Researchers search for more precise ways to measure pain

My experience was/is annoyingly the opposite where I developed chronic neck pain on a relatively fast timeframe and I can't find a physician across all different disciplines that's actually interested in finding out the source. They almost immediately throw up their hands and want to send me to a pain management doctor.

In the meantime, we should take much more advantage of the gap between the sensory and the affective components!

There are many other science-based pain management methods than just drugs. These other methods don't change the sensory part, the pain is there, but they can dramatically change the quality of your life with how you feel the pain.

CBT is very effective for pain management. Even something as simple as distracting yourself from a painful stimulus like a medical procedure can make a huge difference.

For example, your doctor doesn't routinely tell you to show your kids a fun video while they get a shot. But it makes a massive quality of life difference. Without Elmo, my daughter will cry for 5-10 minutes and just be miserable for half an hour. With Elmo, the shot comes, she's annoyed, there are tears for a 5-10 seconds, and then she's fine. There's no reason to not make this routine, except that we think of pain as something entirely objective instead of something that is largely subjective.

I think this research falls into that trap of "This is an important problem, this solution is obviously bad, but we have no good ones, so let's do it." This is likely to cause far more pain than to help anyone.

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.

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.

it's all part of the same biological soup!

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 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 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.

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

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.

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.

There's so much literature showing that inherently "psychological" things are integral to pain experience there's no way to disentangle them. Another poster was noting that pain is affected by experience — so if a pain is new to a patient, does that mean we should ignore their experience of it? If we know that pain perception is amplified by anxiety or fear, we should dismiss it?

I know from firsthand clinical experience the problems with report of pain — misrepresentation in drug seeking, for example — but I almost feel like you'd be better off studying that than anything else. The rest of the stuff they mention is great and all parts of the puzzle but it's all minor parts of the whole process of pain perception, and the whole idea of dismissing "subjective" pain seems absurd to me, because pain is subjective.

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