Thinking about Pain

December 22nd, 2005 by

About a year ago the Insider cautioned people to view snow shoveling as a risk-laden form of heavy lifting. Recently New England experienced a storm of surprising ferocity. I shoveled once, I shoveled twice, and then, all dressed and showered and heading out for a Christmas party, I found that municipal plows had once again closed up the end of my driveway. So resplendant in jacket and tie, I grabbed a shovel, muttered a few curses and furiously attacked the four foot wall of heavy snow.
A few days later, I could not get out of bed. In all, I spent two days literally crawling around the house, sleeping fitfully on the sofa. The pain was severe. My personal physician recommended 600 mg of ibuprofen three times a day. In doing so, he was working within the first line of defense for pain: anti-inflammatory medications — drugs that reduce redness, swelling, and pain. These drugs are NSAIDs — Non-Steroidal Anti-Inflammatory Drugs.
Here’s a little history on NSAIDS from the Pain Foundation’s very useful website:

In 1899, Friedrich Bayer and Company began marketing the first NSAID (Bayer® aspirin) in Europe. Although it is now over 100 years old, Bayer® aspirin is still sold today as a popular NSAID, because it can reduce fever, pain, and symptoms of inflammation. NSAIDs are considered to be inexpensive and are also easily accessible to patients when traveling in virtually every country. They are available for everyone’s use at the local drug store, and some are available by a prescription from your doctor. NSAID medications include aspirin, ibuprofen, naprosyn, ketoprofen, relafen, and many others.

As I began taking my ibuprofen, which I hasten to add was not all that effective or consistent in reducing the pain, I found myself thinking about stronger medications — narcotics — which, we all know, are the most powerful means of blocking pain. And therein I found the answer to a question I’ve raised a few times in this blog: Why do doctors treating work-related injuries frequently prescribe high-risk narcotics (oxycontin, for example)? Where prior speculations focused on the doctors’s brains/stomachs (free lunches sponsored by drug companies) and even genitals (hottie cheerleaders promoting the drugs), my own acute pain led me to conclude that doctors often follow their hearts. They are, in a word, sympathetic to the extreme discomfort of their patients. They reach for the prescription pad to (temporarily) alleviate the pain, while at the same time creating significant potential for lasting problems of a different kind.
My own doctor made no move toward narcotics, nor did I request any. I knew from my own research on back strains that the pain usually resolved itself in a couple of days and that narcotics should be considered a last resort. True to form, the pain lessened significantly after two days. I was moving cautiously by day three and reasonably mobile after five days.
Pain creates a world of its own. When pain is acute, it becomes the single, overarching focus of your life. When this acute pain becomes chronic, patients are at risk for extended disability. Workers comp claims adjusters are often reluctant to approve pain interventions. But help with chronic pain is often a key factor in returning injured workers to the job. Pain specialists help people understand and cope. They teach patients essential skills and strategies to help manage pain while dealing with day-to-day life. These strategies include breathing and stretching exercises or relaxation and pacing techniques. Pain intervention helps people:
1. Examine their thoughts and beliefs about pain that may inhibit or interfere with optimal functioning.
2. Review emotions, behaviors, beliefs, or relationships that could be contributing to their pain.
3. Recognize that they have control over how an experience will affect them and their loved ones.
A patient’s perception of pain is one of the biggest determinants in a successful outcome for pain management. This perception in turn may determine the structure, nature and quality of the patient’s life — including whether the individual is able to resume his or her place in the workforce.
I consider myself lucky to be back to work in less than a week. I am at full duty, if not quite fully recovered. I find myself looking at the long-term forecasts, trying to anticipate the next big storm. Once again, I will be confronted with the need to clear snow from the driveway. I am resolved to stay calm. I might even put in a last minute request to Santa for a snowblower.