Rarely do I hear a patient report that they have a terrible tolerance for pain, and that the slightest splinter makes them curl into a fetal position on the floor. On the contrary, most boast that they have a high pain threshold. Then, when asked to describe their pain on a scale of 0 to 10, with 0 defined as "no pain at all" and a 10 as "having to call an ambulance", they report with a smile, "an 11". It makes me wonder about pain, how people perceive it, and how much people are willing to tolerate it before they take action.
I think it's safe to say the the vast majority of people don't rush to call their doctor the first time they feel something "different". Nobody wants to be an alarmist or be perceived as a problem patient by their primary care doctor. So, they wait. In most instances, time will certainly help them feel better, no matter the malady. Let me note here that I'm not talking about searing chest pain, or a femur that's poking through the leg of your jeans, or even a badly twisted ankle. For this type of pain, dial up that ambulance or get yourself to an ER on your own. Traumatic injury that leads to instant pain and swelling should be diagnosed right away so that proper intervention can take place. Instead, I'm referring to the ache or pain that may come on insidiously, without a discernible precipitating event. The type of pain that may be a "4 or 5" with certain movements, positions, or activities and a "0" at rest. The "It's annoying, but I can suck it up," pain.
What to do about such pain? While there is no one right answer for everyone, I do think there's some common sense advice to be offered. For starters, pain that wakes you up from your sleep should be heeded, not ignored. You can consider it a "red flag" for something more serious. I'm not talking about having some tendinitis in your shoulder and waking up by accidentally rolling on to that injured side. While annoying, this doesn't qualify as a red flag. I'm talking about visceral pain that wakes you and doesn't allow you to find a position of comfort in order to go back to sleep. Another consideration regarding pain is your ability to take it easy and try to rest whatever is hurting. If you have a competition looming 3 weeks down the road you may not have the luxury of delaying treatment. Or if you have tendinitis in your arm and a one-year old who isn't going to wait 6 weeks for you to pick him/her up, your option of rest is compromised. However, if your home life, job and recreation allow you to put on the brakes for a while, it's probably a good idea. Time and rest will allow you to discern if what's ailing you will resolve on it's own or require medical attention.
Just yesterday, I read an article on a physical therapy site which talked about the virtues of taking a "do nothing" approach to physical problems (as well as to a slew of other negative issues that arise in life). The author shared her story of unremitting elbow tendinosis for which she tried every conceivable treatment under the sun, to no avail. Finally, at the suggestion of a physician friend, she decided to do "absolutely nothing" for 6 months and see what happened. As it turned out, in her particular case it ended up helping. That sounds great, except for the fact that I'd bet most of you wouldn't or couldn't "do nothing" for the next six months while resting an aching joint. We have lives to lead and things to accomplish. Not only that, but how boring would it be to have to sideline yourself for that long of a period?
So, where does that leave us? As usual, the common sense approach probably involves some level of compromise. Hitting the panic button at the first sign of pain, or sitting on the sideline for long stretches of time both seem extreme. I would suggest that if you're experiencing some type of non-traumatic musculoskeletal aches and pains that are lasting more than a few weeks and that are not improving or even getting worse, it would be wise to seek some help. So often, people are more worried about the possibility of continuing to do more damage than they are about the pain itself. I've found that with a proper diagnosis and explanation of what's going on, people make a great leap in the healing process. Simply learning that you will not likely cause irreparable damage can be very empowering in dealing with pain.
Finally, I think it's important for people to recognize their options when confronted with pain. My advice is to start with the most conservative treatment and go from there. If you end up in a worse-case scenario whereby you require surgical intervention, at least you've exhausted your options. Surgery, no matter how "routine", is irreversible and always carries some level of risk. And beware the doctor who prescribes an MRI right away before trying any treatment. Recent studies have called into question the correlation between damage revealed by imaging and symptoms. This can lead a cut-happy doctor to point to an image and convince you that your only option is surgery. DO NOT let that happen to you. If you were going to put an extension on your house, you would likely seek three opinions and quotes. When it comes to surgical intervention, treat your body with no less care.
