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Monday, October 26, 2015

Transverse Myelitis and Chest Pain

I have been reflecting on the issue of chest pain since being in contact with a number of Transverse Myelitis support groups.
I have a chronic recurrent pain in my chest. It has been there for 6 years since my TM began. It starts at about level T7 in my thoracic spine, and travels down at an angle to the right, in between two ribs, and round to the front of my chest where (peculiarly) I have a patch of numbness where the ribs join the sternum. The numbness is there all the time. The pain comes and goes. When it is there, it is stinging, seems to be more at the end of a breath or at the beginning of a breath, and seems to affect some of the muscles of my chest, which from time to time go into spasm. It can be just niggling, irritating. At other times it it is sharp, insistent, and takes my breath away. At these times, it makes my eyes water. It seems to be worse some mornings, particularly if I have had a busy day the day before. It seems to be worse after driving a long distance, as if holding my arm up affects the nerves or the spine. It seems to be worse after I have done some gardening or after something else a bit physical. I have recently been doing some easy Karate arm movements - punches and blocks - and that can bring the pain on for a couple of hours although it seems to settle down then for a couple of days. I have noticed recently that it is much worse when I am tense for whatever reason. So after two days of work in town, I am tired, thoughtful and tense - and the pain requires action.
Pain is funny, even if it is not funny. We all describe our pains in different ways - which makes it difficult for doctors to make sense of (particularly the tired or grumpy ones). We all have different beliefs about pain. We all have different tolerances to pain. Mostly I put up with my chest pain as an old friend. I am still alive. I can still work. If I have pain it is telling me I need to take a break. Sometimes I need to take paracetamol, but to this point have not needed to take anything more than that. I guess I have reasonably high tolerance. Some of that may have come from 22 years of training in Karate.
One belief, is that we do not feel pain at the point of the pain, but rather we perceive the pain in our minds. Theoretically this should give us the power to ignore pain. That would be stupid if we were accidentally cutting ourselves or burning ourselves. But sometimes it is useful. Women who feel pain during childbirth often do not feel it at the moment of birth or in the moments after birth when they have the joy of a new baby. Mostly they can forget the pain if they intend to get pregnant again.
There is an odd phenomenon linked to exercise. If I do some exercise for 20 minutes or so (on my indoor bike), the pain will often go away for a time. The exercise does not have to be extreme (although sometimes Karate was (in the past when I could do it, and that was when I really noticed the phenomenon). Exercise provokes endorphins in the brain - the morphine-like substances that naturally occur after exercise, stress, joy, or meditation.
I learned meditation about 35 years ago, and practice mindfulness and meditation in a variety of ways. Meditation helps my pain. The strange thing is that if you focus directly on the pain you sort of cannot find it. It slips between your mental grasp. When you begin to think about something else, pain slips slyly in from the side. If you practice the focus over time, you get better at not feeling pain when it is there.
Acupuncture and Acupressure have helped my pain. There are two or three tender spots along the pathway I described, and apparently these are acupuncture points. Have a needle put in for an hour, and the pain can go away for days. Putting pressure directly onto the spots (Shiatsu) and holding it there for  about 5 minutes, or even rubbing the spots, can make a difference. Seriously...
I have recently given in (after 6 years) and bought a TENS machine for home use. This is Transcutaneous Electrical Nerve Stimulation. Two pads are stuck to the skin - usually one over the pain, and one over the origin of the pain close to the spine (i.e. the nerve root). The machine is portable, and goes into pocket. It has a couple of dials which can change the character of the stimulation and also the intensity. Over 30 minutes you may have to increase intensity to increase 'the buzz'. I only use it every couple of weeks, but pain relief can be up to two days in my case. Oh, it pays to read the instructions carefully, and also get initial advice from a physiotherapist on how to use your TENS. If it does not seem to be helping, go back and discuss placement and settings again.
Now, I know there are people who have really severe pain, or who cannot tolerate pain at any time. They end up taking lots of mild medications, and when those don't work, they end up taking more 'effective' painkillers, and when those don't work, they end up taking narcotics which may do the job for a time, but are costly and addictive. My belief would be that even those in serious and chronic pain can gain something from exercise. My belief would be that even those in serious and chronic pain can gain something from regular and practiced meditation - initially under the eye of a specialist trainer. My belief would be that even those in serious and chronic pain can gain something from acupuncture or learning to do self-administered acupressure.

Do something for yourself. Take charge of just a bit of your recovery. Please give it a go. It may help you, it may not. I hope it does.
'Taking Charge: a journey of recovery'

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