Tom Janisse

I didn’t know the story—until much later.

In an otherwise ordinary moment of my clinical life in the pain clinic, Maurice, a lean 60-year-old man sat quietly in a chair facing mine. His thick hair and bushy eyebrows hooded his French nose and thin lips pressed into a line. No one had either diagnosed or effectively treated his continuous upper back pain. They knew it wasn’t infectious, metabolic, neoplastic, neuropathic, or osteoarthritic. When he heard, “Probably your muscles,” it wasn’t enough reason for him to stop and rest; he needed to keep working.

Several doctors had already tried everything medical I could think of, except injecting the painful trigger points in the rhomboid knots just medial to his right scapula with a 23-gauge needle and two cc’s of bupivicaine.

“This’ll sting,” I said.

Maurice flinched, and I nearly hit the wing but held the needle still until injecting all of the anesthetic to break the ischemic cycle. Within a minute of withdrawal he said, “Better, doctor … yes, much better. Merci.”

At Maurice’s second and subsequent visits I injected the same painful points. Invariably he felt immediately better, but the pain, worse with lifting, gradually reappeared and required another injection.

During our visits I never asked about his life, but he let that be.

On completion of the four-visit program, when I said I couldn’t justify continuing this treatment course, he said, “Doctor, my back’s better,” he pumped his arm like rowing a boat, “but now I have a side pain.” His right arm shot up like asking a question, and his left index pointed across to his latissimus dorsi. Confirming the spasm—often a masked secondary—I injected that site for four weeks, while he complimented at home with stretching and heat, and no lifting.

At series end, I said again, “We have to stop.”

“I know, doctor, so thank you, so much, for treating me during my difficult transition.”

Six months later Maurice called one morning. “Doctor, you helped me finish the rock waterfall I was building in memory of my wife who passed away a year ago. She so loved the sound of water spilling over stone, and now that sound eases my pain as I sit in silence and listen to memories flow from our life together.”

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