After herniating the same disc twice, in addition to at least 3 severe lumbar and 1 severe thoracic muscle strains, I've learned a few things about back pain. I'm not a doctor, just a patient, but wanted to pass these thoughts and ideas along:
Immediately Upon Sensing that Something Has Gone Wrong
- Get on your back with your feet up on something--the floor with your feet on a chair, the couch with your feet over the arm, the bed with pillows. Best to get to somewhere you can stay for awhile, even it means crawling on all fours in agony. Second best position: almost fetal, if you can roll over.
- Breathe, slowly. In and out. Don't try to think much. Just breathe.
- Ice it. 15 minutes at a time, at least once an hour. For the first 24 hours.
- Ibuprofen. At least 3. Gel caps are apparently fastest but take whatever you have. I couldn't say how often, but 2-3 times a day (like every 6-8 hours).
- Call your GP.
- Wait. This is the hard part. Distract yourself with tv, the computer, the phone. Don't really think about moving at all for hours; try not to do anything the first 24. Yes, that means using the bathroom is a pain, especially for women (I've never wanted a penis so badly). Think adult diapers. Because you won't be able to walk. Also, wear clothing that is least restrictive--you don't need to fight fabric--I prefer just a big t-shirt.
- It is tempting to want to go to the ER because it hurts so much and you can't move. If you have numbness or tingling in your legs or can't control your bodily functions, call 911. Otherwise, try to stay home. The ER tends to give you morphine and send you home, after an agonizingly long wait. The morphine is good for awhile but doesn't a) treat the problem or b). last long enough. And it's pretty miserable to wait at the ER.
The First Few Days
- After the first 24 hours, think of applying heat via 8-hour thermal heat pad or the like.
- Try to get up a few minutes every several hours. Have someone spot you. It's going to hurt and be scary. Stop if it is too much.
- If you can get one, wear some kind of lumbar brace for those short walking forays. Medical supply stores sell them. Medical supply stores are your new best friend.
- Contact a specialist. You have two options: an orthopedist is likely to operate; a physiatrist is a pain specialist who does not operate. Apparently, only 10% of back injuries require surgery, but non-surgical recovery is slow (6 months to a year, though not all in bed) and not everyone has that luxury. My physiatrist usually prescribes Valium, Voltaren, fish oil, and lidocaine-steroid trigger shots at the injury spot as soon as I can get in the office. He also ordered a much stiffer lumbar brace.
- To get to the doctor, lie down on your side in the backseat of the car, with a pillow between your legs. Best to wear that lumbar brace because it's gonna be bouncy. And take the ibuprofen.
- Line up your support network. Do you have family nearby? Friends who can help? Church or other organization to assist? What do you need most--childcare? meals? rides? errands? Most people will kindly offer "anything you need." Be prepared to have specific requests so they know how they can help. Sometimes, just having people stop by is as important as anything else to my own recovery. There are also websites to coordinate meals or a variety of caregiving (see NYTimes article).
- Magnesium citrate is a gentler way to jump start or keep your system regular.
- Making "life in a bed" easier: a bolster or wedge for your legs because pillows can be wobbly and unsupportive (from medical supply stores or online); I keep a box on my bed with remote controls, books/magazines, my phone, snacks, a bottle of water, my laptop, and paper and pen so I can find everything easily; baby wipes are good for all manner of things from cleaning up after snack to feeling fresh between showers; now I have a medical rail on the bed to help me pull myself up or to help me roll over; there is also an "oh shit" bar in the shower and next to the toilets for the same reason.
- Follow your specialist's orders re: medicine, heat/cold, rest, and exercise/therapy.
- The psychological battle is now the harder part, as you fear reinjuring your back, self-censor your activities unnecessarily because of the fear, mourn your loss of mobility/independence/strength, become isolated with the cancellation of your usual activities, play "what if?" or "how?". I recommend Mindfulness-Based Stress Reduction (I use the CD and have a book/workbook, would love to take the course sometime) and meditation, both of which acknowledge the present and the pain but provide a way to come to terms with it.
- An up-side is that you quit taking little things like walking, showering, the restroom, etc for granted, at least for awhile. And of course, you appreciate the bigger ones, like family and friends, medical care and insurance. It's definitely a count-your-blessings kind of experience.
- Pay attention to your body's clues and rest if the area becomes too inflamed or tight. Contact your doctor.
- For safety's sake, I always have a phone on me, even when my back is fine. But I want to know that if it goes out, I can reach help immediately.
- And strangest of all, it gets easier each time, I think.