What is your philosophy about pain?

[Michael]

A post on another thread today claimed, with elegant and arresting brevity, that "Stupid Should Hurt." I tend to agree, and reading it prompted me to post a Big Question I've been kicking around a while, in order to learn what others here think.

If, as the formula above claims, folly predictably and usefully results in pain, to what extent do you think the reverse holds true, namely that suffering is itself an educator?

We can clearly trace certain pains to the exercise of poor judgment, eg disrespecting the laws of nutrition or hygiene causes or contributes to obesity, heart disease, tooth decay, poor complexion, and other ailments. The appalling consequences of reckless driving we know about. On the other hand, injury and even illness sometimes arise from good actions, such as incurring harm in the course of sacrificing one's safety or comfort to someone else, whether acutely or long-term.

My question: Setting aside moral condemnation, setting aside "blaming the victim," and certainly setting aside any thought of deliberately inflicting pain in order to teach someone else a lesson (First, do no harm), as you go about your duties as healthcare providers, do you carry in the back of your mind the belief that a) all; some; or c) no suffering offers, in a broad sense, to educate the patient? Is pain always simply an inconvenient evil to be eradicated? Or is it (also?) always in some sense a "wake-up call" to change your life? An ancient Greek playwright said that "Suffering brings wisdom." Are there exceptions?

I know EMS providers are not there to pronounce judgment on what we see. But we are also human, and therefore necessarily a little or a lot contemplative. My own outlook, realizing I know very little about the circumstances behind the events I meet, is first to bring, unconditionally, compassion to those affected at the scenes I find. But at leisure I cannot help asking myself, What use might the wounds I encounter, which I have been fortunate to be spared, hold for their victim?

This question (asked silently) is, I must emphasize, not akin to passing the judgment that the person I meet "deserves" the pain received; that assessment lies outside my moral scope of practice. It is more by way of inwardly aligning myself with the strength of the person to meet a mishap, a person who, if affected at all by my attitude during our brief encounter, should sense -- secondary, of course, to the rendering of technical aid -- kind interest, support for the burden he or she carries, and a hope that the crisis prove ultimately rewarding in some, often initially veiled, way.

Any one else wonder about this? Or would such concerns distract your attention from doing your job?

Your thoughts, please.

[AZCEP]

:shock: Wow, this is pretty deep. :shock:

Not all pain is useful, just as not all pain relief is either. Obvious, or oblivious stupidity usually responds to the education offered by pain better than, say chronic abuse of an organ system.

The nice thing about the situation presented, is humans are the only animals capable of learning from other's mistakes. This doesn't happen often enough, but it is possible.

[emt322632]

I've often said something along the same lines, except it's "pain let's you know you're alive..." what I don't say is that in most situations, pain is often the result of patient stupidity. However it is our duty as healthcare professionals to attempt to make the person as comfortable as possible while we have them. We can't pass judgment, as was noted before, and if we have the capabilities, we should attempt to make the person as comfortable as possible while they are in our care.

[RaceMedic]

I believe that all pain carries a lesson to it. Yes i agree as well that we learn from others mistakes, however i also believe that sometimes the lesson needs to be learned first hand, the person that learns something hurts or has the possibilty to cause pain maybe missing out on something they might really enjoy. For example, say your a young kid and a family member is hurt in a motorcycle wreck. You see the pain that is inflicted on your family. Your parents and others tell you " thats why you should never ride motorcycles" " all they do is cost money and hurt you" you have learned that motorcycles are bad. Are they really ? No. yes there is the possiblity that you could be hurt while riding one, but that holds true for cars and trucks as well. This is a stretch but i think it does make the point.

Would i cause more pain to a PT to teach a lesson, or withhold pain management from them if it available to me? Of course not!!! I would try to, talk to them about it. What happened and such. Educate them on the use of safety devices and things of that nature. Sure, i think we all would and would agree that PT education when appropreite is our duty as well as the treatment is.

Pain does have its place. whether it be physical or emotional. There is something that can be learned first or second handed from pain. What the lesson is depends on you and the situation your in when it happens.

No Micheal your not wasting your time with this. We do provide first responce pre-hospital care primarily, your right. We are also to many that may or may not be hurt phyically a vision of strength and security that they need at that time. We not only have a impact on the physical healing of our PT's, we also in many cases encourage them emotionally and mentally to begin healing.

Be Safe

Race

[rayster]

I believe that all pain carries a lesson to it.

I agree with this to some extent.... but what about innocent people suffering? ie mother losing child in tsunami (natural disaster out of human control), a victim of a spontaneous act of violence or even murder... or a young child who has cancer. What lessons are to be learned from the pain and emotional suffering there? Why is it that innocent people should have to suffer?

