Community Coalition for End of Life Care


The 9 myths of Pain...

This is the second in a series of articles discussing pain. In the last article we discussed “What is pain?” In this article, we want to dispel many myths our culture holds about pain.

Pain must always have a physical basis
Pain can be physical, psychological, emotional, or spiritual. There are many examples of pain that has no identifiable physical basis. One of the easiest to understand is phantom pain. Many people who have limbs amputated can still feel real and often severe pain in parts of the limb that was amputated. This is the brain not working properly, reading nerve signals from body parts that are not there.

But there are many common everyday experiences as well: belly pain in kids who are scared about school, many headaches in people who are stressed, emotional pain after death of a husband or wife….. The mind and spirit are very closely connected with the physical functions of our bodies.

Pain is real even if it does not have an easily identifiable physical cause. And to best control our pain, we should address all areas that might cause or contribute to our pain: physical, psychological, emotional or spiritual.

High pain tolerance is good. Low pain tolerance is a weakness
The ability to tolerate pain has nothing to do with our morals or our character. It has everything to do with our state of body, mind and spirit. We should never pass judgment (good or bad) on people because of their ability to tolerate pain. But, each of us carries responsibility to manage our bodies, minds and spirits healthfully, allowing us to manage our pain in the best possible way.

Pain tolerance depends on many things: some genetic (what we are born with), some due to our past and present lives. People who have been abused, who have abused drugs, or who have been in uncontrolled chronic pain for long periods of time are extremely sensitive to pain. This is because they have damaged pain pathways in their brains. The pathways are worn out and the normal gates in the nerve system that can help block pain are broken or burned out. This makes pain signals pass much more easily and makes the experience of pain much worse.

Acute and chronic pain are the same thing.
Acute and chronic pain are different and people who have acute and chronic pain look different. Acute pain leads to release of brain chemicals that increase our heart rate, blood pressure and so we see grimacing, tense muscles, and agitation: what most of think of as the look of someone in pain. When someone suffers chronic pain, the body cannot sustain such a response. The stores of these “fight or flight” chemicals run low, leading to a different response: people become excessively sensitive to minor stresses, look depressed, tired, and run down. Many people look at someone in chronic pain and think, ‘they don’t look like they are in pain,’ which is wrong.

Caregivers are the best judge of pain
Caregivers are often poor judges of pain. The only person able to judge pain is the person who is experiencing it. This is because pain is such an individual and subjective experience. Studies show that people ‘faking’ pain to get medication to abuse, to get more attention, or for other reasons is much less common than many caregivers think.

Pain medication should only be taken if absolutely needed and you should hold off using pain medication until you can’t take the pain any more.
The opposite of this statement is actually the truth. If you use pain medication before or just when significant pain is starting, you need much less than if you wait until the pain is really bad. For example, studies show that if you use pain medication before surgery even starts, much less pain medication is needed after surgery.

Pain medication should only be prescribed as needed and only for severe pain
Again this is wrong. If significant pain occurs at all times, then pain medication should be taken regularly, “around the clock”, at scheduled times. This prevents the pain from getting worse and in the end, less pain medication is needed to achieve the same effect. Also if you catch pain before it becomes severe, you will need less medication and have less side effects.

Patients who watch the clock to get their pain medication are addicted
Patients who watch the clock are usually not appropriately treated. This means that they are either not getting enough pain medication or their pain medication is wearing off too soon. This is often a result of using only “prn”, or “as needed” pain medication as opposed to “around the clock” pain medication for those in pain at all times. If patients are addicted to pain medication (see below for definition of addiction), then using only “as needed” narcotics for pain control not a good treatment plan.

Use of regular narcotics (opioid pain medication such as morphine, Oxycontin, methadone, Duragesic….) always causes addiction
Addiction is defined as the continued use of a substance (or drug) with the knowledge that the substance is causing harm. The obtaining and use of the substance is often erratic, illegal and for reasons other than intended by prescribers (ie getting a high as opposed to controlling pain). Narcotics rarely lead to addiction if prescribed and taken properly.
Narcotics do cause dependence which means that stopping them abruptly will lead to withdrawal side effects. They can also sometimes cause tolerance which means that a person taking them will require gradually increasing doses to achieve the same effect (similar to alcohol). Dependence and tolerance can be treated by gradually tapering the medication (stopping it slowly by lowering the dose every few days).

Tolerating pain makes you stronger.
Although suffering can lead to building strength of character (Lance Armstrong states he is an example), suffering chronic pain for long or indefinite periods of time almost inevitably has the opposite effect. People who “grow” from periods of suffering almost always suffer for defined periods of time with an end in sight. Suffering chronic, indefinite pain makes you weaker. Uncontrolled or unmanaged chronic pain destroys healthy brain functioning (burns pathways and destroys the normal protective “gates” that block pain) and makes us more sensitive to minor painful insults in the future. Managing pain aggressively and early by building strong psychological, emotional and spiritual lifestyles, as well as appropriate use of therapies including medication, helps makes us stronger people for the future.

This is one of a series of articles from the Community Coalition on End of Life Care: a group of North Country individuals and organizations working to improve quality of life for those suffering from chronic, life limiting conditions….

Related Article: Assessment of pain and pain scales


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