Do you think that everyone manifests pain the same way? How can you tell if a person is in pain when they’re not screaming or actually telling you? These are in fact, legitimate questions that every doctor faces and that many researchers try to answer. It is a genuine medical conundrum and causes a lot of stress to everyone involved, including doctors.
You would think it was straightforward, but the more one looks into it, the murkier the facts become. Does gender make a difference? As a child, I always assumed that girls were “sissies,” because they would cry with a little rough play. Did they cry because they were hurt? Or because they were annoyed? Fast forward a few years and women are now often praised for their high pain “threshold”. I often hear “It’s not as bad as childbirth,” (or other such similar references to child birth) with giving birth presented as the most painful human experience.
How about cultural expressions of pain? I have seen some cultures screaming “whoop, whoop”, while slapping the top of their heads during minor procedures, while others remain calm and collected. We often credit more flamboyant cultures with low thresholds, and histrionic behavior, but I wonder if it’s not so much about the level of pain, but rather the expression of it.
Then, there are the traumas: the awake gunshot victims, amputees, burn victims etc, who at times surprise us with their calm presentation. Are they in pain? Hell yeah! Folks describe them as “being in shock”. But why are they so calm? Occasionally staff assumes they are comfortable and thus give them nothing.
So how do we tackle this problem? Usually using an incredibly stupid question: “on a scale of one to ten, ten being the worst pain you can imagine for example being stung by killer bees and set on fire at the same time, what do you rate your pain as?” Amazing advancement in science! You can even safely try it at home. Believe it or not, that’s what hospitals are starting to do everywhere. Obviously it’s flawed, right? Sure, but that is all we’ve got. Medicine is an art. I hope that it will never be reduced to the pathetic checklists that are being served to us in plentiful supply these days. If you could do this at home, then I’d be out of a job…
By Dr DMS
