s and told them that tooth pain wasn’t caused by worms what do you think they would have said? They has seen those worms with their own eyes, they believed in them every bit as much as we believe in injured discs compressing nerves.
You live in a world that understands the gases in distant stars better than it does many kinds of pain. Almost everything you’ve been told about your pain is incomplete at best!
Who Wrote This Blog?
The truth is, I am just someone who’s seen a lot of pain. Thanks to an army of very trusting people who I have had the honour and privilege to assist. And yet my take on pain is just one tiny star in a literal milky way of possible perspectives on pain. Naturally though, I believe that my little pin prick of light is a fraction brighter than many. If I didn’t, why would I go to the trouble of writing about it?
If I am not deluded, and my perspective on pain does in fact shine a little brighter than some. It will only be because it drew light from many other sources over a long period of time; and condensed them into something useful.
It kills me to admit this, but the truth is there are many things in life I’m unusually bad at.
All manly made sports that involve a ball, elementary DIY tasks, elemental mathematics – being vulnerable – essential IT processes, remembering to buy light bulbs – small talk – keeping on top of paperwork. Just a few examples, from the list of lifeskills my ego would rather I was good at. In many of life’s arenas I’m little more than a running joke amongst those who know me best.
Am I bad at these things just because I believe I’m bad at them? I couldn’t say. Either way, as I type this now I do objectively suck at each of them, and many other things besides.
So as you can see, I’m more than willing to consume my spiritually nutritious humble pie when required. But I can also own up to the few things I am good at.
I do not suck at making roast potatoes – I am good at drawing – I am great at looking after animals – and I definitely don’t suck at helping people out of stubborn pain. Over a long period of time I believe I have been able to consistently demonstrate that I’m unusually good at all of the above. There is a solitary valid reason why it’s worth me talking myself up here.
The fact that I am honest about my limitations and realistic about the fact I am good at treating pain means I may be able to help you. I have helped a tonne of people feel better, move better; and stay that way – so there’s a meaningful chance that I can help you in some way too.
I’ve spent 20 years ‘in the trenches’ treating people with really stubborn pain. I have also spent 25 years reading obsessively about pain and wellbeing. I literally haven’t read a single fiction title in 25 years. I have meditated and read on this pain thing for a long time and it has beaten me into a state of open mindedness.
My first big professional realisation about pain after escaping 6 years of college and university was that I didn’t know much about it. I remember being really despondent about that at the time. I’d expected to walk away from my education feeling like a boss, not an absolute rookie.
I had worked my arse off too. Got through 6 years of higher learning, passed with near enough top marks – and still I came out up to my neck in uncertainty about the true nature of pain. I suspect it was that harsh realisation – after all that effort – that shocked me into a permanenently open minded state regarding pain.
Either way, it wasn’t a conscious decision to play the last 20 years open mindedly. But looking back I’m so grateful I did. Because, by good fortune, it turns out open mindedness is a major asset when you’re trying to navigate and influence highly complex systems – like the human body.
Being open minded means I have always anticipated deeper understandings of the pain I see impact so many lives… and possibly as a result, they keep coming!
Fast forward 20 years of hard graft and x thousand successful missions later – I am still open to new learnings.
So… if I’m still open to new perspectives after all that, then you should be open too, even to ideas that surprise you. Cautiously open though of course!!