Ignoring the problem doesn't help it go away.

January 22, 2009 2:49 PM

I need advice on how to talk to a loved on about her chronic, but unaddressed, health problem.

My girlfriend has chronic back pain, and has for as long as I've known her. It's been getting progressively worse for years, and is now to the point where she's in constant, debilitating pain. But she refuses to confront the underlying problem and instead focuses on easing the symptoms. This is partially due to her lack of health insurance, but also her distrust of doctors.

Her back pain has progressed to the point where her boss sent her home until she saw a doctor about it, which she did under heavy protest. She was given pain meds and told to rest for a week. Once the week was up and the meds were gone she went back to ignoring the problem in the hopes that it would go away. It hasn't, in fact it's worse than ever.

Long story short, she needs to see a medical professional and stop denying that there's a problem. How do I convince her of this?

posted by anonymous to human relations (18 comments total)

You can try to help her address the underlying problem of avoidance/distrust. I say try because you can't really force a person to do something.

Having dealt with a loved one who feared and distrusted doctors, I found it was best to talk about that and help, where you can, to confront those issues. A therapist may be needed and that's ok too.
posted by Brandon Blatcher at 3:00 PM on January 22

Hmm. I'd just tell her you are worried and want her to just go in and get an assessment - not necessarily treatment. Back it up with some research if you have to. And seriously, make the appointment if you have to and offer to go with her. Just be clear that it is something that is starting to affect her job and your life.

When she's assessed, the doctor will probs tell her that if she doesn't do something about her back, it will get progressively worse until she is completely crippled (or something like that) and hopefully that will shock her into getting help.

Basically, gently kick her a** to the hospital. Don't f*ck around with health issues! :)
posted by HolyWood at 3:07 PM on January 22

There may be a reason she distrusts doctors - getting to the bottom of that and finding a doctor that doesn't "tweak" whatever made her dislike/distrust them in teh first place sounds like a good first step from my perspective.
posted by deadmessenger at 3:16 PM on January 22 [1 favorite has favorites]

If at all possible avoid pain treatment clinics and look for individual doctors or physical therapists. They'll offer a more invested approach and won't over-medicate.
Clinics will result in never seeing her doctor and getting her prescriptions upped by a nurse practitioner as the pain gets worse/medications become ineffectual.
posted by Esoquo at 3:24 PM on January 22

I would start by researching her health insurance options. It can be daunting, so if someone less emotionally-invested does it, that could be the biggest help of all. She is somewhat correct in being wary of seeing doctors before she has health insurance, because if they diagnose something before she's covered, she's in for a long, expensive road. I would also consider researching for her a good chiropractor who accepts payment on a sliding scale, which might get her some relief (depending on the exact nature of the problem) without getting into diagnosis territory.
posted by xo at 3:26 PM on January 22 [1 favorite has favorites]

Can you play on her distrust of doctors and help her find someone who takes a more holistic approach? Not a quack, but perhaps a physical therapist, or a doctor who is into integrating different techniques?

My mom (who has back problems) distrusts doctors partly *because* most of them want to throw meds at her instead of trying to find and fix (as much as possible) the underlying problem. She's more open to people who suggest exercises and lifestyle changes instead of just pulling out a prescription pad or screaming "Surgery! You need surgery!" My mom has also found the McKenzie Method and books useful, although YMMV and IANYGFDOPT (I am not your girlfriend's doctor or PT.)
posted by needs more cowbell at 3:32 PM on January 22

Back pain is a famously difficult problem to pinpoint and fix and/or alleviate.

Have you considered the possibility that depression may play a role here, too? In fact, physical pain is a common symptom of depression.

There are many ways to address back pain, including gentle exercises, chiropractic adjustments if you're into that, osteopathic manipulations if you're into that, medication, physical therapy, etc. But she shouldn't try any treatment until she has been evaluated by a medical doctor to confirm the source of the pain (that's is musculoskeletal and not, for instance, bone cancer).

It's notoriously difficult to convince someone to go to the doctor about something. I face this on a annual basis with my husband. I beg and plead but it comes down to him wanting to do it for himself. You can't force anyone to do a darned thing, even if it is to help themselves.
posted by FergieBelle at 4:07 PM on January 22

As for what you can do, she's an adult, and you can't really make her do anything. What you should do, however, in my opinion, is research the insurance options and make an appointment with the appropriate specialist. Chances are it'll take 4 to 6 weeks before she gets a new patient appointment. That will give you time to talk to her about why she doesn't like doctors, and perhaps time to see a therapist.

I, like your girlfriend ignored a back problem, and ended up with permanent, extensive nerve damage. She doesn't want that to happen.

