Misconceptions About Pain – Episode 217

Pain is whatever the patient says it is. Pain is a very personal experience and varies greatly between people. Many people have misconceptions or misbeliefs about pain in children. These myths have lasted even though there is now evidenced to support that they are not true. There are a lot of misconceptions out there, about pain. And we touched on them a little bit last week, one of those is that our doctor can fix us. What Are Those Misconceptions? The idea that we can be fixed or the idea that pain can be chopped out, cut, poked, or drugged out of us, is a huge misconception. And that tends to come from this idea again that pain oozes out the body like pus. It’s easy to understand that, right? We believe that if I poke you in the leg with a knife, that makes pain travel like little pus from that knife cut into your brain. Then, it would make sense that we would be like “Well, oh someone must interrupt the flow of the pain pus.” Pain Generator If there was something in your back, body, shoulder, or whatever, and that was where the pain generator was, it would send the pain signals up to your brain. That’s not simply true. Because any pain in any scenario, you have both nerve information coming from the body, they're not called pain signals but nerve signal. And there are a lot of nerve signals that go up to the brain but you still have to have those brain related aspects. You need to have that cognitive element and that emotional component to construct and experience pain. Dr. Kevin Cuccaro would say that the biggest misconception about pain really is the idea that pain equals damage. Or that pain comes from the body unadulterated, flowing like pus, instead of recognizing that pain constructed in the brain. That’s all pain, acute and chronic. It doesn't mean that when you're experiencing pain that is not real, it's a hundred percent real. But that hundred percent needs an awake and alert brain in order to make it. Misconceptions on Military People By watching all these TV shows about the military and spies, people that have learned they can be tortured and still won't give up the information. Maybe that's because they've trained their brain to maybe put the pain somewhere I mean they're still feeling pain. These people are still feeling a sensation. We kind of touched on this in the first episode. There are three key contributors that you construct and experience a pain. You have the sensation that comes from the body. Then you have that cognition which is like the thoughts and anticipation and appraisal of that sensation. And then you have the meaning that we get to that sensation, and people who have been trained, the military is a great example. They have gone through something like survival training and know what to do under torture. They still have sensations, and they still can have intense sensations. In fact, they're more likely experiencing pain but what they've been able to do is because they understand what is occurring and they've learned a skill set to survive in that scenario. They have more perceived control and less uncertainty with it. So it is likely that they're not experiencing as much pain in those scenarios. 7-Day Limit on Opioids When it comes to acute prescribing, the reason a 7-day limit was usually picked had nothing to do with pain. In fact, Dr. Cuccaro’s personal experience is that most healthcare systems are pretty pain illiterate. But the reason that 7-day window was picked was because if you look at how acute the timeline for what we call an acute opioid prescriptions, somebody who's never been on opioid before. Taking an opioid, after 3 days,