| Overcoming Pain |
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Have you ever wondered why we have a pain sensory system? When you hit your thumb with a hammer or stub your toe in the middle of the night you may question the blessing and the benefits of pain, but pain serves a very important role in the management of our bodies.
Dr. Paul Brand was a world-renowned hand surgeon studied the effects of leprosy first in India and then later at Carville, Louisiana leprosarium. Today, because of his work, we know that the superficial nerves of leprosy patients are damaged resulting in an inability to feel pain. This fact was not yet known early in his career when the accepted medical recommendation was not to operate on leprosy patients because they were poor healers or had “bad flesh”. With careful observation and post-operative follow-up, Dr. Brand realized that it was not an inability to heal but an inability to feel that resulted in poor surgical outcomes. He carefully followed his patients post-operatively, mapping out any new wounds or blisters, and acquiring historical information in non-healing patients. In one case of reported impaired healing he found one young boy using a hoe all day in the fields with an exposed nail digging into the surgical site in his palm. Another with a non-healing ulcer of the foot would walk for miles to have the wound cleaned and debrided and without a limp or pain signal he exposed the ulcer to continued repetitive trauma again walking home. Amputation was planned for this young man until Dr. Brand realized that it was the repetitive trauma of walking that needed to be removed and not the man’s foot. Once the traumatic exposure was identified and removed the wounds healed and they young man’s foot was saved. Pain is our first line of defense in a dangerous and imperfect world, notifying us of an immediate problem and demanding our attention. It protects us from injury and damage, signals areas of need, and protects us from repetitive injurious stresses. In fact, the reason that pain is so unpleasant is that it tells our brains to STOP! Stop what you are doing to avoid further injury and seek immediate attention. When my son falls from his scooter and injures his knee he reflexively moves his knee to a safer position, next he senses pain in the knee, and then based upon the extent of the injury, who is around, and the amount of blood forms a conscious reaction to the pain. If his friends are nearby he will act tough and resist the tears, if he is tired and mom is watching the tears and drama follow. Pain acts both locally, often triggering a reflex to prevent further injury, and centrally in the brain where the signals are given meaning. Suffering is our emotional interpretation of the pain and its perceived cumulative affect on our circumstances. The perception of pain and our emotional response is influenced by a number of factors including family environment, stress, perceived purpose, self-image, sleep, culture, and world-view. It is important to recognize and separate out our emotional response and fears from the cause and ultimately seek out a solution. Today we often ignore pain and worse yet attempt to silence its signals by taking medications before finding the cause. Approximately 35,000 metric tons of aspirin are consumed annually both for pain and now for heart disease. An additional 30 billion Non Steroidal Anti-inflammatories (NSAIDS) are taken annually in the US alone and approximately 37,000 metric tons of acetaminophen or Tylenol. We seek to block the pain so that we can move on with our busy lives. Pain has become a four-letter word in our medical culture and was recently elevated to the fifth vital sign to be acquired and recorded in every patient encounter. While pain is a threat to our quality of life and should be addressed it is our approach to pain that is concerning. Pain is often viewed as a sinister adversary that must be defeated in our quest for a pleasurable life. We ignore it, medicate it, rub it, heat and ice it, and wrap it, inject it but rarely do we stop and seek out the cause of our pain. Once we begin to view pain as an enemy and not an ally we will miss out on its important warning messages and by lending a deaf ear may cause further damage to the ailing body part. Silencing the pain without identifying the cause would be like cutting the wire to the check engine light on your car and continuing to drive blissfully and naively until the engine seizes! It is imperative that we learn to listen to the message and act on the cause before treating the symptom of pain. The first step in pain management should always be clarifying the cause. Simple questions such as, “Why do I have pain and what is the underlying cause?” will highlight areas that should be addressed. The next step is to look for a long-term solution to the problem and potential treatment options that promote healing and not just pain control. Unpacking the message of pain can be much like peeling an onion. Multiple layers may need to be carefully and thoroughly addressed before the problem is fully resolved. The immediate message localizes the most pressing and important problem but may not completely identify the cause. Sherlock Holmes once said, “In solving a problem of this sort, the grand thing is to be able to reason backwards. That is a very useful accomplishment, and a very easy one but people do not practice it much. In the everyday affairs of life it is more useful to reason forward, and so the other comes to be neglected. There are fifty who can reason synthetically for one who can reason analytically.” (A Study in Scarlet; Sir Arthur Conan Doyle 1887) The ultimate goal in managing pain and disease is to find and treat the cause, not just silencing the pain alarm, but working to promote healing, regeneration, and restoration of the injured body part. A nutrient dense diet, body balance, exercise, and stress reduction are the pillars that support a healthy, healing body. Sometimes the body may require some assistance in the healing process and treatments like prolotherapy or PRP are necessary to "jump start" the healing process. |
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