The Conundrum of Pain…and Suffering: Part 1.

~ Roger JG Albert

I’ve been thinking about writing this piece for a long time. It’s only now that I figured out how I wanted to organize my narrative. It’s complicated because there are so many aspects and approaches to both pain and suffering. The medical profession (and the medical ‘industry’) has its clear claim on the alleviation of pain and suffering. Philosophers and psychologists have also long been interested in the topic. Sociologists too. I won’t be quoting any sources this time. I will leave that for subsequent posts where I deal with specific scholarly and popular approaches to pain and suffering. To start, I want to suggest why I find pain and suffering of interesting.

Pain is not something that can be empirically determined. It cannot be objectively measured as far as I know. If you know otherwise, please let me know. That’s why doctors (MDs, that is) sometimes ask you: “On a scale of 1 to 10, how bad is your pain right now?” You answer: “Gee, I don’t know.” And you just throw out a number because it’s such a hard question to answer. You don’t want to say 2 because then what the hell are they doing in their office? You don’t want to say 10 unless you’re writhing in pain on the floor by the examination table. A 7 is usually good for attracting attention without getting ‘the look’. Still, your doctor may be wary.

You can look at anyone, I don’t care whether they have just been badly damaged in a car crash, they have arthritis, psoriasis, lumbago (don’t you just love that word?), and/or gout. You can impute that they’re in pain, but it’s not visible. Pain is not visible. You cannot see pain. It hides in the crevices, nooks and crannies of your body but nobody can see it so how do we know it’s really there? We may see a person with a massive slashing knife wound to the chest and we assume that person is in pain, but we never see the pain so we don’t have any way of determining its intensity or how much shock or other factors have mitigated or attenuated it.

Recently we (Carolyn and I) spent some time in a hospital emergency department because Carolyn needed an emergency appendectomy. All is much better now, but it was obvious that the medical staff were at a loss the first time we went to emerg (that’s what they call it, you know) to figure out what the cause of Carolyn’s pain might be. They may have even wondered whether or not her pain was psychosomatic. They poked and prodded her, took blood and did a CT scan. Nothing of significance was found. I don’t know what the staff thought at the time. They told her she was a conundrum and looked great on paper. In any case, we were sent home with instructions to take antibiotics, pain killers, etc. When over the next few days the pain got worse for Carolyn we went back to emerg after Carolyn was told by her family doctor that she had a classic case of appendicitis. After a few more hours sitting in waiting rooms and getting more tests including a second CT scan, it was determined that indeed, Carolyn had acute appendicitis (which we subsequently found out was evident on the first CT scan). Time for surgery for a ruptured appendix. This entire scenario was upsetting and did not need to happen. Surgery after our first visit would have been routine and we probably would have come home the same night. As it stood, Carolyn spent two days in the hospital recovering. Now, this was all nasty and everything, but I have questions about the presence of pain as Carolyn described it and the CT scan that showed an inflamed appendix. Did they operate because of the pain or because of the CT scan? The CT scan confirmed that there was an organic problem and the assumption that Carolyn was in pain may or may not have factored into the decision to operate. I’m not sure how that works.

Pain is not something that is determined objectively so how are medical personnel to know whether a person is in pain or is faking it? There are people out there who crave attention and will fake medical symptoms to get it. There are people who have what’s called indeterminate illnesses or diseases of indeterminate etiology like fibromyalgia. Some medical doctors and others associated with medicine still don’t believe that fibromyalgia is a thing. They argue that if only you’d relax, your pain would go away…that’s if you ever really had pain…wink, wink, nudge, nudge. It’s a tough call because pain is not visible. People may be grimacing and walking abnormally, and we assume they’re in pain, but we just don’t know for sure. There is probably more attention given to determining the etiology of pain in regular and emergency medicine than anything else. Guesswork has to play a major role along with targeted questioning. “Does it hurt here? No. Here? No. Then what about here? Okay, here then! Well then, we’ll just peel you off the ceiling now and figure out what to do for you. You will definitely need some painkilling meds. Get that IV hooked up. It’s certainly true that pain alone cannot trigger surgery. Just because I tell a doctor I’m in pain, that doesn’t justify her throwing me straight into the operating room. Subjective reports of pain must be supported by evidence of organic abnormality, or is it the other way around?

