Saturday, November 2, 2013

Pain Fallacies

„And pain is all around” ~ Simon & Garfunkel, Bridge Over Troubled Water
Rheuminating pain / As fog and rain return / But the foliage ~ Haiku

The most stupid thing a physician can do, when treating pain patients, is to doubt pain. Pain is a subjective feeling and only the person experiencing pain can tell you if it hurts, where it hurts, and how much it hurts. Doubting pain hurts, too!

1st Fallacy: “I don’t see anything on the X-ray!” – so you shouldn’t complain about pain. I call it the orthopaedics’ fallacy, because lots of patients with low back pain encounter such an attitude. But there’s another trap: any degenerative sign in an X-ray chart may serve as an explanation for pain; often too easy an explanation for chronic pain, which is complex.
2nd Fallacy: “But there’s no inflammation!” – and so you shouldn’t complain about pain. I call it the rheumatologists’ fallacy, because that’s a trap we might fall in. Sometimes inflammation is below detection limit, sometimes we haven’t used all technical equipment like high frequency ultrasound or MRI. Sometimes there isn’t any autoimmune driven inflammation, but there might be pain due to mutilations or post arthritic osteoarthritis. All need extra care!
3rd Fallacy: “If there’s pain, there has to be something wrong!” I might call it the chronic pain fallacy. It’s a trap for physicians and patients as well. After a good diagnostic one shouldn’t turn to more aggressive diagnostic procedures, as this might more harm than yield results. Chronic pain is a disease of its’ own, which gets worse, when there’s input by acute pain, but which doesn’t need this input to hurt badly all over. A good example is fibromyalgia.

Some pains are due to undetected inflammation and need more anti-inflammatory measures.
Some pains might need a change of drug.
Some pains might need a change of attitude.

Let us physicians keep in mind to believe in the pains that patients bring to us!

1 comment:

  1. Thanks for this - I can relate to #2. Earlier this year I had a big change in my pain - caused my ESR numbers to triple! But because they went from 2 to 6, my rheumy wasn't even aware that I had a big change in both inflammation and pain experienced. Thankfully, I figured out the cause and was able to address the situation myself. There are a lot of fallacies out there about pain!