Saturday, January 21, 2012


One of the last projects I worked on was Pain. As we were taught, there are two types of pain: nociceptive pain (good pain; warns the body to stop doing something hazardous like leaving your hand in the fire) and neuropathic pain (bad pain: serves no useful purpose). We were interested in treating both, preferably with the same medication (aka Magic Bullet) but this probably does not exist. Not all nociceptive pain is 'good'. Arthritis for instance although perhaps it discourages the sufferer from continuing to grind bones against bones due to no cartilage left. Narcotics treat both types with various success but have too many side effects. Neuropathc pain is due to damage to the nerve itself. Diabetic neuropathy and fibromyalgia seems to make up much of its cause.

Taxol can also cause lasting neuropathy. In my case, it only lasted for about 12 hours per drug cycle. Every muscle fiber seemed inflamed particularly in my hips and thighs. Fortunately it went away but it does not in many cases.
The best treatments so far for neuropathic pain were developed at our company and we were trying to do better. I am out of the loop now and legally can't discuss my previous work.

I have been told, not at work, that there are two types of pain; memorable and non-memorable. An example of  the former is dental pain and of the latter, childbirth. I suppose the latter serves an evolutionary function. If you truly remembered how awful childbirth was, would you do it again? I am guilty of this. I do remember thinking that I was experiencing severe pain but I couldn't even describe it to myself soon after the birth. Yet I do remember my adventures with an incompetent dentist when I was about 8 who insisted that he numbed me (no he did NOT!) extremely clearly. I got a taste of it the other week when they were preparing me for the crown.

It is hard to measure pain. In the hospital, they ask you what it is on a scale of 1 to 10 or they have pictures of distressed people and you point to the face that most mirrors your own. Not that they believe you. I was only 1 cm dilated and experiencing what I thought was severe pain and I was told that was impossible given how weak my contractions were (that could be measured). Naomi had the opposite: strong contractions that she could not perceive as pain.

It is annoying how little patients reports are trusted. The definition of asthma are three wheezing episodes witnessed by the doctor. Although many episodes have been observed by Shanna, Oliver will not wheeze on command.

From ages 14 to 18, I had severe dysmenorrhea that made me useless for about 8 hours each month. I would say that sometimes the pain would approach end stage labor. I would have dry heaves. I wanted this stopped. I went to the library to research it and was distressed to find out that it was not real and probably some psychological maladjustment on my part to woman hood. I started my periods at 12 but they were painless for a while. How come I suddenly started rejecting my 'womanhood'? This is before they knew about prostaglandins and blocking their pathway. My grandfather used to give us his medical journals. In it I read that those on birth control pills did not have cramps. Well sign me up. Of course my mother would not consider it but as soon as I got to college, I got on them and they worked. Or maybe I just accepted my womanhood. Later, simple anti-imflams did the trick, ibuprofen being the preferred medication.

I feel better today though I am still queasy. Ms. Maya did come down with a milder version of this crud. She still has a bit of an appetite so I take that as a good sign.


Scott K. Johnson said...

Hi Sue,

Thanks for this post. It's such an interesting topic to think about, isn't it? Pain.

It's not something we often think about unless it's forced on us. I appreciated your thoughts on it.

Snowbrush said...

Neurologists seem to think my pain is neurological (based partly upon the fact that it is mirrored in both shoulders and both shins. Orthopedists think it is arthritic (primarily because of X-rays, MRI's, and what the surgeon can see when he operates. After four surgeries that were supposed to help (three were orthopedic and one neurological) I've given up on finding a cause.


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