Coping with chronic back pain means both accepting and defying the condition.

Arthritis Today  |  July/August 1997

There is a sign on the ceiling of my physical therapist’s office. The first time I noticed it I was lying inert atop a compress of steaming towels, staring helplessly into the white space of ceiling tiles, when this hard-etched slogan overhead struck me as both cruel and revelatory. It said: Movement Is Life.

Until that point, movement had always defined my life. By the time I turned 30, about 6 years ago, years of physical abuse from college football, snow skiing, backpacking, lifting without protecting my back, barbaric diet—the full spectrum of macho nonsense—had sent my body into a riot of anatomical dysfunction. Displaced rib heads, crushed discs and crooked hips had triggered painful civil war among bone, nerve and muscle on the battlefield of my back.

Early on I was told two basic things about this conflict, which at worst is like being filleted alive and at best makes me a grumpy old man in the prime of my life. Either there was something physically awry, from bone spurs to a kidney tumor, or the pain was primarily psychosomatic, a function of my mind. In short, that my back was where I located stress.

Of course, after the first year of constant discomfort I realized that this was not something that would simply vanish with a pot of herb tea, a fact which only made me angrier, more tense.

But in another sense coping with back pain has now become primarily a matter of psychology, for it involves an insidious paradox in that one must both accept and defy one’s condition at the same time. But how do you accept chronic pain without being defeated by it? And how do you defy chronic pain without denying the reality of it?

We are a confederacy, back pain sufferers, a secret society of confidantes.

I don’t know yet. But what I am sure of is that striking this balance between accepting illness while fighting for permanent relief is, in itself, a worthy goal. And sometimes having a goal is enough, although it implies a succession of often frustrating means: breathing exercises, meditation, special diets, more exercise, no exercise, chiropractors, physical therapists, family doctors, deep-tissue massage, back pills, vitamin pills, heat, ice, X-rays, ergonomic furniture, aspirin, cold showers, hot tubs, abstinence and indulgence of all sorts and, of course, the always welcome communion with fellow sufferers, whose beleaguered motto is, “I’ve tried everything! ”

We are a confederacy, back pain sufferers, a secret society of confidantes and commiserators who, despite empathy for our comrades in discomfort, are certain that they cannot possibly feel as poorly as we do. What makes it worse is that we often have no clear understanding of our misery, no diagnoses other than the infuriatingly vague “chronic back pain.” We become convinced that normal people do not understand what we go through.

Eventually, pain justifies our belief that we are not really the person those closest to us probably think we are; not really the acid grinch who growls at wife and kids because the invisible rat is again gnawing at this spine; not really the man whose career suffers because he has no tolerance for sedentary desk life; not really the man afraid to enter bed at night because bedeviled sleep is worse than no sleep at all. We are not these people. We are kinder, sweeter, more vigorous.

Call it mastery of the obvious, but by about the third year of dealing with this I realized something. The less I complained about it, the less it hurt. The less I fought it with anger and denial, the less angry I was about it. The less I talked about it, the less I needed to talk about it. The more I moved, the more I found I could move.

In addition to the gentle stretching exercises recommended by therapists, I joined a health club and started pumping iron—hard. I took up jogging again. The endorphin rush after three miles in a pair of cushy jogging shoes is the best relief I get.

In any case, one supposes that pain is a relative thing. My grandmother, a tough old mill hand in her 80s, admits little of it. A couple of years ago, a dentist pulled her few remaining teeth without using Novocain. She never felt a thing. Others I know need anesthesia just to brush properly. Personally, standing somewhere between the numb and the histrionic, I’ve decided there is even a kind of succor in not admitting as much pain as one feels, for quelling the urge to complain at least offers the small victory of composure.

Besides, I am quite sure that even dearest loved ones long ago wearied of hearing about my spinal agonies. And gradually, inevitably, their failure to wholly sympathize only intensified the pain and the sense that I had been disbelieved, was mentally weak, a chronic fraud. Worse, I became less receptive when they needed my support in times of illness.

Of course, I cannot put it out of mind completely. Knotted, bunched, inflamed muscle tissue is the devil in the duality of my well-being. Many nights I lie awake in a cat stretch on my knees, trying to lengthen the muscles, until slumping toward sleep in a fetal ball. The bone-settling vibration of a two-hour car ride can put black rings under my eyes. When my wife and I go to the grocery store, she doesn’t understand why I park so far back in the lot.

“Let’s walk,” I’ll say. “I need to walk.”

People ask, sometimes, how my back is. I tell them it’s about the same, though in fact it may be getting worse. But I don’t go to a chiropractor anymore, and I haven’t seen my physical therapist in about two years, perhaps because I have accepted this thing without losing to it, and I am learning, by degrees, how to defy it without denying that I may have to fight it forever. And I have decided to move on with my life because, as I have learned, movement is life. ✦