I have a high tolerance for internal pain. I don’t say this in boasting, because in all honestly its more of a hindrance than a benefit. I’ve worked through migraines and walked 200 yards to work on a dislocated hip. While this may spur thoughts of “Wow! You’re tough! That’s impressive!”, I don’t do it because I’m a hardened warrior woman. I’m just full of stubborn ambition and I’ve got things to do. But this has a greater impact on my health and risks than whether or not I’m able to work through it or not.
What Is Pain
We all feel pain, but…why? Simply put, pain is the message our body delivers to get us to change a behavior and avoid further damage. Our bodies feel an actual or potential threat, and send a message along our nerves that gives us unpleasant sensations that basically translate to “STOP DOING THE THING!”. As a general rule, the higher the pain, the more damage you’re incurring on your person. If you want detailed information on the biology of processing pain, check out this article on the NIH.
This gets complicated with chronic conditions that have a constant pain level. One, sometimes that part where it’s registering potential threat…is a bit paranoid. It sends us messages of intense pain when there is nothing actually harmful going on in our bodies. They scream if anything but the softest fabric is touching the skin or the wind is gently blowing. The second complication is that if you have things that ARE harmful on a constant level, your nerves have the potential to whimper like an abused housewife instead of scream every time something terrible is going on. That’s far from a kind analogy, but it is illustrative of how nerves can respond and can be helpful if trying to understand why if you feel better, it doesn’t always mean everything is improving. They give up trying to work towards fixing and take a “whatever, nothing is going to ever change anyway because it’s hopeless” attitude.
On a Scale of 1-10…
When doctors ask you to rate your pain on a scale from one to ten, they’re trying to assess the level of danger you’re in. If you are at the point your nerves only whimper OR they’re on the paranoid side, this makes using pain as a diagnostic tool difficult. For an example, the first time I pulled a rib out, it was excruciating. I had a hard time breathing, sitting, lying down, standing…you get the idea. The only way I was pain free was contorting myself in an odd position with one arm twisted above my head until it went back in. That was several years ago. When one goes out now? It’s annoying. I still have discomfort, and damage is still being done to surrounding soft tissue. My body just doesn’t register the intense pain anymore. It’s given up trying to yell that something is desperately wrong. So when I go to my physician and he asks how my pain is today, if I’m honest, I’d rate it probably at a 3. How it should be rated, however, is closer to a 7 or an 8.
So what do I tell him? Do I tell him how I actually feel or how I know I should be feeling?
Though it takes up more talk time, I normally decide to do both. I’ll explain, as quick as I can, that “I’ve got a skewed pain spectrum from chronic pain and that I walked to work on a dislocated hip so please keep that in mind. So I’d rate it on a personal scale of a 3 but it should probably be more accurately a 7?” while using a tone that has a questioning inflection to let them know in subtle ways that I’ve really no clue what I should be saying but I’m trying to be helpful.
On A More Personal Level
Though this presents its own complications talking with physicians, the larger hurdle for me is it plays a huge anxiety role for whether I have a valid complaint worth bringing up to the doctor or not in the first place.
Another contributor recently wrote a wonderful post about being told It’s All In Your Head. It’s a very real problem many of us face. Whether our brains are freaking out and there’s no discernible cause or we’re in so much pain all the time others (including some physicians) don’t believe we can talk calmly AND be experiencing that level of constant pain. I’ve been told in the past that I couldn’t possibly be experiencing a migraine because when THEY have a migraine THEY can’t function. A week later I was hospitalized as my muscles decided to give up and I couldn’t lift myself out of bed. Diagnosis? Status Migraines. How was I still functioning up to that point? Barely. But I had things to do so I pushed.
When you’ve got that level of stubborn ambition, to perform daily tasks while experiencing pain that would normally immobilize the “average” person…how do you decide when its an emergency? I’ve torn ligaments, had pains that my OBGYN related to labor pains when struggling with undiagnosed severe case of simple hyperplasia, dislocated and subluxed joints, status migraines, severe panic attacks that caused chest pains, been stung by a Man O’War, nerve pain from a swollen trigeminal nerve, and that’s just off the top of my head in this moment. Every time I thought to myself “I can still work through this, it’s not bad enough to bother my doctor…right? Severe issues that required medical attention and I was there wondering if I should BOTHER MY DOCTOR not because my doctor is mean and abrasive, but because I couldn’t decide if it was an actual problem or just something mildly annoying. My interpretation of pain is so skewed, my body is no longer sending proportional messages about the level of danger I’m in. It’s like if you accidentally severed a finger and your brain can’t figure out if it’s really severed or not. It’s pretty screwed up if you think about it. On more than one occasion I’ve been in the middle of explaining an issue to a new specialist only to suddenly realize they’re looking at me with an expression that is somehow a mixture of horror, sympathy, and disbelief. It always seems to follow with “and why haven’t you come to see someone before now?”. Well, because to me it didn’t feel that bad. Don’t know what else to tell you.
It screws with your perception of reality just a little bit.
What Can You Do About It
I wrote something about Becoming Your Own Doctor recently, and that aspect has something to do with it. The more that you can learn about your condition, the better aware you are of things to be a bit hypersensitive over. It also is important to discuss things and make your perception of pain known to your physicians. Only when you’re all on the same page, can everyone be making the best decisions possible in regards to your health.
Learn to be more comfortable with communicating with your medical team. I’ve learned the hard way that it’s much better to be a bit on the side of oversharing than to assume what I’m experiencing is harmless. If you need to, to ease any awkward feelings about bringing it up, pretext it with something like, “I’ve no clue if this is relevant, but I figured better to just inform you…”.
Discuss using different variables to your pain scale with your medical team. Let them know what else you’ve considered at that number or what you’ve considered a 10 to put it into perspective. Use descriptive terms and analogies or explain how it impacts your mental state.
Remember it is all about taking the best care of yourself as possible. If you happen to have a condition that alters your perception of pain, it’s best to acknowledge and work with it in a way that is as productive as possible.
