Terrance Heath

I Am Tired of Being in Pain

Filed By Terrance Heath | April 12, 2011 1:30 PM | comments

Filed in: Living
Tags: pain relief

Be kind to your knees. You’ll miss them when they’re gone.

- Mary Schmich

I used to wonder what the phrase above -- from Chicago Tribune columnist Mary Schmich’s now famous column meant. I no longer have to wonder.

The knees were not the first to go, in my case. It was the eyes. But the knees now appear to be on their way out. And they are not going quietly.

Actually, it started a while back. Far enough, in fact, that I can’t pinpoint when it started. For a while, the various methods I turned to to treat it worked pretty well. If I took an over-the-counter pain reliever, and wore a knee brace or a less obtrusive band below the kneecaps, it subsided somewhat.

By “it” I mean pain; burning, searing pain around and behind my left and right kneecaps. In my case, it starts when I’m sitting down, especially if I’ve been sitting down for an extended period. Standing up usually relieves it. Putting my feet up also works. But now the various methods I’ve tried have stopped working. Even standing up doesn’t offer as much relief as it used to. Once the pain starts, it’s there for the duration of the day.

I finally went to the doctor a few weeks ago, and after an examination and x-rays, the diagnosis cam back as chondromalacia patella.

Chondromalacia patellae (also known as CMP) is a term that goes back eighty years. It originally meant “soft cartilage under the knee cap,” a presumed cause of pain at the front of the knee. This condition often affects young, otherwise healthy athletes.

Chondromalacia is due to an irritation of the undersurface of the kneecap. The undersurface of the kneecap, or patella, is covered with a layer of smooth cartilage. This cartilage normally glides effortlessly across the knee during bending of the joint. However, in some individuals, the kneecap tends to rub against one side of the knee joint, and the cartilage surface become irritated, and knee pain is the result.

The term “chondromalacia” sometimes is used to describe abnormal-appearing cartilage anywhere in the body. For example, a radiologist might note chondromalacia on an MRI of an ankle.

Pain at the front of the knee is common in young adults, especially soccer players, gymnasts, cyclists, rowers, tennis players, ballet dancers, horseback riders, volleyball players, and runners. The pain of chondromalacia patellae is typically felt after prolonged sitting, like for a movie, and so is also called “movie sign” or “theater sign”. Snowboarders and skateboarders are prone to this injury, particularly those specializing in jumps where the knees are under great stress. Skateboarders most commonly receive this injury in their non-dominant foot due to the constant kicking and twisting that is required of it during skateboarding

That’s at least one potential diagnosis. Patellofemoral Pain Syndrome is one that goes hand in hand with the above. Osteoarthritis is another. But I get the sense that my doctors are making educated guesses more than diagnoses at this point.

The point is, I hurt. I hurt more often now than I used to. It’s getting to the point where I have to leave my desk sometimes, and work in the lunchroom with my feet up in a chair to get some relief. At home, if I’m sitting on the couch, my feet are on the coffee table to keep my knees straight. Both at work and at home, I have footrests under my desk that allow me to sit without bending my knees.

In the past week, I’ve started standing on the Metro in the morning, instead of sitting down. I may start doing so on the bus too. The reason being, I can tell right away if it’s going to be a good day or a bad day, pain-wise. If I start feeling pain while sitting on the bus, it’s usually too late. The pain will stay with me, at various levels of intensity, throughout the day.

Thus far, nothing works to get rid of it. At least not in the short-term. I bought ankle weights, so I could to the exercises my doctor recommended, and I have my first physical therapy appointment this week. But the benefits of exercise will build up and will only be effective over time. The problem is, I’m in pain now.

I’ve spent enough time standing in pharmacy looking at shelves of over-the-counter pain relievers to know that: (a) they’re all basically the same — either ibuprofen or acetaminophen, sometimes buffered with aspirin and/or caffeine; (b) not one of them does me a damn bit of good. (For example, I took some this morning, am still in pain now, and still have to wait 6 hour before I can take another dose.)

I have another appointment with my doctor to talk about pain medications. There’s a problem, though. I’m a recovering addict and alcoholic. If you’re talking serious pain relief, you’re usually talking opiods. That’s a big danger sign for me. I don’t want to do anything that might put my sobriety at risk. But at the same time, I don’t want to be in pain on a daily basis. I’ve read that both chondromaclia patella and osteoarthritis are treatable but not curable, and both lifelong conditions. So, something’s gonna have to give.

I know there are anti-depressants out there that are used for pain management. I’m hoping that will be one option for me. Because I might need it for more than just pain, if this keeps up. I can understand why people with chronic pain are more likely to experience depression. Like I said, can tell right away if it’s going to be a good day or a bad day pain-wise. Usually, though, I don’t find out until my day’s already underway. So it means sitting at work with pain that usually makes me want to pound desk, scream, cry or some combination of all the above. I usually feel like going home, but I know if I do I’ll still be in pain. I’ll just be in pain in a different place. If I’d known when I woke up this morning that today was going to be a bad day pain-wise, I probably wouldn’t have bothered to get out of bed.

