SaveYourself.ca •Sensible advice for aches, pains & injuries
 

“This Appointment Was Supposed To Change Everything”

Health care and hope for chronic pain patients

850 words, published 2007
by Paul Ingraham, Vancouver, Canada

Today’s short article is emotional, not factual or scientific.

The Post Secret project is an ongoing community art project where people mail in their secrets anonymously on one side of a homemade postcard. It’s a mish-mash of arty and witty non sequiturs offering odd little glimpses into people’s lives. Today’s batch included this one:

Postcard with the text “This appointment was supposed to change everything. It hasn’t …” superimposed over a calendar with a date circled.

Postcard with the text “This appointment was supposed to change everything. It hasn’t …” superimposed over a calendar with a date circled.

Postcard with the text “This appointment was supposed to change everything. It hasn’t …” superimposed over a calendar with a date circled.

Postcard with the text “This appointment was supposed to change everything. It hasn’t …” superimposed over a calendar with a date circled.

I can’t quite read the appointment text. For all I know, it was an appointment for a tattoo consultation or to apply for a mortgage. But in my mind, it must have been some kind of medical appointment for a chronic pain problem.

I’ve seen it so often: people with pain that just won’t let up, people who have been through the wringer, people who feel like they’ve tried everything, people who nurse hope along like a sick little plant that never dies but never thrives. People like that make appointments with people like me, and they do it because they think maybe this appointment will change everything.

And sometimes it does.

It must have been some kind of medical appointment for a chronic pain problem.

Many of these people have truly desperate cases, pain problems that may never be solved … while many of the remainder are often quite treatable despite the fact that they have not yet received good care, and not for lack of trying. They are more the victims of doctorly and therapist ignorance than anything else. It’s extremely common, for instance, for people to go through several kinds of therapy for unexplained pain without relief — only to finally discover that it’s “just” myofascial pain syndrome, arguably the world’s most medically under-rated health problem. Once this “mystery” is solved, relief is close at hand.

Daft misdiagnosis is so common in health care that there’s a name for it: “serial” misdiagnosis. Incredibly, people may even go to several different versions of the right kind of therapist, and still fail to get a sensible diagnosis or relief.

A truly shocking amount of explainable, treatable pain goes unexplained and untreated due to ordinary medical ignorance of pain and injury care. In fact, so much of it goes untreated that an unlucky patient can get the perfectly reasonable impression that their problem is exotic, when the truth is more boring: that health care is in many ways just a primitive and awkward business, especially musculoskeletal health care

As any honest one will tell you, doctors and therapists of all kinds aren’t just imperfect, we’re hopelessly inadequate. None of us know more than a fraction of what is known, and what is known is a fraction of what there is to know: scientific knowledge of common pain problems and their solutions is embarassingly shallow (consider how baffled we are by the results of this famous study of knee surgery, or how obsessed we are with a common way of thinking about pain problems that is full of logical holes). And what little we think we do know we can’t agree on — every patient with chronic pain has witnessed the battle of the experts.

scientific knowledge of common pain problems and their solutions is embarrassingly shallow

And that’s without even mentioning the common pseudoscientific practices that are rampant in alternative health care, including (sigh) my own profession of massage therapy.

No wonder people are often disappointed with the appointment that “was supposed to change everything.”

I want to reach through the computer screen to the person who wrote that and tell him or please do not give up.

If you’re in pain, keep making appointments with new health care professionals. Effective care consists of magical combination of so many different technical and human factors that you could see 1000 therapists in a row and the 1001st could still be completely different, better for your case, your problem.

Keep shopping. Choose the therapist, not the therapy. Don’t be hypnotized by the battle of the experts. Understand that quackery and snake oil are alive and well in the world today, and don’t waste your time with the kooks. Keep studying and learning about all the possible ways that you can hurt, especially “sneaky” pain problems like myofascial pain syndrome (trigger points) that are underdiagnosed in our health care system or routinely treated ineffectively by “qualified” health care professionals.

Don’t give up, keep shopping. No one has ever truly “tried everything”!

Further Reading

There are many kinds of chronic pain. However the vast majority of cases are significantly complicated by trigger points (muscle knots), if not caused by them outright. SaveYourself.ca offers an advanced trigger point tutorial which is devoted to the idea that you have never “tried everything.” I’m confident no one has ever read the tutorial without discovering the least a few new ideas about how to take care of their own pain.

More trigger point information! Now with science!

There’s a lot of junky, flaky information out there about trigger points. The SaveYourself.ca trigger point tutorial offers advanced troubleshooting, resting on a bedrock of (clearly explained) science. Interesting and entertaining, constantly updated and upgraded. Ideal for patients who have failed to get relief from basic tactics, or for beginners who want to get off on the right foot — this tutorial is the ultimate guide to trigger point self-treatment. Better yet, it’s available free with the purchase of some other tutorials (low back, neck, torn muscle, or iliotibial pain). Add it to your shopping cart now ($19.95) or read the first few sections for free!