Killing pain is huge business. We don’t seem to like pain a lot unless we have a personality disorder and we’re masochistic. Big Pharma’s bread and butter is in killing pain. Opioids are huge business. They are used medically to mitigate physical pain symptoms, but they are also used on the street to deal with ‘psychic’ pain. [This is a topic for another blog post.]

Strangely enough, we often put ourselves through a lot of pain and suffering to accomplish a task that we’ve imposed on ourselves like running a marathon. Why run a marathon only to feel intense pain during and afterwards? What drives us to doing this kind of thing? [This is a topic for yet another blog post.]

Then, there are people, a very small minority, who cannot feel physical pain at all. They can put their hand on a hot stove element and not know that they are in trouble until they smell flesh burning. That’s not a scenario that appeals to me at all. In view of this it’s common to consider that pain has benefits in an evolutionary sense. It’s probably a damn good thing that we do feel pain. Too bad our pain is not obvious to others in an objective way. It would make life a lot less painful for a lot of us.

8 thoughts on “The Conundrum of Pain…and Suffering: Part 1.”

  1. Hi Roger, Hi Caroline. I am so very glad to know you are healing Caroline. It bloody hurts doesn’t it !!! Ruptured appendix was once a final curtain call. I had mine when I was 15 … so that was 1969 ….. It took our family doctor, who came to our house to see me, about ten minutes to figure it out and call an ambulance, and get me to hospital, and I was operated on, and out cold sleeping in bed in hospital in under 8 hours. (The onset of pain and nausea etc took a couple of hours prior to that visit, so about 10 hours.) I was there for about a week. Saw my first dead people there after having enjoyed chatting with them before they moved on. That was a big shock …. I mellowed out reading Lord of the Rings part one, and was back in school soon after, and wrote a really bad poem about the experience as if it were an epic of Hobbit proportions, and the nasty dude in the tower burning the earth and slaughtering all the small furry beings was the 2 inch burst tube that used to be in my belly ….. really really bad poem ….. No CAT scans, no MRI, no X-rays, just the rapid good old wicked painful finger prodding, temperature checking, skin pallor, etc etc, and Dr’s familiarity with the symptoms, and wham bam, cut snip stitch, and anti-biotics and all fixed. National health Doctors, and no lawyers chasing in the UK … maybe simple is better ? I dunno. “Stretching” the stitches and standing up and walking hurt like crazy … asprin and a stiff upper lip … I felt really really lucky, but maybe a good dose of ‘proper’ pain meds might have been more fun. I attended a ‘pain clinic’ for some very beneficial sessions a couple of years ago, and they used a colour scale for clients to describe the level of pain. For me, that was instant recognition. None of the 1 out of ten thinking … just instant basic eye-brain-knowing. Didn’t fix anything, but was a great visual. Yes pain is strange. It appears to be a message into our head that can be ‘instant’ from an sudden injury, and also lingering as ‘memory’ of an injury long healed. “Pain Pathways” and “Pain Sensations” can be altered by thoughts as well as by actions, and by meds. Complicated stuff to find a healthy balance…whatever that means …. “hurt, not harm” is I think a good way to think about pain. There are ‘things’ I enjoy that hurt to do, but if they don’t harm me, then that is better than if they hurt and harm me……though, at 64 already, eventually I won’t care whether the “hurt = harm” if the fun meter is peaking : ) Which to be honest, is what got me into chronic pain in the first place, so maybe that’s not a strategy worth sharing.