Under no circumstances should she begin the Mackenzie or any other method of self-treatment without a proper diagnosis. If she's doing cardio or other physical activities she needs to stop until she see's seen a specialist (rehab medicine or orthopedics). To start physical therapy she needs a prescription, again, that would come after seeing a specialist. The specialist will likely order an MRI before he makes a call about physical therapy vs. surgery.

If you are in the Philadelphia area and need recommendations, memail me. There are excellent doctors in the area, but they might not be the obvious choices. There are some who will only add to whatever trauma your girlfriend might have experienced under a doctor's care.

Finally, for suffers of chronic pain, medication is an essential part of the treatment. It sounds like she needs more serious intervention, but it is not a sign of addiction or weakness if she continues to take the meds after seeing the specialist. The stigma attached to the legitimate use of pain medicine is misguided. Chronic pain is one of those things you've either have experienced or not. One may be tempted to compare one's experience of acute pain to those living with chronic pain, but I assure you chronic pain is of another order and a constant living hell.
posted by vincele at 4:11 PM on January 22

You can't make anybody do what they don't want to do. That said, if you haven't already, give her The Talk. The one where you tell her how this makes you feel. How you're worried about her. How you're concerned that, if she doesn't do something to address the underlying problem, it will just get worse and worse for her. And how it's tough for you to see her in pain.

Finally, try another tack. Maybe a doctor is something she'll rebel against, for now. What about a book? Reading a book - particularly from someone who already knows what she's going through - might help. (This book really seriously changed my life - I was much like your GF in my twenties.)

Good luck.
posted by twiki at 4:15 PM on January 22 [1 favorite has favorites]

On preview, back pain is really hard to diagnose. You'll want a second opinion and a surgeon's opinion regardless of the first doctor's diagnosis. People have all sorts of experiences, as the comments reflect, but you and she need to be prepared that surgery might be the only viable option. Hopefully not for sake, but just because a doctor urges surgery and drugs doesn't mean the doctor is sloppy or has ulterior motives.

More often these days, doctors push lucrative steroid shots. They work wonders for some patients, but not all by any means. Personally, I'd trust a doctor who makes his money off shots telling you "surgery" more than a doctor who pushes a long course of shots aggressively.

Like I said before, there's only so long before many back problems lead to permanent damage and your S/O needs to take action before it's too late.
posted by vincele at 4:21 PM on January 22

Okay. Here we go.
Back pain is a famously difficult problem to pinpoint and fix and/or alleviate. This is so very true, but on the other hand, back pain is real too, and that is the problem.

The one thing I would, in looking back, have liked to do better in relationship to my ex-wife was to see and understand that her back trouble got out of hand when it got out of hand and to do something about it. That is: to bully her into seeing a proper doctor, or two or three for that matter. If necessary with force. I am not kidding.

So no, I'm not going to talk about why "ex" and all that. But I'm talking about how bad her back eventually got. I do believe that it was a function of too much tension, too much frustration and, for good measure, a bad slip on the ice, but whatever the case and reasons, she ended up with a dislocated disk which she denied for at least five years. A disk so dislocated that the surgeon who eventually solved the matter for her (because she started fainting and stuff) told her that he hadn't seen anything like that ever before.

Why did she wait so long? Because she didn't trust doctors much, played down the problem for too long, went instead to some back-breaking quack (even at times when I had to drive her there and almost couldn't get her in and out of the car) and forgot about how bad it was between fits.

What were the consequences? You just don't wanna know. Her mental health (not the most stable in any case) went all the way down below where anyone would like to have it, because of the excruciating, everlasting pain. No matter whether there's a depression at the start (I believe there was). Depression sure ensued, and how. Family life suffered. Breakup was the consequence. You cannot now even begin to understand what the effects of a good well-seasoned bad back are going to be for both of your lives.

Don't go there. The danger of bullying her into seeing a good doctor against her will is so much lower than the danger of anything that's waiting further down the lane otherwise. And if you'll have to lift her bodily into the scanner at the hospital, she'll thank you afterward.

Let her read this.
posted by Namlit at 4:53 PM on January 22 [1 favorite has favorites]

Don't bully her. Guys just want to be macho and bully and be big man at home. STop it.

Try this on for size instead:
"Honey, I am seriously concerned about your back pain. I know it is very real, and very serious. I have been doing a lot of research on back pain and treatment because I have been very concerned about your health. I know that you're worried about lack of health insurance, but I found out that you are eligible for state health insurance/researched options and found one that's close to being affordable and I'd really like you to consider taking some action. I am concerned that you could damage yourself irreparably and it would break my heart if that happened. I'd like to understand better why you are so hesitant to see a doctor for this - would you be willing to share that with me?"

and then:
"How can I best support you in seeking proper care for your back?"

She probably won't go see a doctor because 1) it's expensive and 2) she is scared it is something really, really bad and doesn't want to deal with it. Bullying with #2 is not going to remove her fears or concerns.

