Friday, January 22, 2016

A new pain

Latest pain episode confirms all my biases about treating pain, in myself at least...
Complaint: Dull back pain, inter-scapular, left side, some at lateral border of scapula. Sometimes the lateral pain is worse than the medial one.

Onset: Started about five days ago, upon waking after having fallen asleep in recliner.

Contributing factors: 

1. Long (hideously long) hours at the computer (bio), stewing and stressing over the writing project, for months now, feeling more by myself with the stress of all that than I have felt alone about anything since forever, probably.. (psychosocial).

2. Falling asleep in recliner while watching whatever is on TV at 11pm in my time zone (these days, Colbert) is normal, has been for years.
3. No mechanism of injury. When I woke up, deciding to go to bed, it had appeared/was there.
Nature of pain:
I could fall asleep OK on either side, but it would come back and wake me up. It wouldn't let me sleep on my back. If I got up and moved about, or sat and went online for awhile, it would go entirely away. Full range, no pain on movement, so, obviously not a "deep" nerve tunnel syndrome..
Things I tried:
Floor work: This made the rest of me feel pretty good, but the pain returned as usual, at night, forcing me to get up.
Different positions? No luck there. I'm very inventive with sleep positions and pillows, but no joy. Bear in mind I could go to sleep without pain, but it would visit and be the thing that would wake me up.
It felt naggy and dull and deep, and bad enough to wake me... But it would go away easily by getting up and distracting myself.
Thing that finally "worked":
After four nights of this I got out the stretchy tape yesterday and managed to apply two strips to myself, vertically, stretched upward, one along the lateral border of the scap and one along the medial border (see diagram).
The naggy pain went away instantly. (Yay!)
I wasn't going to be convinced, though, unless I got good sleep. Last night, I slept through the whole night without any pain, with the tape on. Not that I didn't wake up occasionally, because I do anyway, but the back felt good, nice, warm, tingly, no matter which position I was in, or went in. Feels good to have had almost 24 hours without that annoying pain.
So, yay!
Confirmation bias: it must have been only cutaneous rami hurting me/my brain. Yay for peripheral sensory neuron opioids secretion (and probably some in the brain too). Tape will stay on until those rami have readapted themselves, and receptors have turned over.
Even though pain at night is usually red flaggy, I didn't worry myself or run off to become medicalized, as this pain did not feel sinister or intractable; Making more effort (getting up, raising my blood pressure, moving around) made it better, not worse.The fact that tape helped so much last night reassures me that it's no big deal (so far anyway..). I'll see what happens tonight: if I get two good nights in a row, my bias will enjoy more confirmation. Self-management, baby, self-management. My sedentary lifestyle may well kill me eventually, no doubt, but so far, so good; my pains in life have all been merely annoying body wall nerve being cranky, not visceral/referred. I've still got every bit I was born with, and most of those seem to still work OK. I will increase my activity level slightly (do more floor work, play more with my barbells, and try to avoid becoming diabetic (I'm 65 and something will kill me eventually) (but did I mention my mother is 92, still with all her bits, and still in good health despite having never done any actual exercise her whole life?) The last thing I want to do is to put myself in the hands of those who would want to perform a scapulectomy or something and try to talk me into that. I live in a pretty orthopaedic-surgery-happy province these days. The other thing, they might want to stent every blood vessel just in case. They like doing that around here too.
[Added Jan 23: I wish I could report that I had two nights painfree in a row, but my confirmation bias
can no longer be supported, as alas, the pain returned and woke me up as I lay on that side. The good news is, it did not come back medially, only laterally, and furthermore, I was able to sleep OK on the other side with a great fat pillow behind me, and my arm back on top of it. My new hypothesis is, the pain medially that seems gone for good was cutaneous dorsal rami kvetching about something that bugged them, in particular, and the lateral cranky bit is possibly a) coming from a deeper tunnel syndrome, maybe, like lower branch of subscapular nerve, or b) posterior branch of one of the lateral cutaneous nerves where it emerges, right there at the side of the trunk, then splits at a horrible angle, kvetching about something that bugs it in particular, but differently. I can reach it well enough but can't quite treat it the way it needs. I'll have to figure out a plan B this weekend. If all else fails, I can go next week to see a local massage therapist who came all the way out to Vancouver last fall to a workshop I taught.
I managed to get both pieces of tape off by myself, so yay about that.] 

Added Jan 25: Update: The lateral scapular pain disappeared on its own. I was able to sleep on either side, totally comfortably. I still had pain medially if I tried to sleep on my back. What nerve is in there? Why, the dorsal scapular nerve, of course.. It's too deep to be hacked with mere tape. The acute crankiness of the cutaneous nerves had been well beat back by the tape, it felt like.. But there was still a very small, dull discomfort medially. All righty then. It's easy to feel dorsal scapular nerve being cranky on other people, and treat it: I had to figure out how to confirm it was "the one," then try to hack that one on myself. Easier said than done. The test was to press the medial interscap. area into a door jam. Yup, it was tender compared to the other side. Now what? I usually treat it on others by having them lie prone, then taking the arm gently into full shoulder elevation (to widen and shorten the neural tunnel), then rotate it externally (to twizzle the nerve inside its tunnel). Much harder to treat on myself. The attached cartoon shows how I managed. Happy to report, no pain of any kind all night long in any position. Yay, back to normal. At least for now. Confirmation bias, back up to 100%.

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Thursday, January 07, 2016

Slowly, steady..

I think I finally figured out how to structure the manual, which to me is how to climb up out of this chasm, which feels like such a relief.

I will put all the heavily referenced deconstruction and reconstruction at the end instead of at the beginning. 

At the beginning I'll put all the 'hey-ho, here's the nervous system, isn't it lovely? treat it first' stories, 'here is the way DNM is different from other stuff' (at least 7 different ways), 'here are at least 3 important treatment concepts'; then, in the middle, bam - here are the treatment suggestions, all visual; and finally, at the end, all the heavy plodding argumentation. It isn't that it isn't important, it is. It isn't that it doesn't need to be in there, it does. It's just that it's still such a plod, no matter how I try to slice it or make it interesting and enticing.

Human cognition, especially in manual therapists, it seems, and definitely in me, works best when motivated by learning how to do, and then doing, something useful. There will be many others, however, I suspect, who won't be interested unless they can read the argumentation first. So for any who need it, it'll be there and they will be directed to it. It's bedrock. Under the surface stuff. In it's rightful place, under all the topsoil. To be dug straight down to, or to end up at eventually, after playing with the stuff at the front of the book.