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A Few Thoughts On Pain

In a recent article in a paper about endodontology cleverly entitled ROOTS magazine, Dr. Michael Sultan recently published an op-ed piece about pain. It is a very interesting article, and it talks at length about the issues surrounding our understanding of pain, and consequently, how we treat it and handle it.

Dissonance

The first thing that is apparent from this piece is the issue of a severe dissonance in the treatment and medicalization of pain. It seems that our understanding of pain is very advanced, as we know about pain receptors and the different distress signals that are sent out to our brain to warn us of pain, but not so much about how to handle these receptors without prescribing potentially dangerous and addictive drugs. This dissonance is between what we know about pain and the techniques we use to treat it. In his article, Dr Sultan says that medical professionals and indeed everyone who works in the medical establishment need to know more about analgesics and anaesthetics, and that training is not good enough. He seems to claim that work as health care providers should be based upon helping our patients, and dealing with pain and abetting it should be one of the first and foremost things that healers; doctors, dentists, etc. know how to do. 

Individual Differences

The other big issue about pain and about its medicalization is that it is so incredibly many faceted and subjective. It is difficult to prescribe exact amounts of a painkiller if we do not have an understanding of how much something hurts exactly. But how do you quantify pain? How much is too much? When does pain being, and when is it “merely” psychological? 

This question alone is one that is worthy of further examination, but this is just one of a few questions like this. Consider how some people are better at dealing with pain, how do you know if your patient is one of these people or not? You cannot start hitting them and asking them when does it start to hurt (even if you would, how would you quantify and interpolate your findings?). The other problem associated with pain is cultural. Men in European culture, for example, are supposed to have a high threshold for pain, and thus will not go to the doctor for something that is causing them pain because they will not admit that the thing itself is causing them pain. Many people will tell you of their grandfather who was all but peeing themselves from incredible pain and still  saying they do not need to go to the hospital. This is bad because you are denying signs of something that is wrong inside of you, thereby stopping others from helping you, by giving false information, or by not relaying accurate information. 

These then are the two major issues that need to be cleared up if we are to make sense of the dilemma of pain. Once these two issues are dealt with, we will be well on our way to a better and fuller understanding of human health.