Neuropathic pain is interesting. I'm not just saying that because I topped out on OTC painkillers for the day hours ago and progressed to feeding myself dextromethorphan -- although, admittedly, that does help. Intellectualization is sometimes the best way to get through the day with a plurality of your marbles intact.
It doesn't hurt quite the same way as other things do. It's poorly-localized, for a start. If you sprain your ankle and then try to put weight on it, your ankle immediately goes OW FUCKER DON'T DO THAT. There's definitely damage, and it's definitely your ankle; you couldn't miss it if you tried. If you get to the clinic and the doctor grabs your foot and tries to move it from side to side, you'll shout the exact same thing at him that your ankle shouted at you, and you will immediately be able to point at the part of you that you want him to stop poking at, at least until someone gives you a whole fucking lot of Vicodin.
When a nerve is pissed at you, it can be surprisingly hard to pinpoint where the problem is. Right now, the best I can do is "left hip". It doesn't seem to be the actual joint out of place; my range of motion is fine, and no particular position or movement hurts any more or less than any other. Nothing grinds. It doesn't seem to be muscular, either; nothing is sore and there's no obvious goose-egg or bruise anywhere. It's just continually and annoyingly uncomfortable, like the secondary echoes you get when you bang your funny bone on something. Not the lightning-fast main bolt, the intense pain that hollows out your insides and makes you quit breathing for a second. More the twinges that radiate out to your fingers and up to your shoulder. It hurts, but it's no identifiable kind of hurt, and it's not really in one specific place. You know where it comes from if you hammer your elbow on the arm of your chair, but imagine having that kind of echo and not knowing what exactly you bumped to make it happen. It's just... wrong, and on-edge.
I'm about 75% sure I did this to myself. One of the really big muscle knots was bugging me right before it happened, so I took a lacrosse ball and rolled it out one night, then went to bed. That was a tactical error. That knot was holding something important in place. I usually sound like a string of firecrackers when I wake up, or perhaps some sort of avant garde John Cage piece meant to be performed by several family-size bowls of very angry Rice Krispies. The morning after I killed off the annoying knot, I also got a cacophony of loud chalky snap noises all around my pelvis, which is slightly more unusual.
See, I pop things all the time. I can refrain for a while, because I know knuckle-noises annoy some people, but not for all that long, or I start to feel like I'm rusting in place. Most of the alarming crackle noises joints make are cavitation pops -- joints that have synovial fluid cushioning them also have some trace gases dissolved in that fluid. If you can pull or tilt the surfaces of the joint far enough apart, you can get the little gas bubbles to fuse into one big bubble, and then collapse in on itself, which is what makes the noise. A pop you can't immediately repeat is probably cavitation; it takes a bit of time for the gas to sort itself out into bubbles so you can do it again.
Any joint that has fluid and articulates can pop. Most people have popped knuckles at some point. Probably also the odd toe or mid-back (thoracic vertebrae). A lot of people can also pop their lower back (lumbar vertebrae), neck (cervical vertebrae), or jaw (temporomandibular joint). Hips and shoulders don't usually stay in one place long enough for bubbles, but depending on your range of motion, you might also have popped your knees or elbows. I can pop my fucking clavicles, and I do on a regular basis. Also my ankles, whenever I sit seza with my weight on my heels, and my kneecaps whenever I kneel. Usually on purpose, since getting them out of the way makes the kneeling more comfortable.
Other things make a sort of clicking sound. These are usually ligaments sliding over something else and snapping out of the way, and are infinitely repeatable. My wrists make a little ticking noise if I rotate them right. A lot of peoples' hips and shoulders start doing this as they age, I think, although usually it doesn't start until they're older than I am now. This is also pretty harmless. If it doesn't hurt, then the ligament hasn't gotten locked up anywhere it shouldn't be, and you're fine.
The big loud chalky snap-clunk sounds, on the other hand, generally mean that I have dislocated something fairly important. I didn't realize this until embarrassingly recently. It makes a big jarring thunk when I get things back in place, but doesn't really hurt, as such, so I had assumed it couldn't be an actual dislocation. Those things make people scream at emergency department nurses, you know? You have to give them muscle relaxants for the spasms and opioids for the pain, and scare up one of the burly orderlies to help. Then I thought about it for a while, and realized that mechanically, I'd been reducing things like hip dislocations the same way doctors do; mine just don't hurt, so there's no screaming and no muscle spasms, and I can do it myself.
