All Pain: Treat It or Accept It?
The issue is whether it is ethical and spiritually worthy to treat all pain. Yes, some pain is a signal of illness which if the illness is properly diagnosed it can be cured and the pain is relived. But, there is pain which ends up without an illness to cure to relieve the pain. And now, the medical profession is faced with an epidemic of pain being treated with narcotics, narcotics leading to habituation fostered by physician prescriptions. And this epidemic is causing concern and challenges to physicians but also should be a concern for the public, the pharmaceutical companies and the government.
Maybe, physicians and patients should look at some pain as an intrinsic and spiritual part of life and that, well, those experiencing pain should understand that and live with it. An example of this view was written by the Lebonese poet Khalil Gibran in a poem titled
"ON PAIN"
Your pain is the breaking of
the shell that encloses
your understanding.
Even as the stone of the fruit must break, that its
Even as the stone of the fruit must break, that its
heart may stand in the sun, so
must you know pain.
And could you keep your heart
in wonder at the
daily miracles of your life,
your pain would not seem
less wondrous than your joy;
And you would accept the
seasons of your heart,
even as you have always
accepted the seasons that
pass over your fields.
And you would watch with
serenity through the
winters of your grief.
Much of your pain is self-chosen.
It is the bitter potion by which the physician within
Much of your pain is self-chosen.
It is the bitter potion by which the physician within
you heals your sick self.
Therefore trust the physician,
and drink his remedy
in silence and tranquillity:
For his hand, though heavy and
hard, is guided by
the tender hand of the Unseen,
And the cup he brings, though
it burn your lips, has
been fashioned of the clay
which the Potter has
moistened with His own sacred
tears.
posted by Maurice Bernstein, M.D. @ 9:48:00 PM
11 comments
11 Comments:
There are many resources on the internet regarding how to deal with physical pain without taking drugs. So Google the topic.
One that I found of interest was on "WikiHow".
The approach is to use "mind-based techniques" to reduce the pain. The approaches presented at the site appear to be in keeping with the words by Khalil Gibran in the above poem "On Pain".
Has any of my visitors here found value in the techniques described in the "WikiHow" article? ..Maurice.
Maurice,
What I have always said about pain is that "Pain is how we know that we are alive..."
That being said, is the goal of the medical profession NOT to relieve (lessen) human suffering?
The James Case and the Chin Case have proven that both legally (society's expectation) and ethically (human dignity (rights), medicine has a duty to alleviate the suffering of patients.
Suffering is NOT only (limited to) physical pain. Suffering can include mental suffering (such as PTSD) from practices that disregard patient dignity (such as those talked about in the Patient Modesty thread).Physicians' failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself (Source: The nature of suffering and the goals of medicine. )
-- Banterings
Banterings, I would argue that pain and suffering in humans are two separate Pain is a sensation which has been clinically quantified by the patient as 1 to 10. Suffering is a complex description by the patient of a emotional response which may or may not be associated directly with pain.
Yes, pain is a sensation for which the medical profession has various tools to modify. Suffering is a complex behavioral response for which the medical profession's duty alone cannot provide direct therapeutic control and requires more education and participation by the patient to resolve--and, of course, understanding by the physician regarding the complexities of the patient's thinking and reaction.
With regard to relief of pain and suffering through medication, it should be noted that a decade or more ago, the complaint of under-use of narcotics was promoted by the medical profession and, not incidentally, by the pharmaceutical manufacturers themselves. Currently, the argument by the profession and the government is that there is over-prescriptions and use of narcotics in view of the increasing addictions and misuse of prescription narcotics. So.. this may be the time to consider the title of this thread "All Pain: Treat it or Accept It?" Perhaps, not "all pain" but certainly "some" pains (perhaps those pains without suffering). ..Maurice.
Here is an article which adds to the discussion, separating pain from suffering:
N Engl J Med. 1982 Mar 18;306(11):639-45.
The nature of suffering and the goals of medicine.
Cassel EJ.
Abstract
The question of suffering and its relation to organic illness has rarely been addressed in the medical literature. This article offers a description of the nature and causes of suffering in patients undergoing medical treatment. A distinction based on clinical observations is made between suffering and physical distress. Suffering is experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychological entity. Suffering can include physical pain but is by no means limited to it. The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick. Physicians' failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself.
..Maurice.
Maurice,
I agree with you that pain is a component of suffering.
Thus, someone with a physical deformity (say a cleft palate) may NOT be in pain, yet they suffer. One of the greatest cases was that of Joseph Carey Merrick (AKA the "Elephant Man").
His physician, Sir Frederick Treves, 1st Baronet, could only do so much for him medically because of the technology of the time. To treat his suffering, he made Mr. Merrick a proper gentleman and introduced him into polite society (as opposed to the carnival and workhouse atmosphere he was use to).
