Sciatica
Sciatica occurs when the sciatic nerve, the largest peripheral nerve in the body, running from your spine down your leg, becomes irritated. This is most common among patients with a herniated spinal disc but can also occur due to accident or other injury. Symptoms include electric-shock-like pain down the leg, numbness and tingling, and muscle weakness. Sciatica can be persistent unless the root cause of the problem is addressed.
All pain is personal, because it’s happening to you, but that does not mean it is you. As we’ve seen in this chapter, pain is an evolutionary tool that can and does get out of hand, but that doesn’t mean you are lacking in control. Sun Tzu advises us to “know your enemy,”2 so become acquainted with your pain. Give it a silly name if it helps. Talk to it. Scold it. Describe it. How can you expect to live with it if you don’t take the trouble to get to know it?
One of the most helpful tools you can use to understand your pain and to help your caregivers understand is to create your own pain profile. This can seem like a lot of work, but once you are practiced at it, it will become second nature and allow you to objectively understand what you are feeling and what, if anything, you need to do about it.
Start by keeping a simple pain diary. Every day, record the following for each individual pain you can identify:
•Location of pain
•Duration of pain
•Intensity of pain
•Description of pain
•Activity immediately before pain
•Medications or action taken for pain and their effect
You can use the list of descriptive words shown earlier to narrow down the feeling of the pain you are experiencing. It is vital that you are able to perceive how your pain manifests and its effect on your day and your world.
Performing this exercise while in pain can be tough, but do the best you can. It may be easier for you to wait until the end of the day, and record every instance you can remember at once—this also helps you to separate and categorize different types of pain you have felt through the day.
Talking to your doctor about, well, anything, can be tough, embarrassing, strained, rushed, complicated. Even the simplest problem can be difficult to talk about with someone who may well be almost a stranger. But here’s the thing: you cannot afford to treat your doctor as a stranger. Yes, you may have only met him/her a few times. Yes, you may not like them very much. But you need to be able to give them detailed, personal information so they can help you as best they can. There is no avoiding this. No one can do it for you, and, if you don’t do it, it won’t get done. A doctor will not magically guess the right treatment for you. It’s up to you to give him or her all of the relevant information.
In the last chapter we said that pain was not infallible. Well, guess what? Neither is your doctor. Unless you are reading this from an incredibly privileged position of wealth, the overwhelming likelihood is that your doctor is overworked, underpaid, stretched across too many patients, and working without enough sleep, support, or resources to properly help his or her patients. Appointment time varies by country, but the average is just over ten minutes—significantly less for more than half of the world’s population (eighteen countries have appointment times of less than five minutes), and a little more for wealthier nations (twenty minutes in the USA).3 Imagine that. Ten minutes—including prescreening by a nurse or medical assistant—to have an in-depth discussion with your doctor about your symptoms, possible causes, and treatment options and to think of and ask intelligent follow-up questions. That’s a tall order even for the most self-assured, articulate person.
So What Can I Do?
1. Be Prepared
This is the one best single, practical thing you can do to ensure your appointment is productive and your health care provider is put in the best position to help you. Before you attend your appointment, write down everything you need to say. List your symptoms (this is where the pain profile you worked on in the last chapter can help) clearly and simply. Include specifics such as the nature of the pain, duration, intensity, location, associated factors—even if you are not sure if they are relevant. If you are not a doctor, you may not know which factors are relevant and which aren’t, so let your doctor make that judgment call. List your medications and include any over-the-counter pain meds you take, how often and what dosage, how effective they are. List any therapies you have tried and their efficacy. If serious, include effects on your mood, routine, ability to work, sex drive, appetite, exercise, etc. You are the person experiencing the problem; the onus is on you to properly describe it.
2. Be Direct
Neither you nor your doctor has time to waste. Be clear and direct about why you have come in, what the problem is, and what you are hoping to achieve from the appointment. Have a goal in mind: a new medication, suggestions for alternative therapies, a referral to a specialist. This may or may not end up being the result, but if you do not have an intention for the appointment, you risk leaving without having made any progress.
3. Do Not Take Your Doctor’s Harried Nature or Brusque Attitude Personally
Do not interpret their attitude as a commentary on your medical situation. Your health care provider is a person, just like you, not a magical all-knowing being with endless capacity for patience and kindness. We might want them to be that, but they’re not. If they’re having a crappy day, they may well show it. Don’t personalize that. If it’s bad, if you feel they’re not listening to you, say so. You are allowed to do that! You have come in with a potentially tricky, difficult-to-diagnose-or-treat problem, and you should have their full attention.
4. Consider Asking for More Time
Pain is a complicated issue, and it is reasonable to expect a discussion of it to take longer than that of a cold or a sprained ankle. When making your appointment (especially with a general practitioner), consider asking for a longer appointment or an appointment at the end of the day—tell the receptionist you feel you need more time to speak with your doctor. They may not be able to help you, but most will appreciate your desire to avoid messing up their schedule by running long in the middle of the day.
5. Ask for a Referral
You may not be able to get the help you need from your family doctor or a specialist for a specific illness. Chronic pain specialists exist and focus purely on the understanding and treatment of physical pain. They have a wealth of knowledge your regular doctor does not and can be valuable resources. Consider asking your doctor for a referral, if this is an option near you.
6. Take Notes during Your Appointment
This may feel silly, but you probably have a lot of doctors’ appointments, regularly, and keeping track of it all can be an important diagnostic and treatment tool. Writing down your doctors’ suggestions, medication advice, and thoughts prevents you from forgetting anything, helps clear up confusion about instructions, and will strengthen the dialogue between you.
7. Take Suggestions Seriously
Your doctor may suggest a medication or treatment that you are uncomfortable with. You are well within your right to say so at the time—but do not discount everything. Doing so will discourage your doctor from trying to problem-solve with you and leave you even more on your own. Take their advice on board and, if possible, take notes on what you have tried and its efficacy.
Your relationship with your doctor is a partnership and should be treated as such. They are not gods