Pain: Let’s Talk

by: Dr. Michael A. Castillo

I was told September is “Pain Awareness Month.” Pain is strictly an individual concept. Medicine uses a blank line 10cm long, 0-10/10 scale, smiley faces to crying faces, and other methods. None are really appropriate for all patients, or have been shown to cross reference to another person’s pain. There is no consistent way to deal with an individual’s pain. Pain can break up a family or a family can endure. Friends can remain friends or can be completely lost. Successful lives can be completely lost or never started. Simple activities can become impossible to accomplish. People in pain can be thought to be lying to get out of life. Pain can lead to depression. At its worst pain can lead to a rapid dwindling life or to suicide.

Shoulder pain

There were no classes in Medical School or instruction in residency in how to deal with patients in pain. Even in pain management we look for a cause and cure. I work with surgeons and pain management physicians today if the patient doesn’t fit their ingrained protocol these intelligent people have no clue what to do or recognize the pain (I must admit sometimes I have no clear answer to decrease a person’s pain, but I do recognize a person’s pain). Most doctors when I started thought people in chronic pain had a psychiatric problem (Most Work Comp doctors still belief this).

We break pain in to acute or chronic. Acute pain has a cause: sprained ankle, appendicitis, tooth abscess, or broken bone. The injury gets better or a doctor can do something. There is an end in sight. To a chronic pain patient, an acute pain can be devastating. Chronic pain is said to last more than three months (Tell that to a patient in severe pain for a week). Chronic pain is called pathological pain. At this time there is no direct cure for some pains: diabetic neuropathy, Lyme Disease, multiple sclerosis, Complex Regional Pain Syndrome (CRPS), Post Surgery Pain, and the list goes on. *I do not mean to diminish any of my patient’s pain from head to toe by not listing their diagnosis or diagnoses.

I could talk/write about pain for hours. I have to apologize to some people in pain because after reading a history I have nothing  better to offer than their current physician (so I guess I fit into the category of intelligent people with no clue). A patient should have their own treatment plan. The plan should be made between the patient with their physician or physicians and support teams. If you have pain, we can talk. I will accept you have pain and in most cases I will try to come up with a plan to help. I would like to thank the people who have trusted me to be their physician.