Today is the beginning of a new experiment. Last night, I went to a party and stayed out very late. I haven’t stayed out that late in nearly a year; I’m not even sure what I was thinking when I decided to do it. I was tired early in the evening, as I always am, but I ate a little something and rallied; I even had enough energy to dress up in a strapless top and a skirt, with some smoky eye make-up, to boot. Around 10 PM, I ventured out, availed myself of my friend’s driveway as a make-shift handicap parking space (certainly, I’d be leaving long before anyone else did), and walked in to a house darkened and teeming with friendly, happy people. I myself was giddy the whole time I was there. I could not shake the feeling that I was doing something very naughty, like sneaking out after curfew. It was more fun than I could remember having in a long time.
Now, a little ill-advised fun is all well and good, but I didn’t leave until almost 1 AM, and didn’t get to bed until after 2. This is problematic, as I’m almost always awake by 6. My body kindly allowed me to sleep until 6:45, but after that, all I could do was doze, more or less, until around 9 when the stiffness and discomfort finally forced me up and around.
That is not enough sleep for me when I’m healthy, and it is definitely not enough sleep for me in my current state of disrepair. Still, I don’t generally feel the psychological effects of too little sleep the very next day, unless you count a little spaciness, a natural state of being for me nowadays thanks to the meds. It’s not until the second day that the fatigue crashes down and a stifling crankiness sets in, and my fuse and my tolerance for fellow humans shrinks to about zero. Today, mood-wise, I’m fine. Tomorrow… well, luckily, it isn’t tomorrow yet.
The physical effects of not enough rest, however, don’t give any such twenty-four hour grace period. I am, as is to be expected, in an impressive amount of pain this morning. But instead of remaining as prone as possible, as I normally would, I’m going to try to go about my business anyway.
(Yes, I am, Momma Ape. Really. Stop laughing.)
Lying around all day is sickeningly depressing. It makes me feel worse, not better. I hate it, and I hate myself while I’m doing it. I want to see what happens if I do some light chores instead. Maybe even bake a batch of cookies. Limit my pain concessions to a few thirty minute sessions of getting horizontal with an ice gel.
(Erm, that last sentence didn’t come out right. But it’s amusing so I’m going to leave it that way.)
I’m down to about 2/3 my normal tramadol dosage. I want to keep going down, but my past experiments in that vein have not gone well, so I’m suppressing the impulse to cut out more pills. After all, it’s only been a few days; I should wait at least a few weeks before taking the next step down. But I’m itching to get on with it. I want to see how much pain I can handle and still function.
Of course, when I write it that way, it sounds like a pretty stupid thing to do. In fact, if it were anyone but me saying this, I’d probably make a pretty firm assertion to that effect. But it is me, and I’ve been in a lot of pain for a long time. Me and pain, we’re intimate pals. In fact, pain has been doing most of my thinking and nearly all of my planning for as long as this has been going on, and to be perfectly frank, I’m getting a little tired of it. No, I’m getting a lot tired of it. So I’m kicking it out of the driver’s seat for a while. I may regret that choice later, but for now, I want to see what happens if I just ignore it and take the wheel myself.
And what is the worst that could happen, anyway? A pain level of 6, 7, or even 8? So what? It’s not like that’s anything new. It’s not all bunnies and rainbows, to be sure, but it hasn’t killed me yet. It also hasn’t made my condition – whatever it is – any worse, nor has the subsequent rest made it any better. As far as my numerous tests and scans have shown, there is no physical or physiological problem with me or my shoulder that can be worsened or improved by anything I do. Or at least, nothing that can be seen with the current level of medical technology.
Nearly all of the time, pain means damage. That’s why it exists. It is there to inform us that some part of us has been hurt and needs attending to. Pain serves a vital function; we vertebrates would have died out long ago without it. It induces a whole host of adaptive responses designed to address the source and/or result of that damage that have remained largely unchanged for hundreds of thousands of years, if not millions. Evolution and natural selection [usually] don’t keep stuff around for that long unless it works.
Sometimes, it helps us get away from the source of the damage; often before we have realized that we have been hurt, as in the automatic response that causes one to yank one’s hand away from a hot stove. Other times, it will recruit muscles to tense up and guard the area to prevent making it worse, as in a sprained ankle or a broken arm. It can be intense, crowding out all reasonable thought, or mild, an annoying reminder that something isn’t right but isn’t a major issue. It can be physical or psychological, and it is often both.
But the pain signaling apparatus in my shoulder appears to have gone haywire. Whatever small amount of tendon damage caused the cascade that resulted in the nerve compression, it spiraled into a pain cycle that went on unabated for five months, until my doctors had no choice but to completely disable the nerve in question. Only then did the muscles stand down. Only then could the physical therapy start to work. Only then could I start eating, sleeping, and breathing normally again. Like a computer trapped in a blue-screen cycle of death, the only solution was to unplug it and reboot.
This isn’t to say that nothing is wrong with my shoulder. There is, apparently, some small amount of damage to my labral tendon resulting in my particular injury presentation. But that’s all it is: a small amount of damage. It isn’t enough to warrant the searing, all-encompassing, does-your-pain-chart-go-to-eleven kind of pain that characterized those first awful weeks and months.
Moreover, the MRI that showed that small tear was taken several months after the initial pain onset, which means that in those intervening months, whatever I did or didn’t do didn’t affect it.
So from what I can tell, the pain in my shoulder is only tangentially related to the actual damage therein. The nerve ablation has enabled the muscles around the offending nerve to stop guarding and relax, and the anti-inflammatories and cortisone injections have freed up some more room for it as it has grown back in. It’s still making quite a fuss, no doubt about it, but it’s no longer screaming all the way to 11.
And if that’s the case – that my pain is not directly connected to my injury – why bother paying attention to it at all? That nerve has been crying wolf for months and months, but no ravenous lupines have been sighted, and the village has retained its full complement of pigs, sheep, chickens, and annoying children. I think it’s time to put it the pain in time out; see how it likes sitting in a chair at the back of the room by itself for a while.
Rest assured, I’m not going to assume that I’m just fine now and act as such. There may very well be something that does need fixing in my shoulder. Just because no-one has been able to find it doesn’t mean it isn’t there; absence of evidence is not evidence of absence. One of the reasons I’m even able to consider reducing pain medicine is because I have learned how to limit my activities and give myself enough time to recuperate between them. But I can’t keep making myself crazy worrying about whether or not my few remaining physical tasks are causing more invisible damage under my scapula. Whatever is wrong with me may not have gotten any better, but it also hasn’t gotten any worse.
Of course, I probably won’t be in such a calm and resilient frame of mind when the fatigue from last night’s sleep deprivation kicks
my ass in tomorrow. But it’s so rare that I can write a post that doesn’t make Momma Ape want to camp out in my apartment to keep an eye on me that I really wanted to get this one written down and published before the next storm rolled in.
So for today, I will feel the pain, but I won’t follow it. It’s just going to have to get along without me. I’m going to go and enjoy this space.
Conceptually… if the pain could be resolved by neurologic means, how much ability would that restore? IIRC the previous ablation only got you down to a 4, so I’m wondering how much other damage remains.
While pain nerves and muscle-control nerves are not always the same thing, in this case, it is unlikely that a procedure that would ensure resection of the nerve and no re-growth would be compatible with retaining full muscular function. So at this point, it’s more of a wait-and-see kind of thing. If the pain spikes again, then it will be time to revisit nerve treatment options.