Interview CP29

Age at interview: 43

Brief Outline:

Back pain since, 1990. Surgery: Discectomy 1990, Discectomy 1991, Spinal stabilisation 1997, Bone fusion 2003. Treatment: Epidural steroid injections. TENS. Pain management: Going on Expert Patient Programme. Current medication: morphine, codeine, tramadol. Past Medication: fentanyl.

Background:

Nurse; married; 2 children.

Uses mild laxative to treat the constipation from taking morphine.

The only side effects you tend to get are the constipation. The nausea has gone now because I've been on it so long, so I don't tend to get sickness, but it's just the constipation you get, but that's easily dealt with so people, I think, when they hear you're taking morphine think, oh, you know, you're going to be on a high all the time. But I think when you take it for what it's needed for you don't get the highs out of it.  

You say you deal with the constipation?

Tablets and Senokot and I think the other one's called lactulose. Just to help it on it's way, and it works alright. 

Knows that he needs to accept his pain and hopes that the Expert Patient Programme will help him.

I haven't accepted it. I think this is the problem. If I'd learned to accept that I had it, then I think I could probably live with it better. I think it's like, you see all these people on the news, thinking in particular that lady who's got breast cancer at the moment who's running all these marathons. Can't remember, Jane somebody I think her name is. And she's obviously accepted that she's got it and is making the best of what she's got left and I think that if I could accept the fact that I had the pain, or constant pain, that you would probably be able to get on with your life a bit better.  

And I think, hopefully that's what this Expert Patient Programme is going to come along to help me come to terms with, accepting the fact that I've got it and get on with it. And I was saying earlier how sometimes my wife and I clash on the way that she deals with things. And it's that she can accept it if she has a problem very easily and just gets on with it and it doesn't bother her and I think that's the problem that I have, is not being able to accept it. 

And perhaps one day when I do' I accept I've got it and I accept it's not going to go away, but I haven't fully accepted the whole of the implications with it. And I think that's, that's probably an obstacle I've got to overcome.

Recognises that medical understanding has moved on and that prolonged bed rest is no longer...

You were told to rest in bed at the time, what are your feelings about that now?

I suppose, I don't know really. Medicine changes all the time and nowadays they don't advise bed rest, not for two weeks, because it's not going to do any good, it'll just make, it doesn't make matters worse but I think your back just stiffens up.  

They recommend now sort of a small amount of bed rest and then to get back exercising. I don't tend to look back and think 'Oh well they told me' what they told me to do was wrong' because at that time that was what the treatment was. So you don't look back and tend to blame anyone for what they did or didn't do. That was the treatment at that time so you tend to go along with it.

Saw a chiropractor and got temporary relief of painful muscle spasms but didn't think that it was...

I've been to a Chiropractor in the past and, yes, they used to relieve some of the muscle spasms you get from when you're holding your back in an awkward position. But with regards to actually getting rid of the pain, no they didn't. They used to help free up the back.  

When you get back pain you, you tend to guard it a lot and it does go into spasm and they were able to relieve that but that's about it.  

The other side of it was it was getting very expensive. When you're going 2-3 times a week and it's sort of '15 a time, and you're on a sort of reduced income, it's just difficult to keep going. So something I had to stop going.

Was concerned about using opioids at work as a nurse but checked with the General Nursing Council...

Taking this medication, does it affect your ability to drive at all?

I haven't noticed it, and I haven't noticed it affecting me at work either. And it's something that I was concerned about. You know working as a nurse on a ward and taking morphine. But I spoke to the Royal College of Nursing and asked what was called the UKCC, which is now the General Medical, or General Nursing Council, about it. And they said, you know, so long as it's prescribed then that's OK.  

The only problem they would have had was if I actually took the tablets to work. That seems to be the only problem, that I wasn't allowed to take them to work. Which I wasn't going to be doing anyway because they're slow release ones. And they only get taken in the morning and evening anyway so it wasn't an issue.  

Was frustrated that the pain clinic seemed to follow a protocol for backs and didn't listen to him.

