Saturday, May 10, 2014

Nerve Pain: It's Not For Sissies...

I'm sure you've all seen this type of pain chart:
It's the common one found in most doctor's offices and clinics.  When discussing pain, you are asked to "rate your pain" with a number between 1 and 10, with the #10 being the most intense pain you have ever experienced.  It seems pretty simple really when asked to identify YOUR experience of pain compared to any pain you have ever felt in your life and qualify that experience with a number, right?  Yeah...NOT.
For those of you have ever experienced NERVE pain, whether associated with MS or any other neurological disease, you know the difficulty of which I speak here in assigning a simple number to something so complex.  Nerve pain does not fit nicely into a number or list of adjective descriptive words.  It's not the same ALL the time and the experience of nerve pain can change with each movement or situation, depending on how our brains or spinal cords are interpreting (or failing to interpret) the sensory experience.
A trip to the doctor's office can go something like this:
Doctor:  "Describe your pain to me."
Patient:  "Well, it's located here (pointing to a body area), but travels down here(pointing somewhere down the body to a more distal area)."
Doctor:  "Is it a throb, or ache, or sharp pain?"
Patient:  "Yes."
Doctor:  "Well which is it?"
Patient:  "All of them."
Doctor:  "And what pain number would you use to describe your pain?"
Patient:  "All of them."
Doctor:  "What do you mean, all of them?  How intense is your pain right now?"
Patient:  "Well, it's not so much the intensity as much as it is the consistency of the pain."
Doctor:  "Sooo...what number is your pain."
Patient:  "I don't know.  It hurts."
Doctor:  "Is it the worst pain you've ever had in your life?"
Patient:  "Well, no.  Once I was hit in the head with a baseball bat and that hurt so bad I passed out.  If that's what you mean by the worst pain I've ever had in my life?"
Doctor:  "So your pain isn't THAT bad then?
Patient:  "No, I haven't passed out from it if that's what you mean.  But I kind of want to scream sometimes because it's constant and even though it's probably only a grimace on your chart there, it's so agitating and relentless and..."
Doctor:  "Is it interfering with your ability to do normal tasks?  Do you feel weakness or a lack of movement?"
Patient:  "No.  Is it only bad if I have those things, too, because I kind of want to scream sometimes, but I can still move everything and I don't FEEL weak."
Doctor:  "So you are tolerating the pain then?"
Patient:  "Um, well...I guess.  But it really hurts.  No, it's not a 10 on your scale there, but I don't quite know how to describe it to you.  I kind of feel like screaming now."
Doctor:  **Finds number for psych consult** 
Because I work in health care, I am very familiar with the use of standardized pain charts.  And yes, they basically suck as a reference guide.  I found this pictorial pain chart online and I think I like it better:
I think THIS pain chart best describes nerve pain -- it qualifies my standard "5 through 7" pain response with such a delightfully distressed/neurotic face, not the bluish/red frowning face of the typical pain chart.  :-)
So often in health care settings, patients are asked to qualify and quantify their experience of pain in terms meant to elicit a particular response from a provider.  I've lost count of how many times I've heard patients wishing to gain narcotics describe their pain as "an 11 on a scale of 1 to 10".  Really?  Seriously??  That usually only gets you a one way ticket to being ignored because YOUR pain, your very SPECIAL pain that is so great it's off the pain chart, is crying for attention in such a way it is no longer believable and therefore narcotics won't help you anyway.  And then there are the patients who say they are only experiencing a "5 out of 10" who's blood pressure is elevated, pulse is rapid, they are diaphoretic, and won't or can't move because the pain is so great.  How does their pain compare to someone who is a "10" (or that wonderful "11") and the "10" person is still laughing, conversing, watching TV, and enjoying themselves?
I'm not going to be so bold here as to say one of the above patient examples is in more pain than the other.  PAIN IS SUBJECTIVE.  It really can't be qualified on a smiley chart because the smiley chart does not take into consideration the individual's past experiences with pain, their current stressors, the barometric pressure, the recent amount of sleep they have gotten, what they ate for dinner, and a host of a million other variables that affect each of our individual responses to pain.
If you've ever had nerve pain and if you ever HAVE been hit in the head with a baseball bat (or frying pan, or 2x4, or...), you know the type of pain a blow to the body generates is quite different than nerve pain.  Baseball bat blows tend to be very intense, blackout crazy intense, throbbing intense, aching intense, sharp intense, and that whole other list of neatly packaged adjectives used to describe pain.  But nerve pain?  Nerve pain is not so simple.  I have personally used the following to describe my nerve pain:  "It's a 5 on a normal pain scale magnified to an 8 or 9 over time because it is constant, agitating, consistently annoying, present even when I sleep, causing me to feel out of control of my body which elicits fear, which creates an emotional pain that further intensifies the physical pain that I think isn't going to go away EVER and, so help me God if you compare your current pain to mine again, I may punch you between the eyes just so you can really have a similar pain experience as mine."
I'm just not sure there is a smiley face that best depicts that description of pain...