Unfortunately, we will all deal with physical pain at some point or another. It's not something that we should just accept as part of life though. A prudent approach to dealing with it can help you get back to normal as quickly as possible. But remember, pain is only a symptom. Without discovering why you had it in the first place and learning how to prevent its recurrence, it's likely to be a repeat companion in your life. Don't let it.
I think it's safe to say the the vast majority of people don't rush to call their doctor the first time they feel something "different". Nobody wants to be an alarmist or be perceived as a problem patient by their primary care doctor. So, they wait. In most instances, time will certainly help them feel better, no matter the malady. Let me note here that I'm not talking about searing chest pain, or a femur that's poking through the leg of your jeans, or even a badly twisted ankle. For this type of pain, dial up that ambulance or get yourself to an ER on your own. Traumatic injury that leads to instant pain and swelling should be diagnosed right away so that proper intervention can take place. Instead, I'm referring to the ache or pain that may come on insidiously, without a discernible precipitating event. The type of pain that may be a "4 or 5" with certain movements, positions, or activities and a "0" at rest. The "It's annoying, but I can suck it up," pain.
What to do about such pain? While there is no one right answer for everyone, I do think there's some common sense advice to be offered. For starters, pain that wakes you up from your sleep should be heeded, not ignored. You can consider it a "red flag" for something more serious. I'm not talking about having some tendinitis in your shoulder and waking up by accidentally rolling on to that injured side. While annoying, this doesn't qualify as a red flag. I'm talking about visceral pain that wakes you and doesn't allow you to find a position of comfort in order to go back to sleep. Another consideration regarding pain is your ability to take it easy and try to rest whatever is hurting. If you have a competition looming 3 weeks down the road you may not have the luxury of delaying treatment. Or if you have tendinitis in your arm and a one-year old who isn't going to wait 6 weeks for you to pick him/her up, your option of rest is compromised. However, if your home life, job and recreation allow you to put on the brakes for a while, it's probably a good idea. Time and rest will allow you to discern if what's ailing you will resolve on it's own or require medical attention.
Just yesterday, I read an article on a physical therapy site which talked about the virtues of taking a "do nothing" approach to physical problems (as well as to a slew of other negative issues that arise in life). The author shared her story of unremitting elbow tendinosis for which she tried every conceivable treatment under the sun, to no avail. Finally, at the suggestion of a physician friend, she decided to do "absolutely nothing" for 6 months and see what happened. As it turned out, in her particular case it ended up helping. That sounds great, except for the fact that I'd bet most of you wouldn't or couldn't "do nothing" for the next six months while resting an aching joint. We have lives to lead and things to accomplish. Not only that, but how boring would it be to have to sideline yourself for that long of a period?
So, where does that leave us? As usual, the common sense approach probably involves some level of compromise. Hitting the panic button at the first sign of pain, or sitting on the sideline for long stretches of time both seem extreme. I would suggest that if you're experiencing some type of non-traumatic musculoskeletal aches and pains that are lasting more than a few weeks and that are not improving or even getting worse, it would be wise to seek some help. So often, people are more worried about the possibility of continuing to do more damage than they are about the pain itself. I've found that with a proper diagnosis and explanation of what's going on, people make a great leap in the healing process. Simply learning that you will not likely cause irreparable damage can be very empowering in dealing with pain.
Finally, I think it's important for people to recognize their options when confronted with pain. My advice is to start with the most conservative treatment and go from there. If you end up in a worse-case scenario whereby you require surgical intervention, at least you've exhausted your options. Surgery, no matter how "routine", is irreversible and always carries some level of risk. And beware the doctor who prescribes an MRI right away before trying any treatment. Recent studies have called into question the correlation between damage revealed by imaging and symptoms. This can lead a cut-happy doctor to point to an image and convince you that your only option is surgery. DO NOT let that happen to you. If you were going to put an extension on your house, you would likely seek three opinions and quotes. When it comes to surgical intervention, treat your body with no less care.
Unfortunately, we will all deal with physical pain at some point or another. It's not something that we should just accept as part of life though. A prudent approach to dealing with it can help you get back to normal as quickly as possible. But remember, pain is only a symptom. Without discovering why you had it in the first place and learning how to prevent its recurrence, it's likely to be a repeat companion in your life. Don't let it.
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