    Be well. I really enjoy your posts Roger. Good thinking. Good challenges to old habits of old pathways of thinking. Thank you : ) Hoolz

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    1. Thanks for this comment John. Carolyn has definitely experienced a nasty couple of weeks, and it’s not over for her yet. the appendicitis seems to have triggered an arthritic flare-up. Now she has another kind of pain to deal with.
      I find it fascinating that the event that could have easily ended my life, kidney cell cancer, was not accompanied by any pain whatsoever. The surgery to remove my kidney, however, has left me with ongoing pain and discomfort. Go figure.

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  2. Cute pain story? I had surgery a few years ago and post surgery pain was managed very well by an epidural drip of some amazing drug that required 2 individual hospital staff to re-fill or adjust the dose. I am guessing that the black market value of this drug is pretty high! The nurses at first would check in every 4 hours or so and ask how my pain was and would ask me using the same 1-10 scale. I was always comfortable and usually answered in the 1-2 range. I liked the attention though and the nurses running an ice cube all over my body to determine the extent of the drugs numbing affect, so my answer was always a carefully measured response. When it was time to leave the epidural had to be removed. If you have never had one, it consists of a needle inserted directly into your spine and then the drip line secured to your body so you can roll around on it while sleeping with no fear that the needle will move and the tube get a kink. Lets emphasize that the doctors did not want this to move and they had it secured very well – using tape much stronger than duct tape. Enter the nurse to remove the epidural. Her first memorable words began with, “Oh, I am so sorry” She then began to remove the tape that ran from my neck to my pelvis. My breath was taken like it has never been before. I recovered just enough to scream out “10, oh f__k, that is a 10.” Never had any cosmetic hair removal, now I know I never will, unless I get some that amazing pain killer drug ahead of time. In hind sight, perhaps they could have squeezed a few more drops out of the IV bag before removing the epidural.

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    1. Great story, Tom. Yes, when I had back surgery I had an epidural.Did you have a residual burning sensation after they tore the tape off your back? I sure did. When I had my kidney removed I had morphine, lots of it, on demand! Doctors know we’re in serious pain after surgery, but they still reacting blindly to it, not having any hard evidence of it. Pain is almost entirely subjective. So doctors can only go on what they can see as the effect of injecting painkillers or pulling tape off of your back! It’s all quite fascinating to me.

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  3. There is a massive bias with women in pain. Medical professionals tend to think we are exaggerating it. Long exposure to this in the medical field has made me what one doc referred to as ‘stoic’ because I learned not to express the pain too much in order for them to take me seriously. But, then, they assume you are even in Less pain. Took me ten years to get treatment for fibromyalgia, which didn’t bother me much because my case is moderate and pacing helps a lot as long as avoid certain types of work, more office jobs. Only with migraines did they actively try to treat it.

    With the opiate epidemic now, people are getting their meds taken from them or not put on opiates at all. But pain is complex. And they literally have no substitute for opiates often or a plan in place or anything. Which has led to a lot of suicides in the pain community. Untreated pain, well, it is soul-sucking. But there are a lot of strategies to utilize that help, often with opiates… like meditation, exercise, and for me Botox for migraines. Tons of things to do.

    One thing I have learned from chronic pain is that pain and suffering are different. I cannot control the pain signal itself, without the assistance of medications. But suffering, well, is our emotional and mental reaction to pain and that is the only thing we have some control over. Things like meditation help with the perception of pain, not the pain intensity itself. But literally, anything that helps with our suffering is something I’ll do to help me cope with the existence of pain.

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    1. Thanks for your comment, Nikki. With Carolyn, I swear it was ageism. I could just sense in the hospital the attitude in some of the staff that “Jeez, another old lady complaining about nothing.” Most of the nurses and staff were fine, great even, but the odd one was very dismissive and that tends to colour the entire experience.
      Pain is complex, as you say. I have multiple sources of pain. If people ask me how much I hurt, I have to ask “in which body part?” and ‘When?’ The area where they removed my kidney is still tender after 16 years. I have arthritis in my hands and feet. I need T3s to sleep at night. But I look good! People tell me that all the time.
      What really fascinates me are the socio-cultural aspects to pain and our reactions to it in certain people. Pain experience and the medical ‘industry’s’ obsession with alleviating it has had some serious consequences for some demographics more than others. I think in some measure it’s a class issue.
      I must say that it’s got to be really tough being a medical doctor and someone comes into the office complaining about pain. She can’t see it, has not idea of its intensity and even if it presents in the upper thorax, could originate elsewhere. I know they’re supposed to be trained to deal with these issues but I can’t help but think that their ‘science’ has to be a large part intuition, empathy, and guesswork.
      I’ll address the issue of pain and suffering in another post.