[For the record: Lean back on my arms to take the weight off that hip, apply traction by digging in that heel and pulling with my calf, then rack the opposite hip straight back while pushing up with the gluteal muscles on the displaced side. The idea is to extend and pull to separate the joint slightly, then push the ball up and over the edge of the socket to snap everything back into place. Normal people have this done for them by having a nurse apply a shitton of drugs and then hold them steady while the doctor yanks rather hard on the distal end of the limb. The object is to get it done as quickly as possible and on the first try, so that it only hurts like a motherfucker once.]
I have trouble sometimes realizing that it's actually pain that's making me cranky until I stop and pay attention. I've gotten good at a sort of subconscious triage: Is something hurting because it's actually damaged? Can I do anything about it? It all gets sorted into "yes/yes, I can fix it now", "yes/yes, but not at this exact moment", "yes/no, I need to call an actual doctor", and "no/probably nothing very effective". If I'm legit sick or a limb is busted or something else reasonably concrete, I make an effort to do something sensible about it. I spent a lot of college forcibly training myself to let other people take care of me when I felt shitty. My mother's reaction to illness about 90% of the time boiled down to 'you're clearly malingering, but I'll let you get away with it as long as you don't remind me you're in the house', which did not exactly teach me how to deal with people trying to nurse me back to health.
But pissed-off nerves? Body just kind of generally complainy? Not really a whole lot you can do there. I can't not use my entire back, that's not how this bipedal thing works. Shoulders and hips are kind of necessary. I just ignore it until I'm stuck on the train home at the end of the day going, why do I feel like I'm about to burst into tears? And then I realize, it's because a thing hurts, and there's no position I can sit or stand in that makes it not hurt, and it's been doing that for several days now with no signs of stopping. Keeping that at bay makes me very tired, and being very tired makes it infinitely more likely I will cry over random pop songs like an emo teenager.
I suppose one of the "nice" things about the pain not being connected to anything in particular is that doing things doesn't hurt appreciably more than not doing things, so there's not much temptation to sit down and do nothing. Bit like all my social interactions as a child, really. The only feedback I'm going to get is "general unpleasantness" no matter what I do, so I might as well just keep my head down and bull through my day.
The resemblance unfortunately ends there. I went through this same stage with the social things, where I was honestly kind of mad at being informed that being that unhappy was not normal and that in fact other people weren't. It isn't fun, knowing that there's a better alternative that I should have been told about years ago. In that case it turned out that I could join the other not-unhappy people by learning how society worked and finding myself a better class of friends. The issue of malfunctioning hips may be one that I can neither improve nor learn how to avoid by figuring out more about how it works, which is by far my least favorite class of problem.
How can there be a thing I cannot think my way around? Madness.
It doesn't hurt quite the same way as other things do. It's poorly-localized, for a start. If you sprain your ankle and then try to put weight on it, your ankle immediately goes OW FUCKER DON'T DO THAT. There's definitely damage, and it's definitely your ankle; you couldn't miss it if you tried. If you get to the clinic and the doctor grabs your foot and tries to move it from side to side, you'll shout the exact same thing at him that your ankle shouted at you, and you will immediately be able to point at the part of you that you want him to stop poking at, at least until someone gives you a whole fucking lot of Vicodin.
When a nerve is pissed at you, it can be surprisingly hard to pinpoint where the problem is. Right now, the best I can do is "left hip". It doesn't seem to be the actual joint out of place; my range of motion is fine, and no particular position or movement hurts any more or less than any other. Nothing grinds. It doesn't seem to be muscular, either; nothing is sore and there's no obvious goose-egg or bruise anywhere. It's just continually and annoyingly uncomfortable, like the secondary echoes you get when you bang your funny bone on something. Not the lightning-fast main bolt, the intense pain that hollows out your insides and makes you quit breathing for a second. More the twinges that radiate out to your fingers and up to your shoulder. It hurts, but it's no identifiable kind of hurt, and it's not really in one specific place. You know where it comes from if you hammer your elbow on the arm of your chair, but imagine having that kind of echo and not knowing what exactly you bumped to make it happen. It's just... wrong, and on-edge.
I'm about 75% sure I did this to myself. One of the really big muscle knots was bugging me right before it happened, so I took a lacrosse ball and rolled it out one night, then went to bed. That was a tactical error. That knot was holding something important in place. I usually sound like a string of firecrackers when I wake up, or perhaps some sort of avant garde John Cage piece meant to be performed by several family-size bowls of very angry Rice Krispies. The morning after I killed off the annoying knot, I also got a cacophony of loud chalky snap noises all around my pelvis, which is slightly more unusual.
See, I pop things all the time. I can refrain for a while, because I know knuckle-noises annoy some people, but not for all that long, or I start to feel like I'm rusting in place. Most of the alarming crackle noises joints make are cavitation pops -- joints that have synovial fluid cushioning them also have some trace gases dissolved in that fluid. If you can pull or tilt the surfaces of the joint far enough apart, you can get the little gas bubbles to fuse into one big bubble, and then collapse in on itself, which is what makes the noise. A pop you can't immediately repeat is probably cavitation; it takes a bit of time for the gas to sort itself out into bubbles so you can do it again.
