Friday, February 11, 2011

Thoughts about pain, pain relief, and life

I recollecting this from a decades old reading experience, so forgive the lack of details. One of the first books in Larry Niven's sci-fi Ringworld series described a spaceship crash into the Ringworld "universe" and the effect the crash had on its occupants.

One of the space travelers was a sort of rich elitist Paris Hilton type character who, in the fictional far-off future, had led a life where she never experienced any significant physical pain.

The crash landing had left her with a sprained ankle, and to the character the experience of this pain was profoundly shocking-- as the story sets the scene, the cushy far-future robot-protected, near-programmatically perfect life of this character was so well insulated that it precluded any event that could result in physical injury.

So during unfolding of the story that followed, the pain of a sprained ankle in and of itself was something of a challenge for this character, but the realization that life could even contain events that could result in such debilitating pain was a life-altering, shaking revelation for this character.

Now, in real present-day life, we of course experience some kind of pain on a daily basis. A sprained ankle can be a significantly painful event: not ordinary pain, but it doesn't provide any life-altering realizations. It is more of an "oh, shit" event. "Oh, shit" because you recognize that, for at least a little while, you're going to have to deal with this pain and maybe even have to adjust your plans around whatever temporary inconvenience the treatment for it presents, but at the same time life will go on and you'll be expected to keep up.

But it is interesting how the same sort of painful event can effect different people. Sometimes, something painful happens to someone and they start to tell you about this, and you might be moved to say "Oh, come on, suck it up: it is not that bad" and other times you are moved to sympathy because of the severity of the event.

What is interesting is that medicine can provide an amazing amount of pain relief. We routinely undergo operations where anesthesia renders all kinds of awful invasive wounding to go completely unfelt. We may be injured in some sort of really bad accident, and the body's own reactions cause the pain to be diminished, and then whatever emergency medicines cause the pain to mostly go away altogether.

But the pain that is most problematic is the pain that goes along with just being alive and generally active, where various stuff happens that makes you hurt to the point where you are not exactly yourself anymore.

For example, I have some problems with back pain due to some lumbar discs that were deformed because of a long ago car wreck. I have some additional problems with my back due to muscle spasms that have occurred off an on throughout my life, since I was 12. Then not too long ago, I mention somewhere in this blog, I broke my femur just below the hip.

So I have pain and stiffness on a daily basis due to these individual issues and due to their combination. I have to think a little before I stand up after sitting for a while, and I have to roll over in bed in a careful manner, to avoid stretching out my back musles in a way that will cause them to spaz.

Now, if you dont' have any back issues, are "normal" in that regard, and if my conditions were somehow magically transplanted into you while you slept, you'd probably wake up being pretty uncomfortable. Like the character in the story, you'd all of a sudden have these new life challenges that would make you uneasy about everything you do, something happening that never happened before-- you didn't get a chance to adapt to them over time, like I have.

You might go to your doctor and say "I woke up and all kinds of things were wrong with me, I hurt a lot". Among other things, like getting an MRI or an x-ray, your doctor might prescribe some pain medicine for you to "get back to normal" and that would be good, and it would probably help.

We have various remedies for pain in our society. At the same time, we also have penalties for "being a wimp", for complaining about those pains that are considered "part of life". We also have ways of expressing or identifying ourselves as "pain tolerant anti-wimps": tattoos, piercings, tough fashions and hard attitudes.

I think it is fair to say that the amount of pain that you consider as "part of life" defines the social class you identify with in a big way. When you are injured and you go to the hospital, you may be asked to rate the pain you're experiencing on a scale that is completely subjective, where the lowest is "no pain at all" and the highest is "the worst pain you've ever felt". But I'd have to say that a lot of people, including myself, would be hard pressed to remember a time when they felt "no pain at all" in their natural state. I am always experiencing some pain, but it is at a level where (I believe, anyway) that it does not affect me unduly.

One of the reasons I'm thinking and writing about this is because of the news stories about medical marijuana, the people that go through what they do in order to become eligible for treatment with it, and also thinking about the issues with pain treatment in general and the situations a person who is dealing with pain deals with.

If you hurt, and someone asks you to do something, you are slower to respond. You are not slower to respond because of how you feel about them or because of what you are being asked to do, but because of how you feel. If you are being treated for pain, there can be the perception on the part of those around you that you are somehow being "coddled".

So, the combination of seeming to be less willing to "pitch in" or seeming to be somehow less fully engaged combined with the perception that you are getting some kind of special treatment can be continually damning for the person in pain. They are using their physical discomfort as "an excuse". They are self-absorbed or self-centered.

For you, my pain is suspect, an inconvenience. But for you, your pain is meaningful and to some extent debilitating.

Now, if someone is using medical marijuana as a pain treatment, then they have all of that perception working against them plus whatever stigma goes with the dubious application of an otherwise illegal substance towards their pain relief. And of course I'm sure there are unscrupulous people who get with unscrupulous doctors in order to get a recommendation for medical marijuana, and they are more or less malingering and they probably think they are somehow getting away with something.

But isn't the "payoff" of success, of the achievement in social class standing, a reduced presence of pain? If you have achieved material wealth, you have ready access to the best medical care, you have comfortable living conditions, you have ample time to rest and relax. Is there some sort of class envy of people who get pain relief, that they are somehow cutting ahead in the line of life before they'd suffered sufficiently?

Who decides how much suffering is "part of life"? Some people seem to think if you are not sufficiently unhappy and in some sort of pain for some portion of your day, you are not entitled to the relaxation and freedom from pain that you get later on in the day, or over the weekend. For these people, it doesn't so much have to do with what you produce or acheive, but more to do with what you've put up with.

Do we need to worry about how much freedom from pain is too much?

One thing is for sure, it gets to be a pretty stupid argument. If someone's pain relief isn't hurting themselves or someone else, what is the problem? I think if you are experiencing enough pain to where you need strong medication to deal with it, you are pretty well sidelined. You are not going to be able to drive, you are not going to be able to do a lot of things. That is not a situation to seek out, to strive for.


Anonymous George Pateman said...

Thank you for putting into words some of the thoughts that have been bouncing around in my head for years. The pain needn't be physical to experience the same reaction from people. In fact, it can be worse. When I tell people that I've suffered from depression for decades, they usually don't understand. Just be happy. Right. May I introduce you to your neurotransmitters? They don't say it but you get the impression that they think you're lazy, crazy or just not someone they respect very much. So be it. When the student is ready, the teacher will appear.

11:14 AM  
Blogger Utenzil said...

Thanks for the comment, George. An aspect of this idea that you touch on is that 'pain' is different things to different people, and different people will also react differently to the same pain. So, sure "c'mon, it's not that bad, be happy" is the response one can expect from somewhere, and absolutely everyone has different 'wiring'. And you're right, neurotransmitters actually don't 'think' of course, but they will convey whatever chemicals that translate into whatever experiences in whatever way they do.

6:38 PM  

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