PAIN, PART 1

Being in a surgeon's office this week has really made me reflect about the wide variation of pain perception. Clearly, assessing and treating pain presents major quandary for physicians- who is really in pain? Whose pain are we missing? Are we killing people by over-managing pain?

I've heard the surgeon discuss narcotic pain medications multiple times with patients this week, and the bottom line is evident: doctors often do a horrible job of screening for pain (I'll place most of the blame on a lack of tools, because there's no magic lab test or xray) but also explaining the proper use of narcotics and the risks of inappropriate or long-term use.

Narcotics are a big pet peeve of mine (not when used "correctly" of course, but even that's not well-defined). Volumes of books could be written on this subject (and have been) so ill try to be brief (and also divide this up into multiple posts).

This is a bit like discussing politics around election time, so I'll try to be as objective as possible (which is impossible)....

Some of my questions:

•  How subjective is pain? Do we actually perceive it differently than others or is there a physiologic reason? (do some people have more nerves or just better mind control?)
• Why do some people need to feel pain? People with borderline personality disorder often cut themselves, apparently (among other reasons) to feel something other than numbness or psychological turmoil.
• Can you change someone's perception?  Why does acupuncture or hypnosis work on some people? (How can people train themselves to walk on hot coals?)
• The million dollar question: how can we measure pain?
• The two million dollar question: how do we target pain without affecting the whole body, or making someone addicted to or dependent on painkillers?  For now though, where's the line between helping improve someone's quality of life and worsening it with side effects?