The Nature of Pain

I've been thinking a lot lately about pain, and what it is and what it means to different people. This might seem like a bit of an odd topic, but I'm working at a health center where a large percentage of the patients (probably 80%) are experiencing some form of chronic pain.

I have to be honest, it has me completely baffled. Some of my patients have nothing clinically wrong with them - their CT scans, MRIs, Xrays all come back showing no substantial problems of any kind. And yet these patients are experiencing pain so excruciating, so severe that they can't work, some patients are unable to get more than 15 minutes of good sleep per night and others can dress themselves, toilet themselves, and that's about all they can do. It breaks my heart every time I meet another chronic pain patient, because I feel so powerless as to how I can help them. Their problems are so complex and multi-faceted, I don't know where to begin.

To me, pain is a manifestation of something wrong in the system - some mechanical factor of movement is out of whack, or some muscles are tight, or poor posture is an issue. But a patient who's been in constant pain for over 17 years, that is hard to get my head around. I don't understand it.....but it's real to them, and I want so desperately to help somehow. At times I feel so incompetent in my meager attempts to help relieve the pain for even a short time, but then at times there can be a glimmer of hope. Like one patient I saw recently had been experiencing chronic back pain almost constantly for 17 years. This patient was so afraid that she had some kind of infection that was slowly spreading through her body and causing all the pain. I was able to offer some relief to her by explaining what I did find and understand about her condition. The fact that nothing severe - no infection or cancer or anything else - was going on really seemed to take a weight off her shoulders. That was one small victory.

The most frustrating part is that the scientific community doesn't quite have their head around chronic pain either. There are theories, but no one really knows for certain. It can be influenced by past physical trauma, psychosocial trauma, sociological factors, psychological state, reprogramming of the pain system in the body - how does a poor physio student figure all that out? :P I guess when it all comes down to it, I want to be able to make my patients better, and right away. I guess I have to learn to be patient and understanding and approach these patients in a different way.

I think this placement is definitely going to make me grow. A LOT. :)