They had a Pain Management Clinic at the local hospital but those were the ones that gave me the injections in the back which didn't help, they didn't seem to, well they did for a few days but that was it, they didn't seem to do anything. And they didn't seem to listen to what I was saying and that got frustrating.  

There seemed to be a protocol for back pain and we'll do this, this and this in this order and if it doesn't work we'll try something else but they never actually listened to what I was saying about the pain that I was having or the treatments they were giving. And so in the end I just stopped going because they weren't doing any good and it was more of an inconvenience in the end of having to go up there. 

What would you have liked them to have done?

I suppose if they had listened to me a bit more about what I was saying and the fact that I, you know, I've had these sort of TENS machines, tried before, I didn't get on with them. And some of the tablets they wanted to put me on I said I didn't want to take because they just made me so sleepy. 'Oh well try them anyway'. And they gave them to me but I didn't bother taking them because I knew what they were like. But it was what they had to try on their list of, you know, their list of orders for treatment of back pain.  

And so that's why I got upset and cross because they wouldn't listen, you know, you'd said you'd tried something before and it, and it didn't help 'Well try it again.'  'Well the tablets make me really sleepy', 'Well try them again'. And you know that they do, so I just gave up going in the end and sort of just sorted things out between myself and my GP now. And she looks up the information and she gives me information that comes through so we tend to do it that way now.

Had some steroid injections into his spine but knew they weren't a long-term solution because...

I had some injections in some of the muscles to try and relieve the muscle spasm that I get there and I actually have some steroids injected into the spine and they worked for a period of time but there's only so much they can give you because the steroids, again, with all their side effects in the long term, which has caused more problems than you have originally.  

Causing the bones to start crumbling because of all the steroids you've had. So again they're only a short term treatment, they're not a long-term cure really.  

Explains that he is always hoping that surgery will cure his back pain even if deep down he knows...

After I had the second disc removed things sort of settled down, that was in 1994. And things seemed to settle down for a while but then about the beginning of 96, end of, not 90, yeah, end of, was it 90? Yes 95/96 things started flaring up again and then I had an awful lot of time off work and it took a long time, for one reason or another, I don't know why, but it took a long time to get an out patient appointment and then I had physio at this time to try and sort things out.  

But nothing seemed to get rid of the problem that I had and eventually I got to see the orthopaedic surgeon who said "Well we can either do nothing and see what happens". We're sort of seven years down the line now and the medical treatments were beginning to change for back problems.  

The surgeons were becoming less keen to operate on backs knowing that once they've gone in there once it was likely to lead to further problems. So he sort of said "Either we do nothing and see if it sorts itself out or you can have a total fusion, bone fusion, or we can just try this stabilisation". So I was offered either the bone graft fusion or the stabilisation and I was reluctant at the time to have a back totally fused.  

I went for this option of, this graph stabilisation, which was a fairly horrendous operation to go through, but it did seem to stabilise the lower back and prevent these discs from causing any more problems. Which it did for a while. I suppose I got 18 months to two years relief from the surgery and then it just all flared up again.  

And then you said just recently you've had the fusion done?

In April of this year I had a bone graph fusion. That was the only thing really that was left to try to see if it would help. And I had that done at the local hospital and it was, I suppose I was in hospital for about a week. And it wasn't that horrendous an operation or I didn't feel it was. It's one of these situations where the pain after the surgery is less than you had beforehand.  

And although, being told that it might take up to a year to 18 months for things to settle down and notice any difference, at the moment I haven't noticed any difference in the pain. And the fusion you don't know about. You don't know that the bone is there or the bolts are there, you don't notice them.  

It's just a case of just hoping that in 18 months time things will be different. And, I think I'm probably the same as a lot of people with chronic pain, you find someone who can do something for you and you put all your faith in them and you hope that they will cure it and when they don't you then start looking for someone else, because you think the next person that comes along will be able to do something. Although, I think, most people realise deep down that you, they will never get rid of the pain. But even if you know that you still look for someone to do it for you.