The concept of suffering allows to look at all the pain one endures: physical, emotional, spiritual, psychological, that of our dignity, etc. (Perhaps this is a better definition of suffering.)
The problem that the medical community has with "suffering" (versus pain) is similar to that they have wit dignity (versus modesty); the medical community is NOT doing enough.
--Banterings
Banterings, what would you have the medical community do with regard to patient suffering? I ask this because, without physician treatable pain, suffering does requires the active direct understanding and participation by the patient to diminish or remove this disability. Would you agree that the physician's direct role in minimizing suffering is not so much a pharmaceutical approach but one of educating the patient regarding the factors and issues involved in the patient's suffering and supporting attempts by the patient for that minimization? Of course, full understanding of the patient's suffering would require the physician having a more personal understanding of what the patient is experiencing and speak to the patient with true empathy.
Banterings, this discussion has led me to realize that the difference between pain and suffering is something that I need to emphasize to my first year medical students as they are starting to interact with their assigned patients. And that relief of suffering will require more than tranquilizers, analgesics or opioids. ..Maurice.
Maurice,
The physician has a role to play in the alleviation of a patient's suffering. While that role is mainly confined to the physical body, there is a certain amount of crossover into psychological (mental) pain in the discipline of psychiatry.
There is also a requirement that the physician NOT cause more suffering ("First, do no harm").
It is the "first, do no harm" and cost-benefit analysis situations that become gray areas. For example, the prescribing of Risperdal to treat schizophrenia. One of the listed side effects is gynecomastia. Although the cost (risk)-benefit analysis is subjective, it's formulation would look something like this:
{ [ (chance of the benefit occurring) X (severity of the benefit) - (chance of the risk occurring) X (severity of the risk) ] + [what the patient wants] } ÷ [ (chance of the benefit occurring from doing nothing) X severity of the benefit from doing nothing) - (chance of the risk occurring from doing nothing) X )severity of the risk from doing nothing) ]
Note: [ (chance of the benefit occurring from doing nothing) X severity of the benefit from doing nothing) - (chance of the risk occurring from doing nothing) X )severity of the risk from doing nothing) ] ÷ [ (chance of the benefit occurring from doing nothing) X severity of the benefit from doing nothing) - (chance of the risk occurring from doing nothing) X )severity of the risk from doing nothing) ] = 1; being a "base line".
Generally, a higher (positive) number indicates a benefit and a lower (negative) number indicates a risk.
As medicine begins to come out of it's dark ages, we are realizing hidden harms of what medicine once thought benign. Specific examples of this include prostate and cervical cancer screening. Research has found psychological harms, over treatment, and false positives.
Does your title, "All Pain: Treat It or Accept It?" refer only refer to physical pain? What about psychological pain (as a component of suffering) when a patient is subjected (for example) to multiple intimate exams by medical students (from the patient modesty thread)? Historically medicine has focused on physical pain.
-- Banterings
Banterings, you can look at the "pain" described in Gibran's poem as either physical pain or even the "pain" of emotional suffering. And there could be an argument that in one or the other there may be a point where "acceptance" is a reasonable response beyond some external treatment. Right? ..Maurice.
It depends on the individual. I have a high tolerance, have had a root canal without any anesthetic (novocaine). Yet, I have talked with my physician about antianxiety medication to get through an office visit (such as sore throat).
There is no question that I can endure pain, yet due to experiences, any medical visits are almost unbearable.
So should I be denied antianxiety medication for something that most people don't need any for?
Should others be denied anesthetics for root canals because I can endure them?
I accept the premise that some pain is going occur. My premise is that "pain is how we know that we are alive." There is also the premise of "That which doesn't kill us makes us stronger." In that regard, pain is a good thing.
The slippery slope is how much care do we deny?
The justification of the denial of care has been borne of the eugenics movement (which incidentally started in the US), and at it''s extreme leads to genocide.
-- Banterings
Maurice,
There is pain in life. To say that we must accept (some of) it is a slippery slope. Should I not then give to the Salvation Army this season because the homeless should accept pain? In the stone age man lived in caves to escape the pain of the cold (among other things). The subjective of "how much do we do" leads us straight to the eugenics movement.
I personally prefer the "road less travelled" where I know I will encounter pain. The sports I participate in are in very harsh conditions filled with danger; many of my friends prefer golf.
What it comes down to is the choice of the individual as to how much pain they choose to endure. The problems start when others try to impose the way we live our life upon us.
Pain and suffering is personal and I think that each person should be responsible for resolution of the symptoms whether or not the person was responsible for the symptoms onset. This means with medical or psychological illness, it is the patient's duty to decide to seek professional help if it appears that self-treatment is unknown,inappropriate or ineffective. It is only the patient who is aware of the origin (history) or degree of the pain and/or suffering so the question arises "shouldn't the person in distress be the first to take responsibility for its resolution?" And that's the question of this thread. ..Maurice.
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