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The doctors thought there was nothing more to be done.

They said I just had to learn to live with the pain, says Kristin Duun-Gavare (41).

Then she read about the unknown diagnosis.

A new method could make her life pain free.

 

Kristin Duun-Gavare (41) has struggled with chronic pain for many years.

Suddenly it cuts like knives on the right side.

Between the attacks, the discomfort is there like a nasty murmur. A warning of what is to come.

Several times she has thought that she can't take it anymore.

Almost a third of all Norwegians say they struggle with chronic pain. Musculoskeletal disorders are one of the biggest causes of sickness absence and disability in this country.

And the longer you go on with the pain, the greater the risk of never getting well.

 

Kristin and her wife Laura (42) and their two children live in a house right outside Oslo.

Everyday life is busy with a full-time job as a system engineer in the Norwegian Armed Forces, healthy packed lunches, reading homework, karate training, swimming, soccer, CrossFit and friend groups. Driving to and from.

And that is where happiness lies, Kristin thinks, in everyday routines.

But it costs.

Because Kristin's pain is there almost all the time.

It often starts in the upper part of the abdomen as lightning or strong stings, and radiates to the back, groin and hips. Followed by a constant monotonous pain that can last several hours or weeks.

Always on the right side of the body, she says.

For the past four years, the pain has been daily. They come and go throughout the day and are aggravated by certain positions and movements. The stomach is constantly upset.

She has tried everything.

Physiotherapy and hard crossfit training, rest and painkillers, trips in rough terrain, diets and pain management, nerve blocks and good shoes, special soles and psychologist.

The whole body is illuminated and examined. With MRI, X-ray, ultrasound, gastroscopy, colonoscopy...

The GP has referred her here and there. She has been examined for fibromyalgia, cancer, endometriosis, arthritis, gallstones, neck prolapse, Crohn's disease, irritable bowel syndrome.

Even the gallbladder has been operated out.

But even then, the pain did not go away.

 

This spring she was referred to the pain clinic at Ahus.

The doctors thought there was nothing more to be done, says Kristin.

It was the last stop.

They said I just had to learn to live with the pain.

 

She keeps it going until the evening. When the children are in bed, the energy is used up.

Her wife is getting tired of the fact that there is always something wrong with her.

"Am I going to feel like this for another 40 years", she thinks and takes two painkillers in an attempt to Get a pain free sleep tonight.

Sometimes she is overcome by discouragement and a lack of solutions.

I don't know if I can do it anymore, to live like this. But then I think about my children, and then I just have to hold out a little longer.

She was sitting in the car scrolling on her mobile while waiting for the children to finish training, when she saw the Facebook post.

Although disliking the forums for pain patients, she stopped at one post:

Several patients have regained their lives.

With a single operation, years of pain were gone.

All of them had received the unknown diagnosis; slipping rib syndrome.

 

At Apexklinikken at Helsfyr in Oslo, physiotherapist Kjetil Nord-Varhaug is examining a patient with dynamic ultrasound. He moves the device around while his twists and turns on the patient's torso, presses his hand under the ribs while he films with the ultrasound machine.

The ribs protects the lungs and heart as a kind of lattice. But sometimes one of the ribs has become detached from the cartilage, and hangs loose. Or moving.

He explains and points.

In the pictures you can see it clearly. A rib bends backwards.

Between each rib, there are blood vessels and the intercostal nerve. When the rib rubs and pushes on the nerve, it can cause intense pain.

The pain follows the nerve pathways further into the body, and can become so intense that in professional circles they are referred to as suicide-inducing.

- Some feel they are going crazy, that they will never find peace. They can't bear to live with the pain and take their own lives, says surgeon Henrik Aamodt at the Thorax clinic at Ahus University Hospital.

 

Despite the great pain loose ribs can cause, these patients are often not believed.

Many doctors don't even know that there is a diagnosis called slipping rib syndrome, says Nord-Varhaug.

It is early morning and quiet in the corridors at Ahus. Kristin is sitting on the edge of the bed with a handful of painkillers and anti-inflammatory pills. Soon she will be wheeled into the operating room.

Had it not been for the fact that her chiropractor had accidentally heard that a clinic in Oslo diagnosed loose ribs, she would not be sitting here now.

She takes one last look at the photos on her phone, from the Halloween celebration with the children the night before. They were still asleep when she left in the morning.

What if this will be another dismissal? There have been so many doctor visits, so many attempts to understand why she is in so much pain.

Can she dare to believe that something will be different this time?

 

It has been ten years since Nord-Varhaug and his colleagues at Apexklinikken began to admit more patients with unexplained and undiagnosed pain.

The patients were desperate. They had been sent from specialist to specialist.

An athlete had to put his skis on the shelf because he could no longer ski. A mother with young children could no longer work. Only twice had she had a break from the intense pain. Both times she was pregnant.

Could it be hormonal? Or was there something in the skeleton? wondered the medical team.

With ultrasound, nerve blocks and anaesthetics, they found that the answer could lie in the nerves between the ribs. Internationally, doctors had started making the diagnosis.

