Catching up?

Well, I didn't post last night - didn't have much to say, and my recent change of job venues (working at the medical school most of the time) has really decreased my content material...at least temporarily. Now that I'm working on the weekends, however, I'll hopefully have lots of DD material for you come next week. On to the blog.

We're taught in medical school that pain is one of the most common complaints that causes patients to visit their physicians. In fact, for most men then only thing that will motivate them to visit their doctor more than pain is some problem with their genitals. I recently attended a lecture on neuropathic pelvic pain, taught by one of the national pelvic pain bigwigs and it really made me think about how we as a society view "ouchies." We're taught from a very young age that pain is bad. If you do something, and it hurts, you probably shouldn't be doing it. Obviously that's very true - pain does a much better job at educating than most professors. What we don't often think about, however, is the complications that chronic, uncontrolled pain brings. There's at least one patient per day that I see while performing Disability Physicals that lists pain as the main thing that keeps them from working. Additionally, the majority of the other applicants usually have pain listed somewhere in their file, even if it's just an "oh by the way," type of complaint. The complications of these "pain syndromes" are immense. Think about how many days of work, jobs, or even lives are lost because people are unable to manage a microscopic neuronal impulse from the brain. Throughout this plethora of pain, however, we've somehow come to the conclusion that life should be pain free, and that every little ache and ouch is an "I need Lortab, now!" type of symptom.

Who is to blame for this mentality? Is it the media? Sure they've done a great job promoting pain-relieving medication and services, but I feel they're just making said services known to the general public. Granted, knowledge is power, and according to some recent facts I read, there are many more people using "generalized, chronic pain," and "fibromyalgia" as reasons why they cannot function from day to day, but you can't (usually) blame the messenger for the message. What about drug companies? They make a nice profit off of medications, therapeutic "rubs," and one-trick ponies (Head-On, anyone?). Once again, however, they're just acting as suppliers to our collective needs. I think that when we boil it down, we as a society are to blame for the pain epidemic.

We've passed the point of viewing pain as your body's way of saying "something's wrong, fix me!" In fact, we have empowered pain itself - changing it from a symptom, to a disease. Amazingly, we've created an entire medical specialty, appropriately named Pain Management, to treat this "new disease," (personally, I don't really understand this - the specialties of Vomitology and Nose-bleediatrics have yet to be created, but who knows, maybe they're next?). The problem with this management approach is twofold. Number one: we're focusing so much on treating pain itself, that we tend to forget that if we treat the root cause of the problem, the pain will go away on its own. We're more than willing to throw Lortab at patients like candy, but asking most doctors to refer to physical therapy, perform manipulation or even do a thorough exam is like pulling teeth. Secondly, we as a nation expect to be pain free. Oh sure, it might hurt if you cut off a toe, but otherwise, you shouldn't be in pain. There's a book called, "Pain, the Unwanted Gift," that chronicles an Orthopedic Surgeon's experience with a leper colony. In the book, the author talks about how the lepers almost embrace pain, because if nothing else, it lets them know that they're alive. Now, I'm not saying that we should hold hands and sing Kumbayah every time we stub our toe, but remember, at least you have a toe that can feel pain.

The purpose of this entry was not to upset anyone that deals with pain daily. Therefore, if you are offended by what I said, I apologize. I simply was trying to state that physicians should try and fix the problem, and not just give medication to fix a symptom. Pain is, unfortunately, a fact of life - there's nothing we can do to escape that. If we acknowledge that fact, however, maybe we can better deal with it when it comes our way.

And now, the disability quote of the day:

Me: "So you say that your carpal tunnel made you depressed, and now you can't work?"
Man: "Yeah, I had a great job. I would move the mouse, and my friend would type. But then I got carpal tunnel, and we both got fired. So now he's mad at me, and I'm depressed."

Until next time,

-DD