A real pain in the neck
When Christina woke up with a pain in her upper right back, her first thought was to call Stephanie, her oldest and a nurse. Since she was healthy, she was sure her daughter would erase her fears.
“Well, a gall stone could give you pain there but it usually starts after eating something with a lot of fat. The pain with that is more colicky, not stabbing like you’ve got. If you woke up with it, it’s probably from sleeping in the wrong position.”
“Oh, yeah, I fell asleep on the couch again last night.”
“A good book or a good movie?”
“Both actually. I kept switching back and forth. I woke up about 1:30 in the morning and went to bed, and then I couldn’t sleep so I went back to the couch. Is there anything I can do for my neck?”
“You’ve never had an ulcer or pain in your stomach, right?”
“No, just a pain in the neck.”
“Ibuprofen should help. Just make sure you take it with food and stop it if you get a stomachache.”
But the ibuprofen wasn’t enough so Christina ended up going to the doctor. He started her on prednisone. She had no idea why that would help with neck pain, and worried about all the side effects she’d heard it could cause. So before she started taking it, she called her son Philip, a pharmacist.
“It helps by decreasing the swelling in the tissue. Less swelling, less pain. But you’re right, it has a lot of side effects like ulcers and making you more prone to infections. Some people have trouble sleeping when they’re on it.”
“Guess I’ll have to pick which troubles I want, neck problems or sleeping problems or stomach problems.”
Christina took the prednisone and continued the Vicodin. One or both seemed to help with her neck pain. Meanwhile, she had more difficulty sleeping than ever. One afternoon her son Jason stopped by to use her washer and dryer. When he noticed how his mother turned at her waist rather than at her neck, he asked what happened to her neck. Jason was not particularly tuned into the problems of others but he was just finishing his first year of graduate school for physical therapy. Christina had no idea how much he’d studied about but found out that day.
“Drugs don’t cure you, mom, they just decrease the pain. Why didn’t your doctor send you for physical therapy?”
“He told me I could if it didn’t get better. It hasn’t so I guess I should.”
“That’s what will get you better. You don’t want to be taking pain meds the rest of your life.”
“I don’t even want to be on them now.”
Christina started physical therapy and during the first visit that she probably had a herniated disc in her neck. The therapist used a model of the neck to explain what caused the pain.
“When people get older the discs between the vertebrae get weaker. Doing things like falling asleep on the couch with your head bent forward again and again, makes it more likely a weakened disc will squeeze off to the side and push onto one of the nerves that come off the spine. That’s what causes all the pain in your upper back.”
“If the problem is in my neck, why does it hurt between my shoulder blade and spine but not my neck?”
“Because the disc is pushing on the nerve for that area, it’s not pushing on your spine. Your spine is protected by your vertebrae and when discs herniate or push into an area where they aren’t supposed to be, they almost always push off to the side, not towards the spine. Your brain can’t tell if the pain is from a problem in your upper back or from a problem with the nerve from that area.”
For part of her therapy, the therapy massages the tensed muscles in her neck. She also had changes to make and exercises to do so she wouldn’t be aggravating the problem. Within a few weeks she was a lot better and no longer needed the Vicodin for pain.
“Jason really got me on the right track,” she told Stephanie a few weeks later.
“It’ll be nice having a physical therapist in the family. I’ll admit I know very little about muscle or bone problems.”
“No one knows about everything.”
“No, and we help each other. I don’t think I’ll mind Jason coming over to do laundry anymore.”
“No, he’s officially the opposite of a pain in the neck now, isn’t he?”
This article is not intended to replace your health care provider. The intent is to illustrate some common problem with a group of medications sometimes prescribed for prostate enlargement and subsequent problems urinating.
To find a consultant pharmacist in your area, log onto this website:
I highly recommend Dr. Armon Neel’s and Bill Hogan’s Are Your Prescriptions Killing You? This excellent book explains the role of the consulting pharmacist in much more detail. It also includes a clear discussion of a number of medication classes, and the implications for the elderly. There are numerous stories illustrating important points. There are also many resources listed.