I have learned a lot about recovering from depression by studying methods for dealing with chronic pain. Now I have had a chance to turn this around. How can my skills in dealing with depression help me manage post-operative pain? Unfortunately, I have had more time than I had hoped to find out.
As planned, I had major surgery on July 5th for correcting problems caused by lumbar stenosis and degenerative disc disease. I’m closing out a month of recovery from the effects of the operation itself, and it has been a slow and painful process.
My surgeon said he had rarely seen so much scarring in a spine that had never before been operated on. I was warned to expect a painful period of recovery, and painful it has been. That’s hardly surprising. The surgery required an incision of about six inches and involved considerable knocking about of bone and muscle. Small bones called laminae were removed from three vertebrae, a damaged disc was cut from another and a fusion “cage” of titanium was installed to hold two out-of-line vertebrae in place.
The whole area of the incision has been healing beautifully, but there has been a lot of sharp, stabbing pain and deep aching as the back muscles slowly mend themselves. I had to remain flat on my back for the first five days after surgery as the most sensitive areas began to restore themselves. The original pain caused by pinched nerves is gone, but post-operative pain has been quite enough to deal with.
And that brings me to the helpfulness of depression management lessons in handling the pure, nasty physical pain of a healing back. Treating pain begins with the use of medication designed to stamp out the hurt, but, like many depression medications, they are strangely ineffective. A major ingredient is oxycodone, an opioid narcotic that can take the edge off the worst pain but also produces bad side effects. It can scramble your brain, freeze your bowels, parch your throat and disrupt your sleep.
(A World of Hurt: Fixing Pain Medicine’s Biggest Mistake (Kindle Single) is a recent New York Times ebook that explores the controversies over the use of opioid pain relievers. There are many disturbing parallels to the fights over the use of antidepressants.)
I have been finding that when the worst pain hits, unpredictably and suddenly, the best response is one I learned to use when sinking into depression. Instead of fighting it and trying to turn it off, I could talk myself into facing the intense hurt of the moment and achieve a kind of relaxation that began to make the pain much more bearable. I think that’s because part of the pain is the anxiety and tension that seize me as soon as I feel the first jolt. The stress and tightness of my body and mind seem to be a big part of physical pain. To achieve even a small degree of awareness, acceptance and a willingness to explore what the pain is all about restores a sense of self-mastery that is wonderfully calming.
A few complications have added to the slow pace of healing. The surgeon had spelled out in the consent form the most common problems associated with this operation in particular and with all lengthy operations under general anesthetic. I’ve had to deal with two of them: a slight tear in the sac that contains the spinal fluid, called the dura, and a blood clot that developed during the immobility and position of my legs during the operation and the flat-on-my-back posture I had to hold for five days following surgery.
The tear in the dura seems to have occurred as a result of a reflex nerve response and the generally scarred condition of my spine. A separate drain was installed to monitor the condition of fluid from the tear following the operation. There was no infection and none of the symptoms that are typical of this problem – primarily “pressure” headaches. The tear healed well and is not an ongoing problem.
The blood clot showed up through excessive swelling of the feet and lower legs. An ultrasound test revealed the location of the small clot under the right knee. To gradually dissolve the clot, I take blood thinners and get regular blood tests to ensure I’m maintaining the ideal balance of clotting and thinning factors. This treatment is going well, but the swelling takes a long time to go down and adds another level of discomfort I could just as easily do without.
Despite all this, I feel I have turned a corner this week in regaining physical strength and balance and have started cutting back on the pain relievers. I am still using a walker to get around, but need it only as a guide rather than a crutch that bears my weight. It’s amazing how quickly the dozens of little muscles involved in walking and keeping you upright lose their strength after a time of immobility. I’m now getting the wonderful feeling of being able to walk on my own again and gathering more strength every day.
The most difficult moments are those when the shadows of depression return. I feel down about the limits of my physical and mental abilities and recognize old tendencies to disparage myself. Fortunately, those are brief spells that I can readily handle.
Perhaps the most powerful part of healing is the incredible love and support of my family. My wife and sons and their great partners are always right there, helping in any way they can. Resilience and recovery need the ongoing support of such loving presence, I’m convinced. Sometimes, a bit of illness and hurt can bring home the great treasure of these relationships.
[Please Note: Though I am making steady progress, the pace of recovery is still slow, and so I've decided to put off resumption of the weekly newsletter for another few weeks. I won't try to set a date but will keep you posted on how things are going.]