WARNING: This article will contain graphic images of leg wounds.
A tall and handsome professional athlete with a wife and kids, former NFL quarterback Alex Smith had it all. Until he didn’t. In 2018, Smith sustained a leg injury on the field that fractured his tibia and fibula in multiple locations. The harrowing events that followed—a life-threatening infection, 17 operations, mental struggles and significant pain—changed the trajectory of Smith’s life. In my recent interview, the father of three openly shares his rocky but resilient journey as well as his Pain Game Plan partnership with Vertex Pharmaceuticals and his aim to empower everyone to advocate for their own physical and mental wellbeing.
Necrotizing Fasciitis
Alex Smith's right lower leg developed necrotizing fasciitis, a rare and life-threatening infection. ... More Redness, swelling, pus and dead (black, necrotic) tissue seen here characterize this 'flesh-eating' diseaseAlex Smith
After the initial surgery, Smith developed an infection of his right leg. Post-operative infections are not uncommon. Among the multiple fractures endured by Smith was an open or compound fracture where the bone pierces through the skin, and is associated with an increased risk of infection. Unfortunately, the former broadcaster was diagnosed with necrotizing fasciitis, a rare, ‘flesh-eating’ disease commonly caused by Group A Streptococcus or Staphylococcus bacteria. Without immediate treatment including intravenous antibiotics and surgery, Smith could have lost both his limb and his life.
“The initial emergency surgery on the day of the injury went well. I needed to stay a couple of days for observation and then go home,” recalled Smith. But his leg became infected and he developed sepsis. “I never made it out of the hospital.”
Over the subsequent weeks and months, Smith underwent a total of 17 surgeries including nearly daily debridements to remove the infected tissue and limb salvage procedures. Today, Smith’s leg looks very different but he has it and it’s functional. He knows he’s lucky to be alive.
“It was a crazy couple-year process and somehow I ended up running back out on the field and playing quarterback again,” reflected a grateful Smith.
Dealing With Pain
Alex Smith underwent 17 surgeries and nearly two years of rehab to save his limb and his life. ... More Post-op repair including multiple skin grafts are notable in his right leg.Vertex Pharmaceuticals
Smith did not anticipate such a prolonged and complicated rehabilitation process. The former Kansas City Chiefs quarterback underwent nearly 20 surgeries, all very different, and all associated with varying types and degrees of pain. He also had to wear an external fixator or “steel cage” that was bolted into his right leg for nearly a year. “Life goes on,” reflected Smith who danced at weddings with a steel cage on his limb. Pain was always there but never discussed. When he was discharged from the hospital, he was given a “bag of pills and a rescue medication” without any explanation from his care team, according to Smith. He and his wife were scared.
“Pain is so universal. It overwhelms you. You marinate in it, it’s hard to escape,” explained the TED speaker. He felt guilty asking for relief. Looking back, he wished he had conversations about pain management with his medical team.
As an addiction medicine specialist and former primary care doctor, I have cared for many patients with pain. But I learned very little about managing pain during formal medical training despite it being one of the most common symptoms we experience. Pain is poorly understood, undertreated, inappropriately treated or not treated at all. Like Smith, many people with pain feel guilt or shame asking for relief.
Treating Pain Safely And Effectively
Pain affects different people in different ways. It varies in form, onset, duration and location. For all these reasons, treatment strategies must be tailored to each individual. Doctors should set treatment goals and expectations. Clinicians should use a step-wise approach when managing pain. Most pain improves with conservative, non-pharmacologic management such as heat, ice, exercise, massage, physical therapy, yoga and acupuncture.
Pharmacotherapy includes different classes of medicines such as over-the-counter NSAIDs and acetaminophen; topical agents (e.g. lidocaine, diclofenac); antidepressants (amitryptaline, venlafaxine); or antiepileptics (pregabalin, gabapentin). If these tools are not effective, opioids such as oxycodone or morphine should be considered. The prescribing physician, NP or PA must review risks and benefits, side effects and monitor clinically with follow-up visits. The opioid overdose reversal agent, naloxone, should also be prescribed as it was for Smith.
Procedures and devices can also be used to manage pain such as steroid injections, nerve blocks, transcutaneous electrical nerve stimulation (TENS) and surgery. Guided meditation and cognitive behavioral therapy can also provide reduce pain.
Mental Health Manifestations
Pain and mental health conditions such as depression and anxiety are often associated.getty
“The physical journey IS the mental journey,” emphasized Smith. The NFLer was in a wheelchair for months. He felt confined, physically limited and depressed, all the while dealing with ongoing pain. “I was not in a good place mentally,” Smith confessed.
Smith is not alone. Studies show that pain and mental health are closely connected. An estimated 35-45% of people with chronic pain experience depression. Anxiety and other mood disorders commonly occur at the same time as chronic pain. As Smith pointed out, pain is so universal. But too many people are suffering in silence. This needs to change.
Strategies Moving Forward
In hindsight, Smith would have had conversations with the medical staff, and he encourages everyone with pain to do the same. I agree completely. “There are no dumb questions,” Smith pointed out. As an NFL quarterback, he recognizes the macho, masculine stereotypes associated with his profession, but they act as obstacles to getting proper care. “I tried to live up to the image of a ‘tough’ football player. It’s so unhealthy.”
Smith strongly encouraged people to ask for help. He pushed back against society’s expectation of a person needing to toughen up.
“In this country, we love this idea of rugged individualism. But no one does anything great alone. Nobody. I am the product of amazing teammates and teams that changed my life, including the military that changed my rehab.”
Smith’s advice on teamwork and leaning on others strongly resonates with me. A common motto in my field is that the opposite of addiction isn’t sobriety, it’s connection. We need to lean on others to get stronger, healthier and happier. Asking for help isn’t a sign of weakness; it’s a sign of strength.