I grew up in a family where you would have had to have had a gaping gushing wound before anyone would believe you were hurt or injured. Unless you had a temperature, you were not sick. I developed an incredible tolerance for pain and suffering and can be fully functional during episodes that would send others to the emergency room.

I am not proud of any of this.

But the last thing I need is Mr. M. bullying me into seeing the doctor. He will talk to me about it, he will express his concern, but when he tried to 'force' me all it did was make me feel like shit and inadequate and broken, and I gotta tell ya, that REALLY didn't make me want to go to the doctor.

Now it's a discussion. He'll ask. He'll inquire. He won't force.
posted by micawber at 5:21 PM on January 22

I second namlit.

For what it's worth I am a woman, sensitive to gender/power issues and I have training to counsel women abused by their partners.

But like namlit's wife I had such a severe problem elderly doctors who had seen it all were amazed I could walk. If there had been someone in my life like namlit who had dragged me to the hospital, I would be better off today.
posted by vincele at 5:30 PM on January 22

If she has been in constant, debilitating pain for a long time, in pain for "years" leading up to this, then she is simply not in her right mind.

No idea what might work, but the odds are against her waking up tomorrow and being ready for scans and images and X-rays. If you want something to happen, you are going to have to be a big part of it.
posted by Lesser Shrew at 7:47 PM on January 22

Well, having a loved one who resists all medical examination and care... I sympathize.

One thing I can say is that subtle nagging, even if she ignores it, may someday help. If something dire happens, like she loses mobility because of the pain, at least you will have warned her many times, and it won't be the first time you've had the conversation.

If you want to try to reach her, focus on telling her how the situation affects you. Do you worry? Are you pained by her discomfort? Are you tired of carrying the groceries? Tell her how it affects you. That's not something inside her body which she can claim total control and privacy over.

It's probably worth talking about how it affects you anyway. I give you the benefit of the doubt for being simply concerned and loving. But you never know what you may be injecting into the equation yourself.
posted by scarabic at 11:25 PM on January 22

Don't bully her. Guys just want to be macho and bully and be big man at home. STop it.

If there had been someone in my life like namlit who had dragged me to the hospital, I would be better off today

Well obviously I wasn't (and still am not) at all macho about it (or anything else) and hence didn't bully her anywhere and that's how she ended up almost crippled and with a family in shambles. In normal life, I'm all in for open discussions of the hesitant sort oh am I ever. And in normal life I am someone too who tries avoiding to go to the doctor, for a variety of reasons. All on your side micawber. But this isn't normal and it's no life. I was trying to be serious here for once, because this is serious.

[we're talking about a woman who had given birth to two kids without pain killers involved and walked away on day 2. And one of those times wasn't easy and took the best of a whole day. And who, in contrast, one day, after fainting from her back pain, ended up on the floor a few centimeters beside a flat mattress, and it took me and her several hours to get her on to that mattress because of the pain. THAT kind of pain.]
posted by Namlit at 1:25 AM on January 23

IANAD, but a person with a herniated lumbar disc. I know you might not want to hear this, but her attitude isn't totally unhealthy. Although back pain can be debilitating, you'll soon find out that doctors most often don't know how to deal with it.

Unless she has a disc pressing on a nerve, doctors will not consider her to have a problem of medical urgency. And if the problem is "only" pain management, then keeping away from doctors is not unwise (lot of controversy over spinal surgery out there).

What I would try to convince her, is just to get the neurologist examination (can be done by an orthopedic surgeon, neurosurgeon or neurologist) and MRI scan to make sure she doesn't have a problem that is endangering herself (pressure on nerve) that can get worse if not treated (point her to the literature stating the dangers of not having this diagnosed on time).

To do this I'd use the argument, that you'd just like her to go to the doctor to make sure that she doesn't have the worst case urgent scenario, just to take the worry off both of you.

If it does turn out to be "only" pain management, I would encourage her towards gentle physiotherapy, swimming and acupuncture (NO Chiropractic manipulations). Just as important, try and pinpoint what aggravates her back and change habits (chair, exercise, stop lifting heavy objects, etc.).
posted by mirileh at 2:48 AM on January 23 [1 favorite has favorites]

Um, in your question you might imply you can identify the cause (posture? Not enough sleep? What?). Can you work on that? I've had "must lie still for a week" acute back pain, and nagging, uncomfortable, interrupting sleep chronic back pain. My back stopped hurting after I stretched and exercised (osteopath suggestions) and stopped sleeping leaned over on the train.
Had I known 30 mins of snoozing on the trains a few times a week would result in me *willing to lose a limb to a rusty saw* to make the pain stop, I wouldn't have done it. But I didn't, but I do now. Fix the underlying if you can. (no back pain for a year now!)
posted by bystander at 4:26 AM on January 23