Pain does have its place. whether it be physical or emotional. There is something that can be learned first or second handed from pain. What the lesson is depends on you and the situation your in when it happens.

Pain does have a good place but I think it is only beneficial to some people. Lets say I put my hand on a hot stove and I get a nice burn as a result. I won't be doing that again because I'll remember the pain it caused me the first time... I think that in that case or other situations that are similar pain would be the friendly teacher.... however I do not believe that this is always the case.

[RaceMedic]

You have brought up a ppoint that i had not considered with the cancer PT's and violent crime references. The only thing i can respond to that at this point is maybe the lesson is not for the child or the families of these people. The lesson could be for the rest of us.

Now please don't get me wrong, i am in no way a tree hugger environmentalist touchy feely everyone lives in hormony with nature with earth as our commune.

I know and admit i have flaws in my thinking but that is what makes me, me. What i answered was my attempt at answering Micheals philosphical question with my attemt at an answer.

I have no answer for you ray. Like i said you bring up points that i had not considered when typing this earlier. The lesson may be as simple as maybe we should enforce the laws we have in place now before making new ones to further limit our personal freedoms and lose our right to privacy, in the case of the violent crimes.

In the case of the kids with CA. Maybe the parents should not have smoked around the baby as an infant. maybe mom should not have drank and did drugs through out the pregnancy.

and to the rest of us.... Sometimes no matter what we do, how we act, or what we say we have to learn accept and realize that sometimes bad things happen.

Be Safe

Race

[Nate]

I would to add a few comments from my point of view. One should remember that there is a fine line between pain control and drug seeking. You have to be careful that your not withholding medications from someone who is REALLY in pain or giving them to someone who IS NOT in pain.

This is where drugs such as Toradol can come into play (although it has a lot of negatives), it can take care of a lot of "minor" pain, but will also have a way of drawing out those who are truly drug seeking. An example would be where you ask if they are allergic to Toradol or ever had the medication and you get the "I can only take ___________."

[Patch]

My pain is mine and mine alone. It belongs to nobody but me. It can not be taxed or appraised. You may sympathize or attempt empathy, but only I have the reality of my pain. It awakens my senses and confirms my mortality. Lessons are there to be learned, if I pay attention. To often I get lost in comfort and glaze over the significance of another's pain. The wolves are gone and my pain remains to remind me they are not gone completely. Death has email, and pain is the message, my sensory organs the in-box. I can ignore or I can acknowledge it. That doesn't matter. What matters is if I choose to learn, I should share what I learn with others who ask.

Everybody needs pain, nobody needs to suffer.

[itku2er]

Pain is all a preception....we all have a different preception of pain......some may stump their big toe and need major pain killers to them the pain is that severe and real.....and to others they can have major surgery and need nothing....it is all in how we in our minds preceive pain.......pain like beauty is in the eye of the beholder...

[Spock]

Pain control is a difficult problem in health care and costs our economy a phenomenal amount of money each year. JCAHO estimates this cost at over a billion dollars per year. We have an obligation to make our patients as comfortable as possible. If this means giving them fentanyl or morphine then so be it. Yes there are drug seekers out there but I think every system quickly identifies these people and once they realize we are on to them they move on.

In nursing school we were taught that only the patient can quantify their pain so if they say their pain is 10/10 then that is what it is no matter how they present. Many health care professionals (MD's, RN's & EMS) have a difficult time accepting this. I can relate to this on a personal basis. I suddenly developed flank pain one day that was very severe. I was sitting on the couch when my wife came home. She took one look at me and asked what was wrong. I told her I thought I had a kidney stone and she should take me to the hospital. She darn near had a stroke because I never complain about pain.

Upon arrival at the ED of the hospital where I work I told the triage RN my pain was 8/10. I had figured out early on in this process that if I sat still my pain would not be worse. Because I wasn't screaming or jumping around she didn't really believe me so I had to wait 2 hours before getting into the ER. Yes she was a witch. I got little pain relief until the chief of anesthesia heard I was in the ER and came to see me. When he found out how little treatment I had received he raised holy hell in the ED and I got pain meds quickly. My experience was suboptimal to say the least despite a $5,000 bill.

Yes pain is sometimes a good thing but that is not for me to say. I am aggressive in my pain management for all patients and worked very hard to add fentanyl to our EMS pain protocol and I am proud to say all of the medics with my service will do the same. Opioids (fentanyl and morphine) are the third most commonly administered medication in our service.

Live long and prosper.

Spock