This I Believe

Howard - Menlo Park, California
Entered on January 3, 2008
Age Group: 50 - 65
Themes: illness

Before my osteoarthritis began 10 years ago, I had never experienced pain which did not resolve after icing, an ace bandage, and anti-inflammatory medication. In spite of twenty years as a physician, I could never understand chronic pain in others. How could I empathize if I could not even remember my own pain 2 minutes after it went away? I pretended to understand. I listened to pain complaints with the same skepticism I felt hearing mentally ill patients describe auditory hallucinations. My firewall against understanding pain in others was reinforced by the bias that those who complained were weak, drug-seeking, or exaggerating.

I was shocked when I developed pain unrelated to an injury or an event, pain which persisted day and night, through sleep, sex, movement, and eating. My naïve assumption was that our bodies would not permit physical experiences incompatible with basic life functions. I assumed I could always return to a pain-free state. I was so frightened when these natural laws of pain were violated that I tried unsuccessfully to stop the pain completely. I over-medicated myself and developed an allergic response. At other times the analgesics wore off, and pain returned with greater intensity, especially at night, resulting in sleep deprivation and need for more medication. I even reduced physical activity to avoid exacerbating pain.

I have since learned that chronic pain cannot be mastered by trying to totally eradicate it. I now believe in feeling the pain.

Orthopedists, physiatrists, and rheumatologists did not offer much except the suggestion to take medications at maximum allowable doses. Through trial-and-error I discovered strategies contrary to the current practice of eliminating pain swiftly and totally. Minimal doses of acetaminophen—taken before pain fully emerged, reduced its later intensity. And daytime activity helped me fall sleep. A 10 minute nap diminished pain. Acupuncture helped. Eventually, I was able to do without medication for weeks.

In the past, physicians withheld analgesics for moralistic reasons. Now pain is the “fifth vital sign”: a physiological marker, to be monitored and medicated. Treatment of other vital signs, eg, elevated temperature, is often delayed in order to diagnose and monitor underlying conditions. But physicians quickly attempt to eradicate pain. Vicodin is offered before being asked if one can tolerate the pain.

As I managed my pain better I noticed examples of those who developed complications–physical and psychological—from trying to eliminate pain. A patient with low back pain developed renal failure because pain medications impaired his bladder function. A marathoner with knee osteoarthritis became increasingly disabled after continuing to run on non-steroidal anti-inflammatory drugs. An elderly man died when myxedema (hypothyroid) coma went untreated because his reduced consciousness was attributed to opiate sedation.

The benefits of feeling some physical pain can outweigh risks of masking it, and fear of pain is sometimes worse than pain itself. I now believe, as Charles Kingsley said, “Pain is no evil, unless it conquers us.” Paradoxically, pain conquers us if we engage in the struggle to totally eliminate it.