In fact, slipping rib syndrome (SRS), also called Cyriax syndrome, was described as early as 1919 by orthopedist and psychotherapist Edgar Ferdinand Cyriax, says Nord-Varhaug.

But for years the loose ribs have been underdiagnosed and overlooked because the symptoms are often confused with other conditions.

Here at home, slipping rib is still mysterious and unknown, says Nord-Varhaug.

While searching for answers to his Norwegian patients, surgeon Adam J. Hansen in Bridgeport, West Virginia, had become interested in loose ribs.

The usual procedure was to remove all or part of the rib if it was a problem, but was there perhaps a more gentle method?

Yes, Hansen thought.

 

By sewing the loose rib to the next, it gave more space to the nerve so that movable or loose ribs no longer lay and irritated nerves and vessels. A simple and quick intervention

30 minutes. A bit of anaesthesia, 5-10 cm, a few stitches, and voila, it's done.

He published a peer-reviewed study in 2020 and concluded with great effect. 80 percent of the patients had significantly less pain six months after the procedure.

The ball started rolling. Dr. Hansen's method spread to thoracic surgeons at hospitals in England and Germany.

 

At Apexklinikken in Oslo, physiotherapist and rib enthusiast Nord-Varhaug had also come across the professional article and enthusiastically shared a You Tube video of the method on the clinic's website.

A couple of miles away, at Ahus University Hospital in Lørenskog, thoracic surgeon Henrik Aamodt was eating his packed lunch when he clicked into the video. With great enthusiasm he watched as Dr. Hansen lifted the loose rib away from the intercostal nerve and attached it with a needle and thread to the next bone

It was a game changer.

Aamodt was convinced.

We have to try this too! he said to his colleagues at Ahus.

 

In the past year, he and the surgical team of three at the thoracic department have operated on 12 chronic pain patients.

For us it is a small and simple intervention, for the patients the effect can be enormous. Years of pain are gone.

Kristin sits in the armchair in front of the TV at home. In a dress.

It is morning and she is home from work on a weekday for once.

 

"I don't like the concept of cozy pants and pajamas. It makes you tired. The day must always start with a shower and make-up. Recently operated or not."

When the surgeon cut through the skin and entered between ribs number nine and ten, he found not one loose rib, but two.

She doesn't know when they came loose.

Perhaps they were congenitally loose, as for some. Maybe it happened when she danced drunk and happy at a community center on Ytterøya in Trøndelag in the early 90s. She celebrated her 18th birthday and fell over the edge of a tree sofa.

I remember that it hurt like hell, but I just took another sip and continued the party.

Perhaps it happened when she became pregnant with her son, eight years ago. She remembers the strange feeling that something clicked inside, something "stuck".

Since then, she has had pain for periods, and for the past four years; daily.

It's tough to have problems that no one sees, says Kristin.

"She looks healthy, it can't be that troublesome", I feel people think.

The worst thing is when I'm met with "it's psychological".

Because what does that mean? That the pain is something I imagine. That I'm hysterical, or that I can't tolerate much?

Kristin is restless. After the operation I was told to take it easy.

It's not easy. Next week I will probably go back to work.

She cannot sit with her hands in her lap.

These years of pain would not have been Much Harder without the job. I love my job, my colleagues. There I have managed to shift the focus away from myself.

 

As a SAP engineer in the defense army, she monitors and coordinates the maintenance of aircrafts.

The job requires full concentration. It probably saved me.

Three weeks have passed since the operation. Kristin does not yet know whether the loose ribs are the cause of all her pain.

But she hopes.

She is back at 50 percent work and she has a good feeling. The pain has already started to subside.

I have a little pain at the operation scar, and my back is a little tired.

But it is.

I hardly dare to believe it.

 

MIRACLE: The rib that has been rubbing on the nerve for years can create wounds and scars that must heal. Some people notice a difference already days after the operation, for others it takes a few weeks and months.

For many, the pain disappears completely. Out of 12 patients, only one has returned without effect, says surgeon Henrik Aamodt at Ahus University Hospital in Lørenskog.

 

PROGRESS: Some people only have pain while sitting, because the nerve gets pinched. For others, the pain is constant, many get side effects elsewhere in the body because you relieve the area of ​​pain. - It can settle in the shoulders, neck and under the soles of the feet, says physiotherapist Kjetil Nord Varhaug at the Apex clinic in Oslo.

 

PAIN BREEDS PAIN: Many chronic pain patients are oversensitized by having been in more pain for so long, says thoracic surgeon Henrik Aamodt.

- Then it takes less before it hurts. Just putting on the seat belt in the car, or wearing a bra with straps can cause intense pain.

 

WRONG DIAGNOSIS: - Many of these patients are referred to gastrointestinal specialists, they have had their gallbladder removed because the pain feels like it is in the stomach region, says physiotherapist Kjetil Nord Varhaug at the Apex clinic in Oslo.

GIVE UP: - The patients are often seen as chronic and are eventually referred to pain clinics where they have to learn methods to cope with their pain, says physiotherapist Kjetil Nord Varhaug at the Apex clinic in Oslo.