This is something I brought up on the TN listserv. I originally got inspired to think about this from a book about pain.
The author of that book was trying to recall an episode when she was in pain. Even the day after, she was having trouble recalling the perceptions of when she was in pain. There was the suggestion that we are designed to forget your pain episodes.
A psychologist wrote a letter saying that medications for pain can actually make the pain worse. It was about muscle pain, and didn't mention if it also applies to nerve pain. I just worried that it would make some doctors hesitant to prescribe pain medicine for people that need it.
There was also a line that made my blood boil:
"Opoid tolerance is a red flag for induced abnormal pain sensitivity." I initially thought it meant that getting tolerant to pain meds indicated that it was more mental pain (thinking you're in pain when you're not).
Later, I thought it made a bit more sense. I am tolerant to a lot of things. If it's a new medication, I'll develop a tolerance over time. But I've mentioned before that have an abnormal pain perception - breaking bones and not feeling the pain. I'm curious about how I'd tolerate labor - but I'm not willing to deal with the consquences of what comes after labor (a child).
So the quote if it means that abnormal pain sensitivity means that pain elsewhere is decreased, I'll be happy to agree with that.
Since I have pain-free days/weeks, when I am in pain I wonder if it's as bad as it used to be. When the pain would be at its worst I'd be alternating between shutting down in a sleepish mode so that at least I wasn't perceiving the pain and when I'd wake up I'd be throwing up anything in my stomach or dry heaving if my stomach was empty. To try and stop the throwing up cycle, I'd do IM injections of Zofran.
The nicest thing about injectable Zofran was that it was completely covered by my insurance - I only had to pay for the needles.I only shut down when I'm in pain. I haven't had the urge to puke yet. But the pain is still pretty bad. But when I try and compare how bad it is compared to what it was, I have a hard time doing so. So I start relating it to my physical reactions to the pain (shutting down, naseua, vomitting, how I hold my head, etc.)
When I'd be admitted for pain management, they always asked the annoying question: "On a scale of 1 to 10, how bad is your pain?" I used to think it was on a scale of how bad it can be, what is your pain. I would answer a 9. Because I was sure that if I had perforated my intestine or was stabbed in the belly, the pain would be even worse.
First of all, if I was sobbing, saying that my pain was a 10 and begging for drugs, they'd treat me as a junkie. But reading the fine print on a wall sign one day when I was in the ER for a friend, it asks to rate your pain based on your experience. But then again, I'd probably say "9" because it might have been worse at some point in my life since I can't quite remember how bad the pain was in the past.
So if you forget how bad the pain was in the past, how can you compare your worst pain to the pain you're in now? It seems like a flawed system.
While I'm happy that asking how much pain a patient is in is something that is documented, is there a better way to measure pain? Part of the problem is that it's something that you can't measure with equipment (like pulse and blood pressure), but you have to rely on the patient.
Perhaps someday there'll be an easy way to hook up a patient to a machine and see how much pain the person is in. Would it work if the person has an abnormal pain sensitivity? Perhaps I should investigate a new field of research....
The other thing I wonder with pain is that when I'm in a pain episode, I don't perceive the pain when I sleep. I should really call it "shutting down" because when I'd wake up, I'd feel that I could use another 8 hours of sleep. But it also makes it difficult to interrupt the start of a pain episode because I might move for a reason which will wake me up enough, and then I'll get slammed with the pain that has probably been going on for hours. Shutting down is a great way to survive without suffering through the pain because only if it'd start zapping with brief moments of intense pain that I'd wake up, but then go back into shut down mode when it'd pass.
I've tried things like biofeedback and self-hypnosis to try and visualize the pain and separating myself from it. I still don't have a physical form that my pain is when I try this. Then if I get a zapper moment, it pulls me out of that state, and I have to start over. I hope someday I can see my pain as a physical form - it should be easy then for me to visualize myself creating a distance from my pain.
Has anyone been able to see their pain as a physical form of some kind? Do you guys think that we are programmed to forget the intensity of pain experienced in the past?
