Do you think intense pain, in its own right, should always be treated? Or are there some circumstances in which people should be expected to suck it up?

[Greensleeves]

I've noticed a very wide variety of approaches to pain relief among the medical professionals I've encountered during my life. Some clearly feel that acute pain, even if it is doing no functional harm, should be treated to the best of medical capability, because nobody should be expected to just cope with it. I've met others (probably more of them!) who see pain only in terms of what it can tell them about functional injury/illness, and not worth spending time/resources treating if it's the only symptom. Bone pain from cancer, long-term nerve pain from a (healed) broken back, dry socket, that sort of thing.

I know there are other considerations, such as the side effects, addictiveness and cost of strong pain relief. There are instances, though, where a good dose of a strong pain killer would enable somebody to get a good night's sleep and a bit of relief in hospital, and they are brusquely told that paracetamol is perfectly adequate, when it clearly isn't (severe pain after a knee operation, for example). I think there's also an element of medical professionals - who are more overworked, stressed and undervalued now than ever - having to be a bit ruthless in how they prioritise issues, and self-protective in how much empathy they spend on patients whose pain, although debilitating, isn't actually an immediate threat to life, or a sign of a new injury.

Curious as to what others think.

Sorry - YABU: yes, there are times when treating severe pain for its own sake isn't necessary, YANBU: severe pain always merits treatment and medical professionals are wrong to neglect it.

As a chronic pain sufferer. . .

YANBU

I live with severe nerve pain/damage. Having that treated enables me to have a full time job and contribute to society. Without being properly medicated purely for the pain I couldn’t function and would have no meaningful life.

You are right about sometimes overworked/over stressed doctors/nurses not being able to focus on it though. It’s an NHS funding issue to blame more that anything else.

Pain always causes harm though? People who live with chronic pain live with a high rate of mental health issues and autoimmune issues. It literally wears out your body.

YANBU Greeny and I would add that pain bias based on the sex of the patient is a thing:

Article from the BBC here
www.bbc.com/future/article/20180518-the-inequality-in-how-women-are-treated-for-pain

I have some friends who live with pain and It is so debilitating. I don't think anyone should have to live with that when There is medication to help. YANBU

As a chronic pain sufferer YANBU.

Just because you can't see it doesn't mean it doesn't exist. Makes me so angry when the doctors try to dismiss it.

This is a crucial point, and I think one of the reasons it doesn't have the traction it should have is that medicine is still very compartmentalised; practitioners used to treating cancer or heart disease or torn ligaments don't generally factor in mental health or the long-term physical and psychological ruin that relentless pain can cause.

YES to this! Women are much more likely to be dismissed as dramatic or told their pain is a part of their condition and they need to learn to live with it. I wonder whether traditional attitudes to childbirth have helped to poison the well here; women are still judged for asking for more and better pain relief during labour, and lauded for being able to tolerate agony.

I absolutely agree thatvpain should be managed but the over prescription of opioid medication in the states is what caused the opioid epidemic.

It's a fine line with no clear answer.

Agree with pp regarding sex bias this is a major problem across the scientific literature

I have osteoarthritis and the pain relief I have on prescription for it doesn’t work very well and has damaging long-term side effects so I don’t take it, just put up with it. The MSK specialist does what he can but recognises that’s not much and it’s all a bit meh, what can you do.
Twice I’ve been to A&E with broken bones and both times when I’ve finally been seen by someone for treatment, after hours of waiting, xrays, what-have-you, the HCP has asked why nobody has given pain relief and acted on that immediately.
Hard to know what’s behind the inconsistencies in approach.

Hypnosis/hypnotherapy has been shown to alleviate chronic pain. It's also been used in place of anaesthetic in operations.

I think pain long term should always be treated. But it is not always possible to eliminate pain, it might involve only reducing it.

And the pharmaceutical firms who pushed opioids also pushed the idea everyone deserved to be pain free. Sadly that is not realistic.

I think they should always try to treat it

I gather I was lucky to be offered consistent proper pain relief for my spinal injury. I have heard of many cases where people were told to put up with it. One woman in my physio group ended up taking her husband to a doctor’s appointment to get proper pills. I was proper shocked! And she said it worked, they listened to him saying she would use them responsibly, but hadn’t listened to her.

The word "deserve" there is interesting. Personally I think the concept of "deserving/undeserving" is rife in medical culture, and is very corrosive. A phenomenon which disproportionately affects women.

I think the opioid crisis is definitely relevant, and needs to be part of the discussion as something we all wish to avoid - but there is a huge gulf between handing out opioids like sweeties, and "here's two Panadol, stop moaning" for severe debilitating pain. As a pp pointed out, hypnotherapy can be very effective for certain types of pain, as can TENS machines, massage therapy, hydrotherapy and a whole range of other treatments. They cost money, though.

My 17 year old daughter has Functional Neurological Disorder and struggles with chronic pain.

She’s told its “just anxiety”, was given a link to a website and we were sent on our merry way.

It is difficult, there is no actual, physical reason for the pain as it’s caused by her brain sending and receiving mixed messages. The only thing that works is diazepam as it interferes with the wonky messages her brain is sending, but no one wants to go there.

It is pretty limiting for her. Traditional medication such as paracetamol or ibuprofen doesn’t work. We went to see a neuro-physio who had some suggestions for her, but it’s a bit hit and miss.

She’s having a bit of a flare up at the moment and everything just hurts, all of the time. She’s been doing some work with CAMHS on listening to her body, and not using too many ‘spoons’ but she’s 17, and wants to go out with her mates, ride her pony, go to college, etc.

As a HCP you should always treat pain, acute or chronic. Chronic pain is far more challenging to manage but this is why we have pain specialists. Just saying to grin and bear it is totally unacceptable professionally IMO.

In two minds here

Sitting tethering in the edge of withdrawal from pain killers I keep refusing to admit I'm additicted go and sick without
I hate the fact I ever agreed to take an opiate
My stomach is trashed from NSAIDs so I can't use them
I am exhausted by obsession with making sure I have medicine in time (I've not done it this time) last night as I lay vomiting onto the floor with no bowl or anything ti catch it asking my husband to fix it all for me l... I don't know...
I wonder if I would have died from the pain I initially had or if I would have lost my first born child

I have a right to be pain free but I judge myself Incredibly harshly for being totally utterly addicted to the point of sickness without it ... to opiates

@Greensleeves I am a big fan of pain clinics. But it is about reducing pain often, not eliminating it.

YANBU

But pain is often very dismissed depending on what it is - women who have c-sections are often sent home with advise to take paracetamol 'if necessary' yet when my DH was sent home after abdominal surgery he was given a bundle of pain killers and told not to struggle through unnecessarily as 'that's what painkillers are for'

Yes, I think all pain should treated if a) it can be safely and b) the person that is affected wishes it so. It should be simple as that.

The deserving/undeserving thing is part of medical culture and the wider culture.

If you have poor health it's because you have done something wrong. There is this idea that if you had a better diet/took more exercise/whatever you wouldn't have ended up with a medical condition. It can't be just bad luck.

Not all pain can be treated.

I worked in palliative care for years, my Colleagues and I always assess the whole person when administering analgesia. No one can achieve a healthy/relaxed mental state if they are in pain or suffering from nausea. There is no purpose to chronic pain, and acute pain is only useful for diagnosis.

I have chronic pain. Yes it should be treated! Everyone is different though and what helps one person may not help another.

For me, medication is only a small part of my pain management plan. I am fortunate to have had access to an excellent NHS pain clinic and also the Curable app which has helped so much.

Others have more success with medication than I have and yes they should be treated.