We all know that pain is a part of life and from a young age we learn how we can best cope with it. We have all seen the Pain Scale at the doctor’s office that goes from 1 to 10 and uses little round colored faces to go from a blue/green smiley face at the #1 level (No Pain) all the way up to the deep red wincing or crying face (Worst Pain Imaginable) at #10. That scale is very hard to calibrate since clearly, every person has different thresholds for pain. I think it’s fair to suggest that we all have some amount of pain on a daily basis. The McGill Pain Questionnaire (MPQ) is a widely used clinical tool for assessing and measuring pain. It was developed by Ronald Melzack and Warren Torgerson at McGill University in 1971. The questionnaire helps patients describe their pain in detail using three major categories: sensory qualities of pain (timing, temperature, pressure – examples include throbbing, shooting, stabbing, sharp, cramping, gnawing, hot, burning, aching, heavy), affective qualities (emotional and evaluative aspects – examples include: tiring, exhausting, fearful, punishing, cruel, terrifying), and evaluative overall intensity of pain (examples include: mild, discomforting, distressing, horrible, excruciating). The questionnaire contains a list of pain descriptors that patients can select to describe their pain experience. Each descriptor is assigned a rank value, and the scores can be tallied to produce a Pain Rating Index (PRI), Present Pain Intensity (PPI) using a 1-5 intensity scale, and Number of Words Chosen (NWC), which is sort of a qualitative gauge. The MPQ is particularly valuable because it captures both the quality and intensity of pain, rather than just intensity alone. This multidimensional approach helps healthcare providers better understand a patient’s pain experience and develop more effective treatment plans.
Pain is extremely common. According to major population studies, chronic pain (lasting 3+ months) affects roughly 20-30% of adults globally with lower back pain particularly widespread, affecting around 80% of people at some point in their lives. The prevalence of pain increases with age, with 40-50% of older adults reporting regular pain. Women generally report higher rates of chronic pain than men, which is interesting since it’s generally held that the pain of childbirth is among the most severe of pains. Childbirth pain is consistently ranked among the most intense forms of pain that humans can experience. On the McGill Pain Scale, unmedicated childbirth typically ranks very high, often around 35-40 out of 50 points. This puts it close to or above amputation of a finger, a third-degree burn or a bone fracture. However, childbirth pain is unique in several ways:
– It’s purposeful pain with a positive outcome
– It’s intermittent rather than constant
– It gradually increases in intensity
– There’s usually a clear endpoint
-The body releases natural pain-managing hormones like endorphins
-The experience varies greatly between individuals and even between different births for the same person
– Cultural and psychological factors significantly influence how it’s perceived and managed.
Headaches affect up to 75% of adults worldwide annually. Musculoskeletal pain (muscles, joints, bones) is one of the leading causes of disability globally. The experience of pain varies significantly between individuals in terms of its type (sharp, dull, burning, etc.), its location, duration and intensity, its impact on daily life and the overall individual response to treatment.
When I wrapped up a 20-year relationship with a physician I used at NYU for 20 years, his final advice to me was that while I was unlikely to have coronary, diabetic or cancer problems (the big three giant-killers), I was a prime candidate for joint an mobility problems. He was not wrong. While I still have all my original equipment and everything works fine and have never been surgically tampered with, I have spent 55 years at 300+ pounds and that’s gotta take a toll on joints and connective tissue no matter how robust and durable they may be.
I am thinking about pain for a very specific reason. I’m having a bit right now. Imagine that. At the moment it’s about my right knee injury that I got from falling on it in the garden (onto a rock). Using the little funny face scale (the MPQ scale seems too serious to use at this point), I think it ranges from 1-4 out of ten. While I have moments when I have winced when trying to get up from a seated position, walking around is mostly a 2-4 affair with the little emoji of the flatline mouth look (as opposed to a smile or frown). I’ve always liked that wide-eyed flatline mouth guy because he looks more bewildered than pained. That’s sort of my reaction so far. I’m not usually in pain, so the discomfort is surprising to me more than upsetting or intolerable. It’s been less than 72 hours so far since my fall and I have been doing all the right RICE (Rest, Ice, Compression, Elevation) things to help it along and I can notice appreciable improvement with the walk-around pain probably at a 2 more often than not. So this seems to have been just a fall and contusion with some related ligament and muscular strain that is working itself out. But here’s the thing we have all experienced…when you hurt something, you compensate and stress other parts of your body, often your lower back. Now I am worried more about throwing something else out of whack than about pain from this particular injury. To compensate for that, today I went to my local Chinese massage therapist, Wendy. She looks like a very hardened rural Chinese soul who tries to be pleasant, but has likely seen some of the harder side of life. I told her (actually more like gesticulated for her) that my right need was sore. In addition to all the necessary and helpful lower back and upper leg deep tissue work, she also put on some Icy Hot, the modern-day equivalent to that old standby Bengay. Those things are counterirritants and include things like menthol, methyl salicylate, camphor, and/or capsaicin. Counterirritants act on pain receptors by creating a cooling/warming sensation and are intended to dull the feeling of pain and reduce inflammation. It sure feels good for a few minutes.
What we all know too well these days is that the best pain management drugs are things like opioids, and we certainly know of the dangers they represent for addiction. For acute pain we use NSAIDs (ibuprofen, naproxen) for inflammation, Acetaminophen/paracetamol for general pain, Ice/heat therapy like Icy Hot, Rest and gentle movement, and perhaps physical therapy. For severe/chronic pain We tend to ratchet up treatment to use prescription NSAIDs, nerve blocks or injections (steroids), acupuncture, TENS units (electrical nerve stimulation), and finally, usually as a last resort, surgery. It would take a lot for me to go to anything beyond ibuprofen (in 800mg clinical doses) and liberal application of Icy Hot.
We all suffer pain differently and it is often as much a function of our character as much as anything. In fact, pain can probably be a major contributor to our character and the type of person we are. And it is so very hard to be judgmental about it (though we generally are) since none of us is in the head of the person feeling the pain. Hobbling around nursing my right knee pain this week hasn’t made me a master of pain management by any means, but it has reminded me that people in pain deserve lots of sympathy.