Any joint that has fluid and articulates can pop. Most people have popped knuckles at some point. Probably also the odd toe or mid-back (thoracic vertebrae). A lot of people can also pop their lower back (lumbar vertebrae), neck (cervical vertebrae), or jaw (temporomandibular joint). Hips and shoulders don't usually stay in one place long enough for bubbles, but depending on your range of motion, you might also have popped your knees or elbows. I can pop my fucking clavicles, and I do on a regular basis. Also my ankles, whenever I sit seza with my weight on my heels, and my kneecaps whenever I kneel. Usually on purpose, since getting them out of the way makes the kneeling more comfortable.
Other things make a sort of clicking sound. These are usually ligaments sliding over something else and snapping out of the way, and are infinitely repeatable. My wrists make a little ticking noise if I rotate them right. A lot of peoples' hips and shoulders start doing this as they age, I think, although usually it doesn't start until they're older than I am now. This is also pretty harmless. If it doesn't hurt, then the ligament hasn't gotten locked up anywhere it shouldn't be, and you're fine.
The big loud chalky snap-clunk sounds, on the other hand, generally mean that I have dislocated something fairly important. I didn't realize this until embarrassingly recently. It makes a big jarring thunk when I get things back in place, but doesn't really hurt, as such, so I had assumed it couldn't be an actual dislocation. Those things make people scream at emergency department nurses, you know? You have to give them muscle relaxants for the spasms and opioids for the pain, and scare up one of the burly orderlies to help. Then I thought about it for a while, and realized that mechanically, I'd been reducing things like hip dislocations the same way doctors do; mine just don't hurt, so there's no screaming and no muscle spasms, and I can do it myself.
[For the record: Lean back on my arms to take the weight off that hip, apply traction by digging in that heel and pulling with my calf, then rack the opposite hip straight back while pushing up with the gluteal muscles on the displaced side. The idea is to extend and pull to separate the joint slightly, then push the ball up and over the edge of the socket to snap everything back into place. Normal people have this done for them by having a nurse apply a shitton of drugs and then hold them steady while the doctor yanks rather hard on the distal end of the limb. The object is to get it done as quickly as possible and on the first try, so that it only hurts like a motherfucker once.]
I have trouble sometimes realizing that it's actually pain that's making me cranky until I stop and pay attention. I've gotten good at a sort of subconscious triage: Is something hurting because it's actually damaged? Can I do anything about it? It all gets sorted into "yes/yes, I can fix it now", "yes/yes, but not at this exact moment", "yes/no, I need to call an actual doctor", and "no/probably nothing very effective". If I'm legit sick or a limb is busted or something else reasonably concrete, I make an effort to do something sensible about it. I spent a lot of college forcibly training myself to let other people take care of me when I felt shitty. My mother's reaction to illness about 90% of the time boiled down to 'you're clearly malingering, but I'll let you get away with it as long as you don't remind me you're in the house', which did not exactly teach me how to deal with people trying to nurse me back to health.
But pissed-off nerves? Body just kind of generally complainy? Not really a whole lot you can do there. I can't not use my entire back, that's not how this bipedal thing works. Shoulders and hips are kind of necessary. I just ignore it until I'm stuck on the train home at the end of the day going, why do I feel like I'm about to burst into tears? And then I realize, it's because a thing hurts, and there's no position I can sit or stand in that makes it not hurt, and it's been doing that for several days now with no signs of stopping. Keeping that at bay makes me very tired, and being very tired makes it infinitely more likely I will cry over random pop songs like an emo teenager.
I suppose one of the "nice" things about the pain not being connected to anything in particular is that doing things doesn't hurt appreciably more than not doing things, so there's not much temptation to sit down and do nothing. Bit like all my social interactions as a child, really. The only feedback I'm going to get is "general unpleasantness" no matter what I do, so I might as well just keep my head down and bull through my day.
The resemblance unfortunately ends there. I went through this same stage with the social things, where I was honestly kind of mad at being informed that being that unhappy was not normal and that in fact other people weren't. It isn't fun, knowing that there's a better alternative that I should have been told about years ago. In that case it turned out that I could join the other not-unhappy people by learning how society worked and finding myself a better class of friends. The issue of malfunctioning hips may be one that I can neither improve nor learn how to avoid by figuring out more about how it works, which is by far my least favorite class of problem.
How can there be a thing I cannot think my way around? Madness.
Comments
Post a Comment