There are many gifts to modern medicine – we know much more today than we could have imagined 100 years ago. We have more advanced tools and lab tests to help us diagnose diseases, and better decision supports to investigate unusual complaints. In spite of this, modern medicine still often falls short of defining and classifying some experiences people have – some of which can be very painful and debilitating. Often, the approach physicians take is to first evaluate for potentially life-threatening conditions, and then work down a list of known options by their clinical severity and relative ease of evaluation (expense and risk of invasiveness). This process can leave a bad taste in the mouth of physicians and patients as sometimes there are no clear answers as to the cause of the pain, and this process can sometimes put doctors at odds with their patients.
It’s important to remember that all pain – even pain that we can see and define – is contextual. A soldier in the heat of battle can suffer enormous tissue damage from a gunshot wound in the arm, and barely feel anything as he rescues his companions from danger. While later in the hospital, alone, tired and scared of what may become of his limb, he can hardly stand a needle prick to obtain a blood sample. Fear, emotion, distraction and the meaning behind an event or feeling can, together, dictate the severity of pain and your reaction to it. Often, it’s the reaction to the pain that engenders more of it. The soldier tenses his forearm and makes it more difficult for the lab tech to draw his blood sample, making the pain worse.
We must also recall that a life without pain is a life without our inborn feedback mechanisms warning us of environmental dangers and potential injury. In essence, we can’t survive without pain. And yet, for some, it can become overwhelming and difficult to manage. It’s always prudent to properly investigate pain symptoms, and it can be difficult for patients with pain to know when they’ve had a proper investigation and when their physician is fully listening to them and acting in their best interest.
Sometimes it’s reasonable to receive a second-opinion to ensure that something’s not being missed. Finding trust in a professional takes time, and you should be transparent in your desire to seek a second opinion if you’re not satisfied with the first. Nevertheless, when multiple opinions are the same, you may find yourself in the very frustrating position of being at the limits of modern medicine to figure out what’s going on. In these cases, I try to focus on managing the pain with my patients, identifying common triggers and related factors that bring it on or make it worse, and improving their lives and their ability to cope with the pain to restore their functioning in the world back. A grieving process can often accompany this approach, as they may have to accept the pain in order to move on with their lives.
Regardless, talk to your doctor about your feelings of the pain, your fear and your sense of helplessness. You may find that they feel the same way. At times, medications can be helpful to alleviate many of the contextual factors making the pain more severe, such as depression or anxiety, and some antidepressant medications can actually work to reduce symptoms of chronic neuropathic pain that can be hard to define. Meeting with a therapist or counselor can help build coping skills and methods to manage the pain so that it no longer creates suffering, and keeping busy with deliberate distractions can help alleviate the loneliness and slowness of time that comes from suffering with chronic pain. Also knowing you’re not alone – millions of Americans also suffer from chronic pain that is ill-defined – can help. Seeking support and comfort from others undergoing similar experiences can help as well.