Pain Management for the Working Musician
Or
The Long and Frustrating Journey to My Back Surgery

As a working musician, the physical demands of our profession can take a serious toll on our bodies. Back pain is a common and debilitating issue that can disrupt or even end our careers. Unfortunately, finding effective treatments for chronic back pain often involves a long and frustrating process, leaving musicians feeling lost or hopeless. 

The problem is that we make up less than 1% of the population.  The average medical professional has probably never personally met a working concert musician.  I have personally found that trying to explain the pressures that a working musician lives with to be a pointless exercise.  Only when I went to a clinic that specialized in musicians (and was treating several Chicago Symphony players) did I feel as though I was understood.

The average person visits the doctor within a few weeks of experiencing consistent pain.  The average working concert musician works through the pain for several months before seeing their doctor.  By the time we’re in the doctor’s office, we’ve been taking OTC painkillers for months.  We have been tolerating pain at least two numbers higher on the pain scale than the average joe because we live in fear of not only losing our jobs, but not being hired again as we now have the injured flag.  And, always, always, the very first thing that the average doctor has suggested to me was to take some time off work!  

Since we really must continue going to rehearsals and concerts, I share this list of what has helped me over the last decade.

Painkillers: 

  • Non-mind-altering painkillers: 
    • Aspirin
    • Tylenol
    • Ibuprofen
    • Diclofenac
    • Aleve
    • lidocaine patches - will take a full number level off the pain
    • Toradol - usually injected in the ER, but it is possible to get a prescription

These are generally safer for those who need to stay mentally sharp, say at a rehearsal with a sarcastic conductor.

  • Mind-altering painkillers:
    • Aspirin & Whiskey: 
      • Seriously, this will give you one hour of amazing pain relief!
    • Muscle relaxaers: 
      • Affects rhythmic accuracy
      • No fine motor memory uptake during practice
      • Can and will impair memory and driving ability
    • Benzodiazepines: 
      • Primarily for anxiety but surprisingly helpful for muscle tension 
      • Will impair rhythmic accuracy and intonation perception
      • you must not drive!.
    • Opioids: 
      • Opioids will mess with rhythmic accuracy 
      • I still perceived intonation errors but I was SO much calmer about them!
      • Range in strength and carry a risk of addiction (required warning)

I learned - the hard way! - that practicing while on either opioids or muscle-relaxers is pointless.  Something about the way that these medications affect the body’s ability to retain fine motor memory.  The rehearsal that I discovered that the viola solo in a certain Songheim show had not stayed in my muscle memory led to a few interesting comments from a sarcastic conductor!

Treatments: What Works, What Doesn't, and What to be Aware Of

Throughout my journey, I've tried numerous back pain treatments. Here's a breakdown of their effectiveness and potential side-effects:

Non-medicinal Treatments that can help:

  • Alcohol (White Russian, anyone?)
  • Heat (I love my heating pad!)
  • ice (I do not love ice, but for inflammation it does work!)
  • massage 
  • physical therapy
  • acupuncture
  • Traction

Treatments with limitations or side-effects:

  • TENS unit:  really good for a few days!.
  • Steroid injections: Provide temporary but significant relief.
  • Lidocaine infusions: I literally had an IV of Lidocaine every week (and got to know lots of the nurses, who were marvelous!)
  • Nerve ablation: Works for a few months until nerves regenerate.
  • Surgery: A major decision, often considered a last resort.

Navigating Medical Treatment: Frustrations and Challenges

Doctors frequently prescribe a lengthy series of treatments before considering back surgery. While there might be good reasons for this path, it can consume years of a musician's career – time that many of us cannot afford to lose. This highlights a disconnect between the medical system and the unique needs of professional musicians.

Furthermore, women can face additional hurdles when seeking pain treatment. This disparity is unacceptable, especially in certain regions. Bringing an advocate to medical appointments can sometimes help to combat this bias.  I distinctly remember bringing my husband to a meeting with a new doctor and that doctor addressed 90% of his attention to my husband!  What was I? The invisible violist?  We never returned.

My Experience with Back Surgery

Ultimately, I underwent a sacroiliac fusion, which resulted in a difficult and lengthy recovery. It took two months to walk, and even longer to walk without assistance. I was able to play again after 8 weeks and at 12 weeks sat in with the local community orchestra for a summer concert.  Painful, but I needed to know that I could play again!

It's Not Easy, But It's Not Hopeless

Managing chronic back pain as a musician is incredibly challenging. The general medical system often doesn't understand our needs and finding doctors who specialize in concert musicians might require an international trip!  However, I urge you not to despair. By learning about the options, advocating for yourself, and perhaps seeking support, it's possible to manage pain and protect your musical career.

Copyright © 2025 Melissa Gregory-Simon

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Pain Management for the Working Musician

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