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The 9 myths of Pain...
This is the second in a series of articles discussing pain. In the last article we discussed “What is pain?” In this article, we want to dispel many myths our culture holds about pain.
MYTH #1
Pain must always have a physical basis
TRUTH
Pain can be physical, psychological, emotional, or spiritual. There are many
examples of pain that has no identifiable physical basis. One of the easiest
to understand is phantom pain. Many people who have limbs amputated can still
feel real and often severe pain in parts of the limb that was amputated. This
is the brain not working properly, reading nerve signals from body parts that
are not there.
But there are many common everyday experiences as well: belly pain in kids who are scared about school, many headaches in people who are stressed, emotional pain after death of a husband or wife….. The mind and spirit are very closely connected with the physical functions of our bodies.
Pain is real even if it does not have an easily identifiable physical cause. And to best control our pain, we should address all areas that might cause or contribute to our pain: physical, psychological, emotional or spiritual.
MYTH #2
High pain tolerance is good. Low pain tolerance is a weakness
TRUTH
The ability to tolerate pain has nothing to do with our morals or our character.
It has everything to do with our state of body, mind and spirit. We should
never pass judgment (good or bad) on people because of their ability to tolerate
pain. But, each of us carries responsibility to manage our bodies, minds and
spirits healthfully, allowing us to manage our pain in the best possible way.
Pain tolerance depends on many things: some genetic (what we are born with), some due to our past and present lives. People who have been abused, who have abused drugs, or who have been in uncontrolled chronic pain for long periods of time are extremely sensitive to pain. This is because they have damaged pain pathways in their brains. The pathways are worn out and the normal gates in the nerve system that can help block pain are broken or burned out. This makes pain signals pass much more easily and makes the experience of pain much worse.
MYTH #3
Acute and chronic pain are the same thing.
TRUTH
Acute and chronic pain are different and people who have acute and chronic
pain look different. Acute pain leads to release of brain chemicals that increase
our heart rate, blood pressure and so we see grimacing, tense muscles, and
agitation: what most of think of as the look of someone in pain. When someone
suffers chronic pain, the body cannot sustain such a response. The stores
of these “fight or flight” chemicals run low, leading to a different response:
people become excessively sensitive to minor stresses, look depressed, tired,
and run down. Many people look at someone in chronic pain and think, ‘they
don’t look like they are in pain,’ which is wrong.
MYTH #4
Caregivers are the best judge of pain
TRUTH
Caregivers are often poor judges of pain. The only person able to judge pain
is the person who is experiencing it. This is because pain is such an individual
and subjective experience. Studies show that people ‘faking’ pain to get medication
to abuse, to get more attention, or for other reasons is much less common
than many caregivers think.
MYTH #5
Pain medication should only be taken if absolutely needed and you should hold
off using pain medication until you can’t take the pain any more.
TRUTH
The opposite of this statement is actually the truth. If you use pain medication
before or just when significant pain is starting, you need much less than
if you wait until the pain is really bad. For example, studies show that if
you use pain medication before surgery even starts, much less pain medication
is needed after surgery.
MYTH #6
Pain medication should only be prescribed as needed and only for severe pain
TRUTH
Again this is wrong. If significant pain occurs at all times, then pain medication
should be taken regularly, “around the clock”, at scheduled times. This prevents
the pain from getting worse and in the end, less pain medication is needed
to achieve the same effect. Also if you catch pain before it becomes severe,
you will need less medication and have less side effects.
MYTH #7
Patients who watch the clock to get their pain medication are addicted
TRUTH
Patients who watch the clock are usually not appropriately treated. This means
that they are either not getting enough pain medication or their pain medication
is wearing off too soon. This is often a result of using only “prn”, or “as
needed” pain medication as opposed to “around the clock” pain medication for
those in pain at all times. If patients are addicted to pain medication (see
below for definition of addiction), then using only “as needed” narcotics
for pain control not a good treatment plan.
MYTH #8
Use of regular narcotics (opioid pain medication such as morphine, Oxycontin,
methadone, Duragesic….) always causes addiction
TRUTH
Addiction is defined as the continued use of a substance (or drug) with the
knowledge that the substance is causing harm. The obtaining and use of the
substance is often erratic, illegal and for reasons other than intended by
prescribers (ie getting a high as opposed to controlling pain). Narcotics
rarely lead to addiction if prescribed and taken properly.
Narcotics do cause dependence which means that stopping them abruptly will
lead to withdrawal side effects. They can also sometimes cause tolerance which
means that a person taking them will require gradually increasing doses to
achieve the same effect (similar to alcohol). Dependence and tolerance can
be treated by gradually tapering the medication (stopping it slowly by lowering
the dose every few days).
MYTH #9
Tolerating pain makes you stronger.
TRUTH
Although suffering can lead to building strength of character (Lance Armstrong
states he is an example), suffering chronic pain for long or indefinite periods
of time almost inevitably has the opposite effect. People who “grow” from
periods of suffering almost always suffer for defined periods of time with
an end in sight. Suffering chronic, indefinite pain makes you weaker. Uncontrolled
or unmanaged chronic pain destroys healthy brain functioning (burns pathways
and destroys the normal protective “gates” that block pain) and makes us more
sensitive to minor painful insults in the future. Managing pain aggressively
and early by building strong psychological, emotional and spiritual lifestyles,
as well as appropriate use of therapies including medication, helps makes
us stronger people for the future.
This is one of a series of articles from the Community Coalition on End of Life Care: a group of North Country individuals and organizations working to improve quality of life for those suffering from chronic, life limiting conditions….
Related Article: Assessment of pain and pain
scales
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