Pain is like the warning lights on your car’s dashboard. It
alerts you to something that needs investigation. Pain serves an
important function. It’s your body’s way of saying, “Pay
attention.”
We all avoid pain. You wouldn’t knowingly slam your thumb in the
car door or touch a hot stove. It’s human nature to avoid
situations that cause pain, and we do what we can to rid
ourselves of the pain as soon as possible — such as taking an
aspirin for a minor headache.
When your pain is severe enough, or worrisome enough — or lasts
long enough — you find yourself in your doctor’s office. Then,
ideally, you and your doctor figure out what’s causing the pain
and fix the underlying cause. The most satisfying encounters for
both you and your doctor occur when the pain points to a clear
diagnosis; you’re treated and the disease is cured. A good
example is a cough and pain in the chest when taking a deep
breath leading to the diagnosis of pneumonia that is cured with
antibiotics. But not all pain is solved that easily.
Each of us tolerates pain differently — even pain from the same
cause. Surprisingly, the patient who would complain the most
bitterly when we injected a local anesthetic that tended to burn
a little was not the frail 80-year-old grandmother, it was the
strapping 25-year-old body builder who said he “wasn’t afraid of
nothin.” Those are also the patients most likely to faint when
blood was taken.
As a surgeon, I did many “lumps and bumps” operations. Depending
on the patient’s tolerance for pain, I could perform the
procedure in my office or in the operating room, where, among
other things, sedation was available. It usually was clear
whether a procedure could be done in the office or required the
support of the operating room staff.
Then there were the judgment calls. It could go either way. If I
looked at the top of a patient’s head and saw orange or red, the
patient would go to the operating room. My experience supports
the thinking that redheads are more sensitive to pain.
How do you get pain to move from “pay attention”‘ to “problem
fixed?”
Your doctor needs help from you when your “pain light” flashes
on. There is no way your doctor can measure your pain. Sure we
can check your heart rate, which tends to beat faster if you’re
in pain, or your blood pressure, which also rises. Clues like a
fever or a high white blood cell count that can point to the
cause of the pain; they don’t measure your experience of the
pain.
Only you know what your pain feels like.
Sometimes the cause of the pain can be identified before the
doctor even sees you. The broken bone on an X-ray, abnormal blood
thyroid level or malignant prostate cells on a pathology slide
speak for themselves. Sometimes tests will show what is not
causing the pain: a normal EKG usually means that your chest pain
is not from a heart attack, and a normal breast exam, mammogram
and breast ultrasound suggest that breast pain is not caused by
breast cancer.
No test can exclude a medical condition with 100 percent
certainty. Or in medical lingo, tests can have “false negatives”
— meaning you have the condition even though the test says you
don’t. This is another reason you want your doctor to perform a
complete evaluation, and not just make a diagnosis over the
telephone.
Sometimes there are measurable findings that explain the cause of
the pain, but we do not know why. We doctors even have fancy ways
of saying, “We have no idea what’s causing it.”
My patient Paul was in a panic when he read about his “idiopathic
pancreatitis” in his medical record. This means that he had
inflammation of his pancreas that we could see on a CAT scan, yet
we don’t know why his pancreas became inflamed. The two most
common causes of pancreatitis are gallstones and alcohol use.
Paul didn’t have gallstones and he never drank. He was not at
risk for numbers of other uncommon causes of pancreatitis. So why
the pain?
The good news for Paul is that there was a way of explaining what
was happening, and the diagnosis guided treatment. The bad news
for him is that in the absence of knowing why he got
pancreatitis, there was very little we could tell him to prevent
further attacks. Ask anyone who’s had a bout of pancreatitis and
they will tell you that’s not something they ever want to go
through again.
It’s easy to lose sight of the fact that pain is there to serve
you. Pain is not the problem. Finding out what’s causing the pain
is the challenge.
The key for you and your doctor is to eliminate the pain, but not
ignore the message the pain is bringing. You might get medication
to treat heartburn and your pain will go away, but you may
overlook the stress at work that’s causing the heartburn. It’s
like putting tape over the dashboard in your car so you won’t get
distracted by the flashing red trouble lights.
What do you do when you have pain that can’t be explained by a
lab test or X-ray or any changes your doctor can see or feel or
hear when examining you? This can be a frustrating situation,
both for you and your doctor. If you have ever had a headache or
backache or the heartache of depression, you are most likely
nodding your head.
My advice is to become a medical detective. Find things to
measure and describe with numbers and keep a log. Here are some
measures to write down:
– Rate your pain on a scale from 1 to 10 (10 is the worst ever)
– Duration of episode (minutes/hours)
– Number of episodes per day
– Amount of sleep
– Stress level (1 to 10)
– Medication taken that day
You might have hunches about what’s causing the pain or making it
better. It might be what you eat, or your physical activity or
the weather. This can become part of your log and a springboard
for discussion with your doctor.
The next time you experience pain, listen to the voice that tells
you that pain is the enemy. Then remind yourself that your pain
is also your friend.
It’s there to draw your attention to an important message if you
will only listen.
By 2004 Vicki Rackner
