Everyone you ever talk to says that they have a high pain tolerance. I don’t really have a reason to ask my patients, but the offer the information anyway.
“Doc, this shoulder pain is terrible. And I have a HIGH PAIN TOLERANCE.” As if this suffering were severe enough to kill a less tough person. “I wouldn’t even be here getting this MRI if this pain weren’t the worst pain ever suffered by a human. What is it on a scale of one-to-ten? At least a fifty.”
Now, I don’t mean to disrespect people or disregard their suffering. I’m just saying that, if pain tolerance is distributed on a bell curve, like pretty much everything else, not everyone can have a high pain tolerance. Most people will have an average tolerance, a few will be high, and a few will be low.
A group of people who has the highest pain tolerance, in my experience, is old women. You bring me an 80-year-old grandmother for a breast biopsy, I probably wouldn’t even need to use numbing medication. You don’t get to 80 by being a wimp. They’re always really laid back, like they’ve seen it all, and this is nothing.
“You can’t hurt me, sonny. I’ve delivered 18 kids before the invention of epidurals. Bring it on.”
You know who has the lowest tolerance for pain, in my opinion? Young men. And young women. Young people, as in 20-30 years of age. They get more X-rays of their hands, feet, back, pelvis, that are completely negative. No fracture, no dislocation, no arthritis. They have perfectly healthy bodies, but they are convinced that they are being tortured.
And maybe they are, who am I to say. Whenever I catch myself getting cynical after reading 200 normal spine MRIs in a row, I have to remind myself: I have no idea what this person is experiencing. It’s not that I’m super tough myself. It’s not like I have debilitating back pain that I just fight through- I have no back pain. My back feels great!
My wife took me into her electrologist to get my burgeoning old man ear hair removed, and the lady asked me how my pain tolerance was. I have no idea. I guessed, “Average?” I’m not a whiny baby, but I do yell when I step on the legos, because it hurts. For a few minutes. So I’d guess I’m about average. Oh, and also, electrolysis hurts like a bitch.
Some patients are low on the scale. I was performing a lumbar puncture (spinal tap) on a patient the other day, and before I push the long needle down into the spinal canal, I use a tiny needle to anesthetize the skin and superficial tissues. Before I even broke the skin, a single drop of lidocaine dripped from my needle and landed on this 40-year-old lady’s back. She screamed like I was branding her with a glowing hot iron. This is a drop of what is essentially water, folks. So, clearly, this patient’s issue is mental or emotional. Some kind of high level of fear that exacerbates physical sensation. Either that or she has a wildly rare condition where the nerves are hypersensitive. I’m betting on the mental issues.
So, why does all of this matter? Well, it has a massive effect on our world. Millions of people abusing narcotics usually starts with pain that might be treated with ibuprofen.
“My back hurts, I need OxyContin. Wait, that was fun. I need some more. I need moreandmoreandmore. Whoops, I stopped breathing. Guess I should have stopped with ibuprofen.”
I realize this is anecdotal, but I don’t think narcotics even provide much in the way of pain relief. I took hydrocodone for a couple of days after a surgery. I was now loopy, but the pain was still there. And, the resulting constipation was worse than the pain from the incision. So I threw the pills away and took Advil. Worked like a charm.
Think about all of the millions of ER visits. Many of these people have nothing wrong with them, at least nothing emergent. They have a headache, or belly pain, or dizziness. So they go to the ER at 11 PM for a five-thousand dollar workup. Which shows that there is nothing that is going to cost them life or limb. What if we could run a test on each patient as they walk into the ER? Measure their pain tolerance. There actually are some machines that do this. They’re called doloromiters.
“OK, sir, I’m going to measure your blood pressure, your temperature, and your pain tolerance. Oh, I’m sorry sir, this says that you’re a huge pantywaist. I’m going to have to stop you right there. Why don’t you go home and take an Advil and see your regular doctor tomorrow?” You just saved five thousand dollars.
I have a theory that much of the obesity is related to pain tolerance. I don’t have any proof of this, so please don’t shoot me. What if the pain of being hungry or running a few miles is too much to bear for someone with a low pain tolerance, and it results in obesity? It would be an interesting idea that might help discover new ways to combat obesity.
Maybe we could use Advil.
“Pain is the 5th vital sign.” That was the mantra when I was in medical school. Pain probably was under-assessed and under-treated for much of modern medical history, but I think that mentality helped fuel the opioid crisis in our country.
I will never forget my intern year– making rounds in the early morning hours, assessing my patients’ 5th vital sign. Many of my patients were connected to IV narcotics for pain control. One of them, a woman in her 20s or 30s with chronic pain, would reliably answer “15” when asked where her pain was on a scale of 1-10 (even after I explained that 10 is the worst pain imaginable). Perhaps it would have been more believable had she not been resting comfortably in bed with no outward signs of discomfort, never bothering to look away from her cellphone to discuss her medical condition.
Boy, I think I really helped her…