Friday, September 27, 2013

Hurts So Good...

 

Have you ever been in pain? Not the annoying pain of a paper cut, or when your hammer misses the nail. I’m talking teeth-gnashing, stomach-churning, cursing-like-a-sailor pain.

Males and females have their own versions of ultimate pain. For females, it’s the agony of childbirth; for males, getting wracked in the testicles. Since I swore off children and lack a scrotum, I’m a virgin in both realms. But that doesn’t mean I haven’t experienced pain.

I suffered a few serious mishaps as a child (see April’s Disfigured), but fortunately the pain associated with those injuries has been blurred by time. Since then, I’ve experienced true pain on only two occasions.
The first was the twelve hours I spent writhing in bed until my appendix finally burst (which ironically brought me a bit of relief). The second was a week later when the swelling in my belly caused my small intestine to crimp. HOLY MOTHER OF GOD!! It made the appendicitis seem like a day at the beach.

What exactly is pain and why are we equipped with such reflexes? Let’s explore…
Pain is a physiological response to noxious stimuli that warns us of danger. It comes in two forms: nociceptive and neuropathic. Nociceptive is what we typically think of as pain – nerves activated by insult or injury that send signals to the brain. Think of burns, trauma, or inflammation. Neuropathic pain is caused by damage to parts of the nervous system and is frequently chronic, meaning it can last for years. I can think of nothing worse…

Well, maybe one thing: the inability to feel pain. Known as congenital insensitivity to pain (CIP), this genetic disorder leaves its victims unable to distinguish true pain. The disorder affects the peripheral nervous system, leaving the person with a disconnect between the central nervous system and the nerves that detect sensation. The result is a shortened lifespan due to an accumulation of injuries and medical problems that go undetected. How would you know you were having a heart attack if you couldn’t feel the chest pain?
Pain comes in many forms and the type or characteristic of pain can aid in diagnosing the underlying problem. Is the pain acute (sudden) or chronic (ongoing)? Radiating or non-radiating? Is it sharp or dull? Pinpoint or diffuse? Stabbing, piercing, throbbing, searing? The answers help weed out differential diagnoses.
As a medic working Orlando’s west side, pain was part of our toolkit. The homeless are crafty when it comes to devising reasons to go to the hospital, where a warm bed and hot meal await (can you blame them?). Delivering noxious stimuli to transients feigning unconsciousness was part of every shift. We were masters at the sternal rub – knuckling someone’s sternum to make them flinch. Only the most skillful actors evaded our assessments.

But what about mixing pleasure and pain? (You were hoping I’d go there). I’ve never ventured into the dark closet of sadomasochism, but apparently there are a whole slew of folks who simply love the leather. So I read up on the subject (I’m up Shit Creek if the FBI ever reviews my Google searches). According to Psychology Today, S&M is all about "power and control" and is far more prevalent than we realize. It comes down to role playing. The sadist wields the pain; the masochist is happy to receive it. Hey, as long as it’s between two consenting adults, have at it.
Although we shun pain, it’s vital to our survival. Imagine navigating life without pain’s subtle reminders. Pain is a red flag for bad decisions. Think you can run a marathon? Give it a try and let me know what your muscles have to say about it. Going skydiving? Better train. I jumped during grad school (adrenaline withdrawals following my departure from the fire department) and hard landings were a reminder to use proper form. Pain is the mother hen of safety. Just imaging pain can sometimes make us pause and reconsider.

I’ll leave you with a curious tale about pain (or lack thereof). A patient of mine, although drunk and with his leg in a cast, decided to take a ride on the back of his friend’s motorcycle. Unbeknownst to him, the fracture had damaged certain nerve pathways in his foot. After a few joyful miles, he happened to look down and realize his foot had slipped from the pedal. He had been dragging his damaged appendage and subsequently ground off two of his toes.
Like I said -  pain is a good thing. So the next time you experience a mishap, remember that pain is your body’s way of communicating. I strongly recommend you listen.


Preview: Get out your notepads, boys, for next week we’ll be delving into the female anatomy. Join me as we learn all about the lady-parts.