Pain Fest - exacerbation of postural muscle dysbalance, phantom pain and allodynia / tender skin [pain escalation]
As I attended a conference last week, Monday through Saturday, most of the time was spent with static activities - standing, sitting, walking about slowly - while I was wearing my cosmetic arm. I managed to get relief from that type of activity by getting into a pool twice that week - but that didn't prevent this from happening. Twice a week just wasn't enough for that. Because in essence, I had an extreme escalation of pain. I never had that before, and can only speculate about the causes.
Usually, I can manage to keep the skin on my stump all smooth and in good condition underneath the prosthetic liner, but wearing the prosthetic arm for almost 14 hours per day, wearing "proper" clothing - shirts, jackets - at hot sommer temperatures without air conditioning had my stump itch and pain while I was sweating loads. It helps to understand that wearing a prosthetic arm provides insulation and does keep the heat in quite a bit. Normally, I don't wear that much stuff, not so many layers.
By Monday, phantom pains were worse as ever already after a long trip with packing and unpacking. The week started out as a Pain Fest with a good 4-6/10.
- Stump pains were happily feeding phantom pains and these caused extra tension in my back, face, neck and shoulders.
- These are not all separate though. My phantom hand neurologically projects onto body surface areas that my brain now maps to face, neck and jaw. So I must have gotten some overlay exacerbations.
- Keeping a static posture for hours on end, day after day, with an asymmetric arm is not exactly recommended by Town Police. So tender muscles and phantom pains feed forwarded each other in what is called a Vicious Cycle. Back and shoulders were tense all the way through.
- I do have a considerable number of issues there. The left shoulder has an anatomical plexus compression problem that is not treated, the left elbow has a chronic overuse epicondylitis, the left wrist has a mild carpal tunnel syndrome, and there was a somewhat serious brachial plexus tear on the right side years ago. Also, I had a few instances of impingement or discus hernia in my cervical spine during the last decade. So, I normally have painful and/or numb areas of my skin anywhere around there. But during normal work days, I manage to ignore these and get on with things.
By Thursday night, my phantom pain was a solid brimming 8/10, my neck and back muscles were brick hard and pained on a 4/10, and my stump skin showed mild red spots that burned and itched more than usual. Also, I probably had not slept that well due to the increasing pain and found myself tired.
By Friday, my neck, jaw, back and shoulder muscles were enamel hard, pained on a roaring 9/10, the skin anywhere between scalp and pelvis on my back and side of the body was extremely tender on touch (a condition that is called allodynia), the phantom pains were a flaming 8/10 and I was nauseous all day from the pain. After lunch, I felt exhausted and tired. I was extremely anxious to get to the hotel that afternoon to recover.
Solution: This time around I did not accept defeat. So when I planned to go aggressively against that, I decided to first take an extensive hot shower. I then took 2 x 500mg Panadol, drank about 0,5 L of cold water and went to sleep. After 1-2 hours, I got up, and repeated that procedure - hot shower, Panadols, water. After a while I had recovered a bit - enough to go to dinner. After dinner, I repeated the procedure all through the night, getting up every 1-2 hours, taking hot showers, drying myself, Panadols, water. It was a real vicious-cycle-breaking exercise. Next morning, I felt wretched and exhausted from the ordeal but the disabling aspects of the pain were gone. After I got home, I went to a straight ~21-22 hour deep sleep to recover from the preceding week.
Take-home message: It pays off to have pain killers and a chill-out fall-back solution (quiet hotel room, hot shower, drinking water supplies) with you when trying out unusual stuff that borders extreme sports. Like, sitting around for a week. And plan for extensive recovery times for such activities. Who'd a thunk it.