Understanding Pain

By Michael Jorrin, "Doc Gumshoe", June 30, 2021

What started me down this path was a promotional piece for a new drug that was purported to suppress pain through a novel mechanism that prevented the nerve signal that conveyed to the brain a sensation that would usually be experienced as painful from actually being painful. In other words, while mincing an onion, you accidentally sliced into your left index finger. You felt the slicing sensation, you saw the blood, but it didn’t hurt. That’s not like an anaesthetic, which totally blocks the slicing sensation. With an anaesthetic, you feel nothing. But with this new drug (if you believe the hype) you do not lose sensation, but you do not feel pain. (Note, I definitely do not believe the hype – it came from a source that daily clogs my spam filter with a couple of dozen over-the-top claims. The phrase was something like “this little pill will end your pain.” The only little pill that I could think of that would “end your pain” was cyanide, so I took a look.)

What that hype ignored is that pain is actually highly useful. (I had thought of titling this piece “Praising Pain,” but then it seemed to me that it sounded too much like “Raising Cain,” and Doc Gumshoe does not want to be identified as a raiser of Cain.)

But, for the usefulness of pain, let me give an example. I was cooking a turkey for Thanksgiving a couple of years ago, and I took the gigantic stainless steel casserole out of the oven, carefully holding the two handles of the casserole with my hands encased in those padded mittens that protect the hands from hot objects. I set the casserole on the kitchen counter, which happens to be limestone and thus heat resistant. I took the lid off the casserole, and got a large ladle to scoop some of the turkey juices and pour them over the turkey. I then picked up one of the handles of the casserole in order to tip it and let the juices run to the other end of the casserole. Only I had taken the mitten off the wrong hand. I had the ladle in my left hand, which was protected by the mitten, and I picked up the casserole with my bare right hand.

It hurt like the dickens, or the deuce, whatever the demon of pain is named. I quickly put the casserole down, and ran to the sink to pour cold water on my burnt hand. The burn was not severe enough to require an emergency run to urgent care, and in any case there were things to be done before our dinner guests arrived, so I cursed myself for being a half-witted dunce and got back to work.

The burn kept hurting for days, of course. But imagine if, when I picked up that casserole with my bare hand, the instant message to my brain had not been that I had to put that casserole down and let go of the handle really, really quickly. If I had held on, it would have required more than a visit to urgent care.

So, of course, pain is an exceedingly valuable warning that something is going on that needs attention. The more excruciating the pain is, the more immediate the attention needs to be. Pain that comes on gradually can be a signal of a different kind; for instance, some migraineurs experience persistent headaches after being exposed to certain stimuli – red wine, certain foods, piercing or flashing lights. The signal to the migraineur is, avoid those stimuli whenever possible.

And then there are the pains and aches that tell us that something in our bodies is not working right. I had knee pains, growing in severity, for several years before it was decided that the best course would be to swap my natural bone knee joints for nice new ones made of titanium and plastic. This happened in a couple of installments, which Doc Gumshoe has described in some detail. My knee pain basically stopped. Except, of course, for the pain I experienced during the rehab period. The rehab was absolutely essential if I was to regain normal use of my legs, but the pain that came along with it was inescapable.

The pain during the rehab sessions taught me, I think, a valuable lesson. For several weeks after the surgery, the pain in the knee was fairly constant, and I was able to keep it under control by using various analgesics – oxycodone for the first few days after the surgery, followed by NSAIDS. But the rehab sessions were something else entirely.

What rehabilitation therapy is trying to accomplish is a return to normal. That means that I needed to bend my leg as much as I had been able to before the knee joint became arthritic, and I also needed to straighten my leg completely, locking the knee joint and getting the leg as straight as an arrow.

I could – and did – try to do that on my own, but there were limits to what I could manage. So the physical therapist steps in, to add his (or her) own muscle to mine. That meant that as I was lying on the table trying to straighten my leg, the Cruel Cristina would get up on the table and use all her weight to press down so as to get my leg really, really straight. The goal (never quite r