Pain and Meaning - slipped discs and pain scales

It's been six months now since I suffered a 'slipped disc'. The searing initial pain has faded now, replaced by an uncomfortable tugging on my sciatic nerve. One thing I have noticed is that almost everyone I know claims to have had a 'slipped disc' at one time or another.

They mostly tell me this when they are carrying very heavy boxes or running for a bus, balancing on one leg or leaning forward. Sadly, these are all movements that I cannot, and will never be able to, manage. When I enquire about leg numbness and walking problems, I am met by blank stares - their own 'slipped disc' did not endow the weird feeling of body dissociation on them.

So I decided that I would research what, exactly, 'slipped disc' meant. Damage to a disc in the lower back falls into several categories. A bulging disc is where the disc between the vertebrae pokes out and touches the sciatic nerve, causing intermittent pain. A herniated, or prolapsed, disc, is where the jelly in the disc squeezes out and makes a lump between the disc and the sciatic nerve. This causes damage to the sciatic nerve and affects areas of the leg relating to the position of the damaged disc. My herniated disc at L4/L5 (as above) caused numbness of my right lower leg and my right foot. A bulging disc is not the same as a herniated/prolapsed disc.

The pain associated with a herniated disc is severe. However, because the generic name of 'slipped disc' is given to all these disc conditions, it is sometimes interpreted as a twinge to the sciatic nerve, which is more likely to be a bulging disc. So, not only are you in severe pain, but many people are relating your condition as something that is associated with less pain.

This generic terminology comes from generalisation of pain. Whilst we need some kind of generalisation in order to develop medicine, some data sets that tell us that a condition is common to many people and needs attention, this is at odds with the human experience of pain. The individual expression of pain is an important communication tool, an vital part of us telling another person that we are injured. Whilst some pain scaling tools tell us that someone is in pain, a scaling of 1 - 5 does not tell us anything about their experience, how this affects their lives.

The question 'is it hurting?' from a doctor, answered in the affirmative, or even from 1 - 5, elicits a prescription for pain medication; it does not tell him that one morning four months ago I woke up crying at having to endure this for another day, or felt desperately sorry for whoever had to put my socks on for me.

The meaning of pain is not 1 - 5. High or low. Good or bad. Severe or minor. It is woven into our everyday experiences as we try, in a world that is very different from our pain-free world, it makes meaning of the new difficulties faced by our health.

I went back to my doctor for my six month check up yesterday and asked when the pain would go completely. He told me that it wouldn't. He asked me how bad it was, high or low, 1 - 5, and prescribed me painkillers. He said that what I have is a lifelong condition. I nodded and smiled and swallowed back the tears until I got outside the surgery.

He didn't ask me about the difficulty I have walking and how this affects my job, or how I can't bend to lift my baby granddaughter, or how I'm so exhausted after a day at work that I can't visit my family. That's what pain really means.

I've got a set of exercises, the McKenzie Stretches, that a physiotherapist taught me and, for the time being, these are keeping severe pain at bay, along with the TENS machine; I'm feeling a whole lot better as my back heals and I improve my posture and strengthen my core. I actually feel lucky, because at the beginning of this I was told I might not walk again; I'm beginning to smile again now and my life is back on track.

Writing it down has helped, writing all these experiences in a note book that, now, I can put away and hopefully never have to go back to. And in the future, if anyone every asks me how much my 'slipped disc' hurts, I'll give it them to read and hope that, instead of making an assumption based on a medical stereotype, they will understand how I and my life were affected, and what this meant to me.

For my notes on lower back herniated slipped disc please click here

How we understand pain

I recently had a run in with pain as I have injured my back quite badly. Whilst I was in hospital recovering I began to think about all the aspects of communicating pain that were going on around me.

The first question I was asked was: on a scale of one to three, three being childbirth, how much pain are you in? The baseline on this is seriously flawed as I have had three entirely different experiences of childbirth, at three very different levels of pain. It also made me wonder how this question would be applied to men experiencing pain. Here my pain was owned by a scale of one to three for the benefit of statistical assessment with no definition of my own experience.

The second was being eyed by a suspicious nurse who told me that 'I couldn't be in much pain as I hadn't asked for painkillers at six o'clock'. This entirely subjective view on the part of the nurse was working on an assumption and not on my reality. I had not asked for painkillers at six o'clock because I had no buzzer to summon a nurse and could not walk up the ward to ask. Here my pain was owned by the nurse who was assuming based on his own perception.

The third was an account given by another nurse who told me, whilst holding the key to the pharmacy cupboard, that many patients admit themselves to the hospital with fake illness in order to obtain strong painkillers that give them a buzz. This societal problem of addiction is another way of communicating psychological and societal pain. However, it didn't help me as I was really in a lot of pain. My pain was owned here by an objective risk assessment of whether or not I was faking my injury.

In my five day visit to the hospital, no professionals asked me how I was feeling. Several nurses and doctors looked at me and made an assumption based on how I appeared outwardly or how I was holding my body. An MRI scan revealed my injury had caused a herniated disc (see diagram above). No one acknowledged that my pain was my own, and that I could find words to express it myself. By overlaying my pain with other measures that rely on someone else making and assessment, my pain was negated into a construction of something external to my body. This is not a satisfactory situation for someone who is in acute pain, or in any circumstance.

Because I am not someone who will make a fuss, I was discharged with a prescription for paracetamol and ibuprofen, whereas someone else with the same injury as me who cried and complained more was discharged with much stronger painkillers. It seriously worries me to think that in the NHS today it's the person who shouts loudest who gets the best treatment. What happened to an adult, non-hierarchical conversation about how we are feeling? What happened to someone listening to my expression of how I feel instead of form filling and rating my pain for me?

I took my pain home with me, whereas my pain 'outcome form' still lies in the bottom on my hospital file.

For my notes on a lower back herniated slipped disc please click here