Lost in Translation: The Language of Pain

There are many patients who are simply lost. The pain is overwhelming and when it persists for a long time, desperation takes the place of hope. When this happens, patients vainly cling to anything that helps or even prevents the pain from getting worse. People reduce or eliminate strenuous activities, alter their daily routine, or even deviate from their personal pursuits and life goals. Some treatments such as opiate pain medications and benzodiazepines simply mask the problem and allow it to fester unchecked while the patient falls deeper into an abyss of anger, self-blame, and hopelessness.

Often the solution is far simpler than they realize. A short-period of rest, followed by rehabilitation with stretches or exercises is the mainstay of many painful complaints. Lifestyle and behavioral changes, however, are far more ominous than a simply starting a new medicine, undergoing a procedure, or even enduring surgery.

For better or worse, there is no easy fix to pain but there are sustainable approaches. To solve a problem, it must first be defined.  Identifying the source of pain, however,  is not as simple as ordering an MRI. With aging, our skin, the most visible part of our bodies clearly changes. So does the spine. Some of these changes are normal and may be misleading as to the cause of the pain. Often, the history or nature of the pain along with physical exam findings can more conclusively help to identify the pain. Imaging only helps to confirm it.

I find it so difficult to discriminate the lost patient from the one in pursuit of a secondary gain. patients from the malicious ones who pursue some secondary gain.  When I am wrong in either direction, I’m devastated, but more so with the patient who is lost and desperate.