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.

Yes, I actually suffer with trigeminal neuralgia myself. Along with a couple of other chronic pain conditions.

@alloalloallo - please consider talking to a Control Practitioner about your daughter's pain. Every girl (and boy!) should be free to ride their pony 😊

Happy to DM you a list of practitioners.

I’ve tried hypnotherapy. Extensively.
Made no difference tbh.

I think in cancer pain relief is taken seriously. The issue is with conditions that are not life threatening.

i'm kind of on the fence.

I have long term chronic pain relating to my lower spine, buggered disks and arthritis.. i have prescribed pain meds, neuro meds...etc to handle the pain.

I dont take them to the point the pain is deadened.. i leave a little in the bank for a REALLY bad day when its absolutely unbearable.. i tolerate a certain level of pain.

I noticed over the years that when i deaden the pain completely my ability to tolerate pain drops dramatically.. the slightly twinge of something else bothering me, or bleeding through the meds floors me... i'm also more likely to overdo stuff and make things worse.

But when i leave myself in a certain level of tolerable pain, i listen to my body more, i realise my limits, i rest if its getting too much, and i make the conscious decision to treat any extra pain knowing i have wiggle room with my meds to do so..

So while i absolutely believe all pain ought to be addressed because its inhumane to leave people in severe pain if something can be done, i also think pain suffers should be encouraged to learn to live with it to a certain extent.

I have nerve damage. If I didn't take my painkillers I couldn't function.

I'm going to say yes because extreme pain and how someone react to it at the time it's happening can cause lasting trauma and PTSD.

All pain should be treated absolutely, but not all pain can be treated with pain killers. If there is a recognised cause - gallstones for example then this should be treated as a priority.

For acute pain - such as immediately after an injury, illness or medical procedure a good a 'high level' pain killer as required can be beneficial to help the patient retain mobility and improve recovery amongst other things, and reduced as healing occurs.

With chronic pain, certainly pain lasting more than 3 months then the benefits of painkillers are far less certain for a lot of causes (not all). Ultimately the evidence and showing that any benefits are short lived, and quite soon the side effects of the pain killers become far worse and more debilitating than then the pain was. This is why people aren't (or shouldn't be) prescribed ever stronger painkillers.

I'm only a paramedic, but as I understand the evidence shows that in order to actually improve from chronic pain it need to support our mind and body from multiple angles tailored to the patient and the condition- these will often revolve around lifestyle changes - improving muscle strength (supports your body), reduce your weight (reduces strain on your body), improve your mental health (I think most will recognise that we experience worse pain in depression, but having a good day and we feel better about our pain), coupled with painkillers which we wont develop a tolerance/resistance too or cause long term damage to our bodies. All this is obviously simple to say but can be very difficult to achieve, especially the first steps.

I have chronic nerve pain - all day every day. I spend most of my days meditating to keep on top of the pain and cannot get any medication from the pain clinic- they just tell me to meditate. It's a very very hard life and I have to work incredibly hard to keep on top of it in order to be a mother, sister, friend and so on. If I could find a mediation that would take it away - or even reduce it I would take it without hesitation.

I went to see the doctor about bad pain once, he wanted to prescribe tramadol but the electronic prescription system was down so he couldn't so he told me to call in the morning and get the GP on duty then to prescribe and put it in my notes so it would be seen by that GP. Next morning I called and the GP on duty said to me "no, young people just need to learn to cope with pain". Complete lack of empathy.
Ended up in A&E later as the pain was too bad, got the prescription and a very shocked reaction from the doctor there and told to make a complaint, which I did and she got disciplined. Pain needs to be treated where possible, its inhumane not to.

There are some types of pain (eg CRPS) that just don't respond well to painkillers or even nerve implants. But that doesn't mean that there are no treatments that can help. Patients still need to be given support and CBT can often be really useful.
I know a pain management consultant who recommends a website called Taming the beast, there are some very good resources on there.

Everyone should be offered it. I have a chronic pain condition that affects my entire body. I could take 12 painkillers a day and have done. But the reality is it fogs my brain and makes me drowsy, so unable to work, go out, do anything. I live with it as much as I can and take a few at bedtime. But it's depressing and exhausting a lot of the time. I'm not ready to spend my days drugged up on the sofa though. Realistically no amount of medication will completely get rid of the pain.

Lots of people on this thread could probably benefit from these resources on the neuroscience of chronic pain:

podcasts.apple.com/gb/podcast/tell-me-about-your-pain/id1503847664

www.curablehealth.com/help#help-top-faq/general/what-is-curable

www.curablehealth.com/blog/7-tips-for-curable-app-success

I'm only a paramedic

Never say "only" - you are so much more than that.

I have several issues which result in long term chronic pain. On a good day 6/10 bad days a full 10.

I have stage 4 endometriosis and adenomyosis (plus other issues) and could literally punch the next (male) dr who asks ne if i have tried ibuprofen. 🙄 last man to ask me this i asked him if i kicked him on the dick and asked him the same thing what would he say.

I have been treated appallingly due to different attitudes on how to treat pain. I accept i can never be pain free but the few meds i take keep me at work.

Their approach now is "pain clinic" bullshit which might be ok for mild pain but no amount of "deep breathing" is going to stop me being in pain.

It's insulting, degrading and you get made to feel like a drug chaser. I'm not i just want a life.

109% this

This is bullshit tried it repeatedly along with acupuncture

I feel for your daughter i have FND after having a spinal cord virus. Diazepam is the only thing that works. May as well be asking them for rocking horse shit as they won't give it you

I have found pain clinics to be very hit and miss

Just having this conversation with a friend. There is zero need to put up with pain.

I cannot understand why one is expected to endure a breast biopsy with only minimal local “numbing” (which we all know does sweet FA) but yet a colon biopsy is done under full sedation.

Makes no logical sense to me and clinicians refuse to answer.

<of course I know the actual answer>

Pain clinic is really not bullshit... I suffered a heart attack because my largely untreatable pain issues caused stress/cortisol/crispy arteries. Pain clinic severely reduced the stress levels in the first instance and has allowed me to reduce pain levels from an average of 7/10 down to 4.

If I don't do my exercises I feel more pain. The exercises are both physical and mental.

I have been to about 20 pain clinics in about 14 years. They are very good for short term pain issues but me personally not great for long term chronic pain caused by complex neurological conditions. Just my opinion they help a lot of people.

Best one i did was 16 weeks in house at the Walton centre

Pain is a challenging thing to deal with. For short-term pain (accident / medical procedure), yes there should be plenty of pain relief and if one type doesn't work it should be possible to get another. there is so much variation in how people respond to a procedure that it can be hard to judge in advance.

For long term chronic pain, unfortunately there is no easy solution. opiates etc have a v high risk of addiction, so pain management is probably best. That might be some drugs and some physio or other ways to learn to deal with pain. And that is what a good pain clinic should be able to provide.

Reading this, I can kind of understand why some people in desperation resort to illegal drugs. YANBU