Researchers search for more precise ways to measure pain

I remember that after I had surgery on my finger (the bone healed wrong so they had to cut it and rotate it), a nurse asked me to rate my pain 1-10, and I said: "it's alright, like a 7?", and she was like "that's not alright, let me give you some meds".

It did actually feel like a 7/10, it really hurt, but somehow it didn't bother me. And it was like that for weeks after the surgery, I didn't really end up taking any pain meds when I got home.

And I wouldn't say my pain tolerance is generally particularly high, pain does usually bother me as much as anyone. Not sure what that was about.

> There are already far, far too many examples of physicians not trust patients about pain.

I am friends with a couple of ER doctors, who are probably the worst offenders (self-acknowledged) in this space. It's based on a real phenomenon, though, of drug-seeking behavior.

As people with chronic pain communicate with each other (through things like Reddit) on the best way to communicate to doctors that their pain is legitimate, those techniques are also inadvertently taught to other people who are seeking pain medication for recreational purposes.

I think the cause of widespread drug legalization has been weakened by a couple of real world efforts in that direction, but I still stubbornly cling to the belief that if people are allowed to make their own choices, then you can partition the recreational users from the chronic pain sufferers and maybe let medical science have a slightly better change of addressing the latter case. That said, given factors like cost and insurance coverage, it may just be a realigning of incentives rather than fixing the problem itself.

Not surprised either, I've met a doctor who trusted me that I was in pain exactly once, every other doctor or nurse has looked at me like I was some kind of drug addict.

The strongest such look I've ever gotten was a nurse in the ER when I went in with a splinter under my nail. I already felt kinda silly to go to the ER for something so obviously harmless, but it was late I just couldn't handle the pain. She'd offered me ibuprofen, but I had already taken the largest recommend dose of that, so I asked if maybe I could be given a local anaesthetic. She looked like she was considering whether to call the cops, since I was obviously a... Well what, actually? Local anaesthetic addict?Is that even a thing? Why would that be a thing?

I've come to the conclusion that healthcare in my country is better at judging you than they are at caring for you, which is really fucked up

I'm fascinated by the athletic side of all of this.

I have a friend who has had the aspiration to become a regular exerciser for years, but he says everything he tries just hurts too much. I exercise regularly myself, but we haven't found a way to talk about it, because it's so hard to share subjective sensations of pain. In some sense, everything I do hurts, too, and everyone who works out or plays a sport acknowledges a lot of pain. People differentiate routine pain from pain that requires effort to endure and distinguishes both of those from pain that indicates an injury happening or being aggravated, and people value and hone their ability to distinguish the second two from each other, because they don't want to get injured but also don't want to let pain hold them back from doing something that makes their body healthier and stronger.

I've known people who have endured through pain and suffered terrible consequences from it. Five years ago, my wife's aunt loved to say "I'm a tough old bird," and she has since lost a leg unnecessarily, because she thought that having high pain tolerance was a viable alternative to going to a doctor. Now she's in a wheelchair and does everything the doctors say.

Other people have had opposite experiences, where learning to disregard pain led to breakthroughs for them. One woman I know set a big triathlon PR a year after having a kid, and when people asked her how she was able to do that, she said, "After having a kid, the pain just wasn't a big deal to me anymore." She's big into the science, so I expected to hear something about hormones, but for her, her expanded pain tolerance was the entire explanation for her better performance.

Personally, just doing normal exercise presents me with an incredibly rich variety of "painful" sensations and a lot of difficult decisions. Right now I have a nagging shoulder injury, and every time an exercise generates a "painful" sensation in my shoulder, I have to decide, is this reflective of something making this injury worse? better? neutral impact? Should I stop right away so I don't aggravate the injury, or should I do this exercise more often because it's stimulating the tissue in just the right way? There's so much said and written about it, but it often seems frustratingly tautological. You have to know what the sensations mean before you can figure out which words refer to which sensations.

I'm not sure how this fits in, but in my experience a further complication as someone with chronic pain/illness is that often the thing that bothers me the most isn't what I would describe as painful. I would describe it as very uncomfortable but on a different axis than pain. As a simple example that I think most people can relate to - I do not think of being dizzy as painful, but it's very impactful if you are dizzy all of the time. I had an episode of vertigo that was one of the most miserable experiences of my life but I don't think I experienced much pain during it.

I guess if the goal is to tell whether the person needs pain meds that complication may not matter as much since they don't help (afaik) with those symptoms. But I do sometimes feel like my health problems get taken less seriously if I report on my pain levels rather than my discomfort and/or how it impacts me. Eventually I found a migraine pain scale that focuses on how it affects your life rather than directly how physically painful it is and that helped me have a normalized system for reporting.

