cyclists felling greater than better

The Self-Imposed Cycle of Pain

Feeling “better” is easy. Being “greater than better” takes a little effort.  

I have a slogan that I use in my practice: Be greater than better. However, it’s more than just some nice sounding words.


It’s a statement—a positive future vision for people dealing with long-term chronic pain because of ongoing neck and back problems. It’s prescriptive: we can always deal with day-to-day pain and feel “better” for a while, however, we can also decide to reach for solutions that eliminate the things that generate pain. We are greater than pain.


In perspective of what I call the “cycle of pain,” it reminds us that there are few challenges in life that are truly insurmountable. In fact, many causes of spine pain are well-within our ability to control. At my practice in Beverly Hills, and among patients I see from Cedar Sinai Medical Center in Los Angeles, CA, and military personnel referrals from the Lanman Foundation, we can, and often do, mitigate the causes of pain that are a result of a spinal disorder. We achieve these mitigations in partnership between myself and my patient, and by what we know about spinal disorders and the effective means of treating them.


To be perfectly honest, feeling “better” is easy. You can stop moving or you can take pain medication. For most of us, neither of these actions are very good options for maintaining a high quality of life. How long can one sit or lie motionless? How much medication can you take before you habituate? From my perspective, this is a self-imposed cycle of pain perpetuated by temporary measures that end nothing. I can say this, as a patient and doctor of thousands of patients, when you’re dealing with chronic neck and back pain, you have two choices: solve the pain or surpass the illness. You can lay back and hope that it won’t hurt that much today, or you can begin work to improve yourself beyond the endless cycle of momentary relief and the next moment you feel discomfort.


I have that first-hand experience of dealing with day-to-day, persistent pain in my neck, and now in my lower back. I’ve had the kind of pain that hangs over my body like a bad cold. A patient described her neck pain as wearing a heavy cloak. I added: with pins and needles on the inside. Before my first surgery, I will attest to the temptation of sitting motionless somewhere. I contemplated pain medication. But the worst thing I did to myself was that I waited.


My first cervical fusion, more than 15 years ago, came after a long and hard decision. First off, I don’t prefer fusions if I am a candidate for motion preservation surgery. I see them as instruments that unnecessarily lowers the quality of life. I’m hard pressed to prescribe fusions unless absolutely necessary. However, that’s what I ended up doing—a single-level cervical fusion—after I waited and endured chronic neck pain for nearly 10 years.


Why did I wait so long? Because I was busy with life; busy with growing a relatively new practice; busy with my family, my friends, my activities—busy with treating patients who were far far worse off than me. I suffered the localized pain, but also numbness in my thumb and tingling in the upper arm that sometimes flared up as a burning sensation. There came a time when these symptoms were so severe that I feared they might affect my ability to treat patients. I sought the consultation of a colleague and confirmed what I suspected: a severely herniated disc. I took time off from everything, had the surgery, and was back up on my feet within weeks—pain free.


Looking back, I understand why many of my patients wait so long to call and see a doctor. This is the self-imposed cycle of pain that often makes our condition worse. When we’re talking about spinal disorders like herniated discs, for instance, the pain you experience is from a nerve compressed by part of the disc that’s been squeezed out of the space between your vertebrae. Nerve compression is not something that anyone should take lightly. Prolonged compression may lead to nerve function loss. While surgery can correct the situation, and remove the pain generator, you probably cannot grow back lost nerve. Nerve loss may be permanent.


Diagnosed early, there are many many other options, including nonsurgical therapies that can delay surgery for years. There are minimally invasive micro surgeries administered on an outpatient basis. That means you’re literally in and out of the clinic within hours and experience postoperative recovery times often measured in days.


Most aspects of the cycle of pain are well within our control. We do not have to sustain pain as part of our daily lives. Anyone can be greater than better. I’m living proof.



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