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  4. I have way too much to say on this topic. I’ll try to keep it brief.

    Firstly, I always encourage people to send in complaints/concerns to the hospital. It is disconcerting that now it flows through Victoria before it arrives at our hospital. But I discovered that writing a letter to the editor just encourages others to chime in with their stories, not that that isn’t an important to be able to do, telling our stories. But registering a complaint/concern forces them to have a review. I really think Caroline’s case needs a review. I am shocked that they didn’t discover the cause at her first visit, especially as the scan showed it. If protocol for seniors had been followed for my mother her bladder cancer would have been discovered in emerg in December, instead at our second visit in January when she was writhing in pain and begging “Just let me go.” But that is another long story.

    My mother had a very high pain threshold. I am a wimp. So I never questioned that her pain was real when she found out she had fibromyalgia. But I could see where others might question it because it is tricky to diagnose and, as you point out, invisible to the rest of us.

    I am interested in what you had to say about rating pain on a scale of 1-10. I used to think it was a good idea. Well, I woke up with discomfort at about 1 am on Tue morning this week that at first I thought was stomach flu or food poisoning. It took a trip to the toilet, then to the sink and finally to the floor before I realized it was a kidney stone attack. My last one was 31 years ago when I was 8 months pregnant. That old attack consisted of very sharp, unbearable, steady pain which was unrelenting and not responsive to labour breathing which I tried. Without hesitation I would have called it a 10. This time the pain was unbearable and steady, but it had a strange dullness to it. So I couldn’t give it a number. It made me quite impatient at the hospital. I was treated very well so I am sorry to say I said, “I don’t know” in an irritable voice one time when I was asked. I also found that as soon as I felt it again it was time to call for more morphine, or else it would be back to unbearable before the morphine kicked in. I was sent home at about 10:30 that same night and have been feeling better and better, still a little foggy because of meds I was sent home with.

    I did discover last year, after a bout with my shoulder, how debilitating chronic pain is. I was blessed to have it dealt with easily with physio. But I was able to observe how it can be to have chronic pain. The pain made me afraid that I couldn’t work anymore. More disturbingly I found myself constantly cross, intolerant and impatient. Hopefully I would have found ways to deal with that aspect had there been no cure for the pain. But it sure gave me a new, heightened respect for people who deal with chronic conditions. It changes your entire life.

    Thanks for your article. It’s an important subject.

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    1. Thank you, Kathy. By the way, my wife’s name is Carolyn. She’s a little sensitive about being called Caroline. 😉
      Many, many old friends still make that mistake. Don’t know why.
      Back on topic: we did complain and are still complaining. We put in a formal complaint to the College of Physicians and Surgeons and we also complained to VIHA. The hospital administration is supposed to call me in the next couple of days about it.
      On to another issue. I have had multiple major surgeries to remove various body parts. I have residual and chronic pain from all of them except my appendectomy. I’ve also torn both rotator cuffs and my left shoulder is buggered from overuse. I’m left handed, very left handed. My mobility is now seriously compromised. Oh, I can still do things, but I pay in terms of pain. I’ll being going to physio next week. I hope that makes a difference. I’m getting it scanned sometime too. Still waiting to hear from the imaging department at the hospital.
      One thing that is very interesting to me. I’m often told how good I look even though I make silly remarks like “Well, one more day above ground!” Maybe I should look sicker. I don’t know.

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