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Pain Tolerance

Posted Jan 24 2011 1:47pm
My favorite scripture is Luke 9 24-25 "For whosoever will save his life shall lose it: but whosoever will lose his life for my sake, the same shall save it. For what is a man advantaged, if he gain the whole world, and lose himself, or be cast away?" My favorite line from a movie is, “Life is pain, highness, anyone who tells you differently is trying to sell something.”

Lately, I have been thinking about pain tolerance. Recently I had a patient who was generally not tolerant of any inconvenience in his life. He was impatient and angry when I first met him. He contacted me upset that he couldn’t get his CT scan the same day. We found a stone which was not obstructing his kidney and therefore should not have been causing significant pain. His pain, however, had been present for years in a location separate from his kidney. I explained that treating his stone might not resolve his pain. He could not accept this. I scheduled surgery and eventually successfully pulverized the stone with a laser and told him that he would now pass the small pieces. Two days later I got a call from a hysterical patient that had become unhinged (10 times worse than becoming unglued) As I listened to the wailing over the phone I felt bad and arranged for him to come in to be treated for his pain. But I was left to wonder why he had reacted so violently to something that generally is not that painful for most people.

Often, people will exclaim to me that they have a high pain tolerance as they are asking for more narcotics. The degree of their reported pain does not correlate with their clinical presentation. My first reaction is to wonder why some people tolerate pain so differently from others. Over the years I have found a non scientific correlation between certain personality traits and pain tolerance. Those who are impatient, demanding and overly critical often are upset when a solution to their problem cannot be resolved instantaneously. These individuals also don’t tolerate pain well. They cannot abide loss of control in their life. Medical care has its flaws. It is not always immediate. There are many things we cannot fix. Some pain cannot be relieved, even with strong narcotics. Many will suffer despite are best efforts.

What is pain tolerance? I view it as two different responses to a given noxious stimulus. First, it is the way in which we perceive the pain. This is measured in a subjective quantization by our brain relative to the physical injury or insult to our body. Second is how we respond to the perceived pain. To what degree can we suppress the impact of the pain on our consciousness and continue to focus on the task before us. The difficulty is that we can only judge one person with and any true credibility; ourselves. When someone tells me that they are in pain, I always believe them. Who am I to say, “That does not hurt.” However, it is clear that a specific fixed source of pain stimulus will evoke a wide variety of responses from different individuals. One might continue to work while another will be in the hospital on intravenous narcotics.

Yet, how someone will respond to pain is not completely unpredictable based on how they handle others aspects of their life. People who are intolerant, feel entitled or tend to blame others for any problem in their life also tend to blame others for their pain. Our society raises us with the notion that all pain is avoidable and that if we experience pain, someone is culpable and, ergo, owes us recompense. Yet, there are many others that see beyond their pain. They accept it, manage it and work to overcome it. Their positive outlook is more potent than Percocet. They combine faith and science with hope that they might emerge, maybe not pain free, but whole. They accept their new normal and move on.

Some pain is acute and may last for a few seconds or a few weeks. Some suffer pain every day of their life. It never goes away. This is the worst. My heart aches for these.

Some pain is not physical. Emotional pain associated with loss of companionship or isolation, even within a relationship. Spiritual pain associated with guilt and thoughts of worthlessness. Depression deprives so many from enjoying even a little beauty in their day. We feel pain in so many ways. I want so much to alleviate pain from peoples’ lives. As a doctor I can treat the source of their physical ailment. But so much more is needed. Beyond healing the body, I can help heal the soul. First, I must listen, without judgment. Second, I must offer hope.

Last year I had a patient who was very sick. He wanted to die for the last five years since he lost his wife. He argued, “Why should you treat me? Just let me get sicker and die.” He had nothing to live for. As we spoke I knew that the only remedy was for him to lose himself in the service of others if he were to save himself. We spoke of what he could to help other people. Finally he commented. “For all this time I have been preparing to die when I should have been preparing to live.” He smiled and I saw the flicker of hope rekindled.

Life is pain. We can’t always remove it. But we can lose ourselves in the service of others to save ourselves. From Him that suffered all things comes our hope and our tolerance of pain.

Kevin
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