How Pain Serves As Your Body's Warning Signal
By Vicki Rackner MD, Thu Dec 8th

Pain is like the warning lights on your car's dashboard. Italerts you to something that needs investigation. Pain serves animportant function. It's your body's way of saying, "Payattention."

We all avoid pain. You wouldn't knowingly slam your thumb in thecar door or touch a hot stove. It's human nature to avoidsituations that cause pain, and we do what we can to ridourselves of the pain as soon as possible -- such as taking anaspirin for a minor headache.

When your pain is severe enough, or worrisome enough -- or lastslong enough -- you find yourself in your doctor's office. Then,ideally, you and your doctor figure out what's causing the painand fix the underlying cause. The most satisfying encounters forboth you and your doctor occur when the pain points to a cleardiagnosis; you're treated and the disease is cured. A goodexample is a cough and pain in the chest when taking a deepbreath leading to the diagnosis of pneumonia that is cured withantibiotics. But not all pain is solved that easily.

Each of us tolerates pain differently -- even pain from the samecause. Surprisingly, the patient who would complain the mostbitterly when we injected a local anesthetic that tended to burna little was not the frail 80-year-old grandmother, it was thestrapping 25-year-old body builder who said he "wasn't afraid ofnothin." Those are also the patients most likely to faint whenblood was taken.

As a surgeon, I did many "lumps and bumps" operations. Dependingon the patient's tolerance for pain, I could perform theprocedure in my office or in the operating room, where, amongother things, sedation was available. It usually was clearwhether a procedure could be done in the office or required thesupport of the operating room staff.

Then there were the judgment calls. It could go either way. If Ilooked at the top of a patient's head and saw orange or red, thepatient would go to the operating room. My experience supportsthe thinking that redheads are more sensitive to pain.

How do you get pain to move from "pay attention"' to "problemfixed?"

Your doctor needs help from you when your "pain light" flasheson. There is no way your doctor can measure your pain. Sure wecan check your heart rate, which tends to beat faster if you'rein pain, or your blood pressure, which also rises. Clues like afever or a high white blood cell count that can point to thecause of the pain; they don't measure your experience of thepain.

Only you know what your pain feels like.

Sometimes the cause of the pain can be identified before thedoctor even sees you. The broken bone on an X-ray, abnormalblood thyroid level or malignant prostate cells on a pathologyslide speak for themselves. Sometimes tests will show what isnot causing the pain: a normal EKG usually means that your chestpain is not from a heart attack, and a normal breast exam,mammogram and breast ultrasound suggest that breast pain is notcaused by breast cancer.

No test can exclude a medical condition with 100 percentcertainty. Or in medical lingo, tests can have "false negatives"-- meaning you have the condition even though the test says youdon't. This is another reason you want your doctor to perform acomplete evaluation, and not just make a diagnosis over thetelephone.

Sometimes there are measurable findings that explain the

causeof the pain, but we do not know why. We doctors even have fancyways of saying, "We have no idea what's causing it."

My patient Paul was in a panic when he read about his"idiopathic pancreatitis" in his medical record. This means thathe had inflammation of his pancreas that we could see on a CATscan, yet we don't know why his pancreas became inflamed. Thetwo most common causes of pancreatitis are gallstones andalcohol use. Paul didn't have gallstones and he never drank. Hewas not at risk for numbers of other uncommon causes ofpancreatitis. So why the pain?

The good news for Paul is that there was a way of explainingwhat was happening, and the diagnosis guided treatment. The badnews for him is that in the absence of knowing why he gotpancreatitis, there was very little we could tell him to preventfurther attacks. Ask anyone who's had a bout of pancreatitis andthey will tell you that's not something they ever want to gothrough again.

It's easy to lose sight of the fact that pain is there to serveyou. Pain is not the problem. Finding out what's causing thepain is the challenge.

The key for you and your doctor is to eliminate the pain, butnot ignore the message the pain is bringing. You might getmedication to treat heartburn and your pain will go away, butyou may overlook the stress at work that's causing theheartburn. It's like putting tape over the dashboard in your carso you won't get distracted by the flashing red trouble lights.

What do you do when you have pain that can't be explained by alab test or X-ray or any changes your doctor can see or feel orhear when examining you? This can be a frustrating situation,both for you and your doctor. If you have ever had a headache orbackache or the heartache of depression, you are most likelynodding your head.

My advice is to become a medical detective. Find things tomeasure and describe with numbers and keep a log. Here are somemeasures to write down:

- Rate your pain on a scale from 1 to 10 (10 is the worst ever)- Duration of episode (minutes/hours) - Number of episodes perday - Amount of sleep - Stress level (1 to 10) - Medicationtaken that day

You might have hunches about what's causing the pain or makingit better. It might be what you eat, or your physical activityor the weather. This can become part of your log and aspringboard for discussion with your doctor.

The next time you experience pain, listen to the voice thattells you that pain is the enemy. Then remind yourself that yourpain is also your friend.

It's there to draw your attention to an important message if youwill only listen.

Copyright © 2004 Vicki Rackner

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About the author:Vicki Rackner, MD, president of Medical Bridges, is a board-certified surgeon who left the operating room to help employeesbecome active participants in their health care. She is aconsultant, speaker and author of the *Personal Health Journal*,and author of the lead story for *Chicken Soup for the BreastCancer Soul.* Dr. Rackner can be reached athttp://www.MedicalBridges.com or (425) 451-3777.