I’m even more worried about how it’s going to effect my activities. Right now, I’m dreading sitting down to dinner this evening. (More and more often, at home, I eat my breakfast and lunch while standing at the kitchen counter.) We’ve got a vacation planned this summer that will involved a long road-trip there and back. I’m already thinking “What am I going to do?”

What I am going to do today is hurt. What I’m going to do today is be in pain. What I’m going to do today is live with the pain that started this morning (at least one coworker noticed me wincing during the staff meeting). It’ll accompany me on my ride home, sit with me during dinner, haunt me while I’m spending time with the kids before bedtime, and linger until I finally go to sleep tonight.

Tomorrow may be a better day, with less pain. But today is not. Today, I am tired of being pain.

crossposted at Republic of T


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That sounds very awful and I am so sorry to hear you are going through it. If it is what the doctor suggested, what can be done? Does it need surgery?

I'm 48 and I have a similar problem.
Started 2.5 years ago.
Three weeks ago I lifted an 80 lb. laser printer, ok I lifted six of them that day. Still freakin hurts! ICY hot, booze (just makes it worse the next morning), free money, nothing works! Arrgh!

Ah, to be so naive as to think the american medical establishment takes pain seriously. Nope. I have been in pain every day since I was fifteen and have never had a doctor who was willing to try anything other than the same old anti-imflamatories (which I now refuse flat out to take, as they never work and they always make me puke). The good news for you, I suppose, is that prescription anti-inflamatories will often help when it comes to arthritis and certain other conditions and are non-addictive. However, I understand that addiction is an issue for you because of your personal history, but there is such a terror of addiction in medicine that they would rather see people be in agony every day than let them decide to take that risk.

I was in the Navy for 20 years. One of the things that I noticed was that those in my job rating were contantly having knee injuries.
Mostly those injuries were due to running on a steel deck with a 50 pound tool box in one hand and a black box weighting any where from 20 pounds to 80+ pounds. If that wasn't bad enough, the deck moved, was oily and we had aircraft rolling all around trying to kill us all the time.
The deck heaves, the box pulls you off balance as you hit grease...twisting a knee was certian.
Only one command ever got a 'real' doctor. A sports physiologist who could fix a knee in under 2 hours and most would walk out under thier own power. But a football team found him and bought his contract out.
The military still hasn't figured out that military personel are athletes. If they have they certianly have a weird way of showing it.

I'm so sorry to hear about this, Terrance. I hope you find something to relieve the pain.

I've always had bad knees, from childhood. Cold weather is especially hard to deal with. It's arthritis, pure and simple, but one thing helped -- a lot: I studied modern dance for several years, and my knees stopped hurting. It was, I think, the combination of building up the muscles around them and improving the circulation. From what you say about the effect of sitting, that may be your answer: exercise that will help the circulation and strengthen the muscles without stressing the joint.

Ethan Alister | April 13, 2011 7:55 AM

Knees are one of the most terribly "designed" parts of the human body. We all will likely feel your pain one day. I am sorry to see this happening to you so young. I hope that tomorrow will be a low pain day for you.

Jerame has the same problem. Plus, my eyes went out a long time ago. I've had to wear glasses since 4th grade and I've noticed myself looking under them to see lately. Bifocals at 38? I hope not!

Well, I'm getting more aggressive about finding a solution. I had an appointment with my primary care doc yesterday about medication, and he upped the dosage on my NSAID medicine. We'll see how that works out.

I explained to my PC doc how bad it's gotten. I found it impossible to sit at my desk on Monday. Instead, I spent part of the sitting on the floor of my office with my laptop, and the rest of the day sitting in the lunchroom with my feet in a chair and my laptop on my lap.

My PC doc's opinion was that I should opt for surgery. In fact, he was so emphatic he almost insisted I call the orthopedist and make an appointment before I left his office.

I called the orthopedist when I got back to my office, and got an appointment for Friday. I'm going to tell him I either want to go with the hyaluronic acid injections he mentioned or arthroscopic surgery.

We'll see what happens.

Jay Kallio | April 14, 2011 5:53 AM

I have lived in severe chronic pain for 25 years for an inoperable condition (stage 4 endometriosis) that has only been slightly treatable, so I understand how isolating, stressful, and depressing it is. I often compared the experience to being all alone, battling a major hurricane that was internal, that no one else could see or hear, and found too upsetting to know about. The pain blotted out all other experience, so it did not feel possible to share experiences with others, the pain was an insurmountable wall.

I found that going to a pain management specialist was helpful, and they often have some alternatives to opioids if you do not want that kind of pain management. I was able to get back some vestiges of a life with that type of help. Best of luck with your Knees. I hope you find some real relief.