[kianN]

“As pain becomes chronic, it is increasingly associated with activity in the affective and motivational systems tied to avoidance and less closely tied to systems encoding nociceptive input” [1]

I’ve been on the slippery slope of chronic pain. Minor post surgery issues caused me to change my routine and avoid certain activities which only exacerbated the issues, which led to more avoidance. Eventually I couldn’t walk.

The American medical system is very focused on avoiding health issues that show up on mri, rather than quality of life health. But quality of life issues quickly become serious.

I think the middle ground of activity: not all out intense as if you are healthy, but also not avoiding movement is so challenging to find for many people but also so crucial. A lot of chronic pain for myself and I suspect for many others could be avoided with short and quick combination of therapy and daily movement. So simple but so challenging to effectively identify and allocate resources.

Not suggesting this is the total solution but it’s the pathway that I took to return to activity and I’ve seen it help a number of my friends as well.

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8482298/

[kccqzy]

> Minor post surgery issues

My wife has had two surgeries and each time she had a minor post surgery issue. One of them was an area that was tender to touch; another was chronic pain. Neither was mentioned as a possible side effect of the surgery by the surgeon. The main takeaway even if a bit extreme here is avoid all surgeries unless absolutely necessary.

[Retric]

Surgery is a bigger deal than doctors make it seem, but after surgery care can make a huge difference.

I had a surgery asked for more pain meds once on day 5 or 6. Instead the surgeon had me come in to look at the wound, made a tiny incision a blob of pus came out and things felt fine the next day. That’s the kind of thing that could have easily resulted in major problems, but just the right treatment at just the right time fixed it.

[theshackleford]

> Instead the surgeon had me come in to look at the wound

I'm surprised this is not the standard for any surgery involving a significant incision. In my country it's been the standard for instance for all three of my cervical spine surgeries, including the one I just had.

At the 7-10 day mark I must go to my normal GP who performs wound review and checks for signs of infection or other anomaly.

[Retric]

It was standard to have a follow up. He called me in early, the same day they called. And he looked to it himself rather than having a GP do so.

[theshackleford]

Oh ok that makes sense, for a second it just sounded like it would have went I caught otherwise and I began wondering if maybe this wasn’t as much of a standard as I thought it was.

[zdragnar]

Depending on the underlying issue, delaying a surgery could easily lead to needing an even more invasive or extensive procedure, with worse complications or side effects. A blanket avoidance of all surgeries is a great way to be even more miserable.

Anecdotal case: My wife broke her arm some 10 years ago or so. She was really upset about potential recovery time, insurance copayments and such, especially since she was (at the time) a single mother. The doctor suggested setting it and letting it heal on its own, which was absolutely the wrong call. Had she gotten surgery straight away, she would have recovered by the time she actually ended up getting surgery.

I've often wondered if there wasn't a malpractice case that could have been made, but it was before we met so that's lost to time.

[SoftTalker]

Any time you have surgery, especially anything to repair a bone, joint, muscle, or tendon, do the post-op physical therapy religously. Do not skip it. It will be uncomfortable at first, but stick with it. If you slack off or don't do it, you may end up with persistent pain and mobility issues.

[TaupeRanger]

Vasectomies are never “absolutely necessary”, but the risk of chronic pain (very small) vs the risk of unintended pregnancy, risk to the partner, or potential financial hardship, can make it a good decision. It’s never black and white in medicine.

[glasscannon]

> used me to change my routine and avoid certain activities which only exacerbated the issues, which led to more avoidance. Eventually I couldn’t walk.

Anecdotally, I had a phase where pretty much the same thing happened to me with the Achilles (+ calf/ankle) flare-ups I was having (during this part of my chronic journey). Eventually got through it by doing small walks around my home, then outside but keeping the frequency high each day (i.e. instead of 1 "long" walk, doing 3-4 short ones). I.e. Desensitisation / daily movement

[kianN]

Splitting up activity to bite sized chunks was critical for me as well. It prevents over straining but I think more importantly it also prevents you from being stagnant for an extended period of time.

[ericmcer]

Your method is how I treated pain and it served me well for many years (including broken ankle, countless elbow/wrist/finger injuries), as soon as I could I started movement again, and for tendon injuries even decent intensity seemed to help trigger healing.

That all changed when I tore my achilles, the pain/recovery/etc. process had me doubting everything I knew about recovery and now 14 months later I still question if it needs more rest or more activity or the whole thing is in my head. Ankle/foot injuries seem to have an entirely different approach because standing and walking are so fundamental that you might overdo it just by deciding to make eggs or something.

[littlexsparkee]

I learned this the hard way, got achilles/ankle tendon issues trying to rest from a joint problem instead of ramping up activity which would've made me more resilient.

[rand17]

You are not wrong in my opinion - at least all my doctors share the same idea.

[anticensor]

Pain is a legitimate diagnosis, though.

[zdragnar]

Pain is a symptom. There's a strong psychological component to pain avoidance which can lead to behaviors that make it worse. Physical therapy isn't going to feel good, but it plays an important role in lots of recovery scenarios, and I think should be more often prescribed after surgeries.

I deal with fibromyalgia pain. When I first developed it, I pretty much avoided doing anything, and really that was the opposite of what I should have done. There's no "recovery" and really no avoiding it; all I ended up doing was letting my physical condition weaken to the point that even normal activities were painful, so I was hurting for two reasons.

Treating the underlying cause of the symptom, and training to avoid behaviors that exacerbate the symptom is the real key.

[nradov]

Make friends with pain.