2. The affective-emotional component: how much does the pain hurt, and how does it affect emotional state?

I am going to add the spiritual aspect to this. I read a post on Reddit asking if Jesus truly suffered more than anyone else on earth, given that more people suffer for longer than his 24 hours ish on the cross.

Without believing the story of Christ at all, I was still able to do the mental exercise to see that the nature of the pain had nothing to do with the duration. For example, watching your mother watch you get crucified is heart stopping (or to watch another mother have to go through that).

So, what is the purpose of a human feeling that pain as an experiencer or as an observer? Why would our body elicit that psychic pain, why wouldn’t we just focus on the physical and ignore these other things? In that moment, your only concern should be the physical, but it’s not just physical.

The psychic pain almost has no use in a state of physical torture other than to inform the conscious of its duty to morality. Unfortunately, I do not believe science can ever conclude this is the answer (in no possible way, I’m open to being wrong).

I've found meditation very useful in this regard. If you focus on observing in detail #1 type pain, you find that the #2 becomes much more managable. The technique is to get curious about the pain, ask what type it is (hot/cold/electric etc), where exactly is the pain. what shape is it? how does it change over time? It sounds counter-intuitive but by focusing on it it becomes easier to manage (because I think a lot of #2 is story and mental reactions to the pain rather than the actual pain itself and the mental reactions are self-fulfilling in a negative way).

Maybe this explanation is intentionally simplified, but what it’s telling me is that medical science is just lost.

It is crazy to me that womens’ pain is so ignored. I’ve always (half-) joked that if men got periods, there would be 30 alternatives to midol by the end of the month. Maybe we’re just better at crying like babies?

As a chronic pain sufferer, I experienced the same as you, explaining where I am limited in life rather than expressing how much pain I’m in gets much better results.

A similar problem I’ve had is that I tell my doctors I have terrible sinus pain. Often the response to that is that I should consider allergy meds, as well as a confirmation that I am indeed “pretty stuffed up”.

But when I say I cannot sleep a full 8 hours due to sinus blockage, suddenly we need sleep evaluations, humidifiers, antihistamines prescribed, methods for lubricating my sinuses, netti pots, etc.

Chronic “pain” as a spouse is the perfect metaphor. I can’t push through it, I have to use patience and understanding and it’s always somewhere on my mind. That’s the only way to make progress or be sane long term. I’ve grown and matured because of it. I’ve also experienced the post surgery pain that briefly takes you out of this world. For a split second I was in the Hell dimension a la Event Horizon the movie before I had taken my first dose of opiates and had adjusted my arm too much. I don’t mean the pain was hellishly bad; I didn’t cry out which is probably what a 10/10 pain would elicit. It was more like dread and “seeing” but not with vision the mutilated flesh and gore inside my repaired wrist.

"Redheads get less pain relief" - are there any references you have so I can explore this more?

I am often baffled by how some people are able to articulate how a specific pain feels or even where exactly the pain is. Describing pain intensity is hard beyond "not very painful" and "very painful". But adding a dimension of pain type is something I struggle with. Sour pain makes as much sense to me as piercing pain, which is to say: no sense at all.

I've been pierced (not for fun or aesthetics) by large nails in an accident, and it felt nothing like the icepick headaches I get, which my doctor tells me are a piercing pain.

Human internal experience is weird as fuck. If it can help diagnostics in any way, I'm all for more precise pain measurements. But I'm sure someone will abuse that research for torture.

I think the closest proximity to suan/sour is just sore. I like the suan metaphore, like something marinated/fermnated/drowning/gone slightly off in dull pain. It wierd because "sour" does feel very apt descriptor, English has sharp/stabbing/throbbing/burning/shooting/stinging/tingling/numbing... etc lots of metaphores. But "sour" is just your default sore/ache.

There are clearly different types of pain. I use the french words for high and low pitch to describe two groups of pain, although I never used them.with a doctor because it would be meaningless for ut

They might miss a type of pain that the current trials aren't measuring because healthcare doesn't believe that group of patients and further entrench that prejudice into the measure. It's a very real risk of such a device.

I'm unsure how to interpret this statement. Are you saying that the amount of pain experienced depends on the patient's prior exposure and some 'tolerance' stat? And that we should ignore their actual statements about, and reactions to, stimulus when assessing the effect of that stimulus on them?

This is a Black Mirror episode based on a short story by Penn Jillette (of Penn & Teller)

https://en.wikipedia.org/wiki/Black_Museum_(Black_Mirror)

Poor misunderstood Karl. I knew what he meant when he said that glass ashtrays hold cold.