1st OA and Chronic Low Back Pain Edition

Ryan Lamb

Overcoming obstacles to find a new normal.

Label for Ryan: Warrior

“Pao won’t let me get out of bed yet, or Pao is really being mean this morning,” says Ryan Lamb. Pao isn’t a person or one of his beloved dogs. Pao is the word Ryan uses to refer to his pain. In fact, it stands for “Pain All Over.” Giving his pain a name allows a separation from his condition and recognizing that his pain isn’t his identity. “It’s just a way for me to accept it, and it gives those that are close to me an easy way to relate with me with regard to what I’m currently experiencing from a pain perspective,” he explains.

The crack of the bat

Ryan was playing softball with his company’s team when he heard a loud pop in his back. He tried to ignore the searing pain. Days later, Ryan’s knees buckled, sending him to the ground. He knew it was time to see a doctor. That loud pop was the sound of his L5 vertebra breaking.

Ryan received a spinal fusion in April of 2012. During the healing process, he re-broke the bones that had been fused together, which meant another surgery. While the second surgery may have been successful from a surgeon’s point of view, Ryan’s life was forever changed.

Becoming chronic

Because of the surgeries, Ryan developed post-laminectomy syndrome, also known as “failed back surgery syndrome,” creating chronic low back pain. He categorizes his symptoms as mini-flares (which last less than 12 hours) and flares (which last four to five days without relief). Mini-flares occur approximately every one to two days, while flares happen once or twice a month. “I have some sort of pain every day,” says Ryan.

In 2014, Ryan had a spinal cord stimulator implanted. It was surgically placed under his skin and has a wire that runs up the spinal cord. When activated, it sends electrical pulses that disrupt the nerves that are firing pain signals. The stimulator is controlled by a remote that Ryan can turn on and off.

While the stimulator provided some relief, Ryan also relied on extremely high doses of prescription opioids just to survive each day. But eventually, state legislation surrounding opioid prescriptions significantly impacted Ryan’s ability to obtain the drug. In 2015, over a six-week time frame, he decided to detox from opioids by himself—a practice not recommended, and potentially dangerous without a doctor’s supervision.

Ryan was still experiencing significant pain that radiated down his legs two years after the neurostimulator was implanted and a year after he had detoxed. He compares the sensation to a feeling of numbness and tingling in his legs—similar to when a limb “falls asleep,” except instead of lasting minutes, it happens for hours at a time. He was finally also diagnosed with complex regional pain syndrome (CRPS).

CRPS is a disorder of the nervous system the heightens the nerves’ responses to certain stimuli. A person usually develops this condition after an accident or even something as simple as spraining a wrist or fracturing a bone. Those with severe CRPS find that the slightest touch creates an incredible amount of pain, with the affected area swelling, turning red, and feeling like the bone is on fire or is cold as steel. Even air passing over the skin can cause a CRPS flare-up.

Searching for better pain management

In 2016, Ryan’s doctor suggested high-frequency neuromodulation. Using his existing stimulator, Ryan turns up the frequency of his stimulator for longer periods of time. He’s noticed an improvement in the severity of discomfort he has on a daily basis. The constant numbness and tingling has reduced, but it’s still not a cure for CRPS or post-laminectomy syndrome.

Ryan’s most recent surgery was to install an intrathecal pain drug pump, which was implanted in July 2017. The pump is placed between the muscle and skin of the abdomen. A catheter carries pain medication to the spinal cord and nerves, slowly releasing medication over a period of time.

Finding a new normal

“Pain has changed my life 180 degrees,” says Ryan. “I used to have a very good job, made great money, was in a relationship, enjoyed myself physically and socially—that is all gone now,” he says. Friends have slowly stopped asking Ryan to attend social activities. He had to move in with his mom, and was unable to return to work. He was recently approved for Social Security Disability benefits, a process that required many appeals and a hearing before a judge.

Ryan is only 32 years old but has been dealing with chronic pain for over a decade. Because he is so young, he finds that others can’t believe how he experiences such intense pain and has had so many surgeries. “I have a pretty high tolerance and keep a lot of it to myself,” he says. Sometimes he feels he has to prove his pain by lifting his shirt to show people the huge bulge in his abdomen from his pain pump. “That seems to catch people off guard and then it’s like a flipping light bulb goes off in their minds and they all of a sudden believe me,” Ryan says, dumbfounded that it has to come to that.

Ryan’s life revolves around his two dogs, Kona and Kayla. They give him a reason to get up every morning, even when Pao begins to scream within his body. He tries to be active in the morning. Ryan is proud of a new goal he has set for this year. He wants to do “at least one physical activity per day, even if it’s just walking around the block once or twice. Also, I’ve started guided meditation with the help of a friend who is a nutritionist.”

Ryan has been through a lot at a young age, which has given him wisdom beyond his years. “I wish the general public understood that they need to be more supportive of folks with chronic pain, regardless of their age,” he says. For those who are newly diagnosed, he offers this advice:

Take your time. Learn your pain and learn to accept it. Pain can make you grumpy, “and no one wants to spend time around a grump, right?” jokes Ryan.
During dark moments he suggests finding a way to look at yourself from an outside perspective. “Decide if you like the person that you see,” he says.
Remain positive or at least optimistic. “This was very hard for me because no one wants to accept that they have a chronic pain condition,” Ryan explains.

Appreciating support

Ryan’s life would be drastically different if he didn’t have the help, love, and support of his mother, who has been right by his side for the last two years. She helps with the puppies, picks up his medication, does the laundry—anything and everything that his pain condition has made it difficult to do. Ryan’s mom managed the cumbersome Social Security Disability application and appeals process for him. The recent victory of finally being awarded benefits is a victory he attributes to her hard work. He believes it will alleviate some of the burden she has taken on as a caretaker, at least from a financial standpoint. It will give him the ability to stand on two feet on his own for the first time in a long time.