Pain: Myth Busters

Few people can say that they never experienced pain; still it remains a puzzle for many. Misinformation abounds despite extensive coverage in radio, TV and the Internet, and some legends may persist for generations. Here are just a few of the most common pain myths.

1. Clipping a nerve relieves pain.

   Common sense suggests that if a nerve is cut, the part of the body served by that nerve should become numb and painless. Numb yes, painless no. It took doctors quite a while to figure out that clipping a nerve in cases of intractable pain may decrease the pain at first, frequently followed by a recurrence of the pain, often more severe than the original one. This is often referred to as anesthesia dolorosa, Latin for "painful numbness".

   A similar situation is found in cases of amputation of a painful limb. It is not unusual in these patients the development of a "phantom limb", characterized by continuing pain in the limb that does not exists anymore, often with complains that the removed segment is still there and feels painfully twisted.

   Initially labeled as a psychological issue, phantom pain is now seen as a neurological disorder, arising from the remaining stump of the nerve and the structures it connects to, including the spinal cord and the brain itself.

2. Disks go "in and out" when they cause pain.

   Not really. The disks that act as cushions between the backbones, or vertebrae, are composed of a hard, cartilaginous outer ring, firmly attached to the bones, surrounding a softer center. The whole thing may be described as similar to a crème filled doughnut. A ruptured disk, which by itself can be very painful, may allow some of the inner softer material to leak or herniate leading to possible compression of a nerve, an even more painful condition.

   The degree of pain fluctuates depending on nerve irritability, muscle spasm, and even on the weather. Once ruptured or herniated, however, a disk never heals, it never "goes back in."

3. Although painful, surgery is a cure for back pain.

   As in the example above, a herniated disk may need to be treated surgically, to remove the pressure exerted over a nerve. The typical pain from such a nerve irritation is sciatica, a severe burning, shooting pain that travels down the back of the thigh and leg. Although surgery is often successful in reducing or eliminating the leg pain, it often fails to get rid of the low back pain that usually accompanies a herniated disk. Some degree of pain and reduced ability to perform activities are common after surgery.

4. Placebos exert just psychological effects.

   Placebo refers to the improvement observed in a number of conditions, mainly pain, when treatments known to be ineffective are employed. Sugar pills or plain water have been used to treat a variety of ailments for many years, on average helping one person out of three. The effect may not be profound or long lasting but it is certainly powerful enough to compare favorably even against drugs such as opiates and antidepressants.

   Recent imaging studies utilizing PET scanners have demonstrated that patients suffering from Parkinson's disease, who improve with placebo treatment, improve by actually producing more dopamine, the chemical lacking in the brain of Parkinsonian patients. Therefore, a process that begins as a psychological event may lead to intrinsic changes in the nervous system similar to the changes seen when real medication is administered.

   The search for the mechanism underlying the placebo effect has become the new Holy Grail, pursued by scientists who expect to find a way to minimize sickness without the troublesome side effects of drugs

5. Doubling the dose of an over-the-counter pain killer doubles the pain relief obtained.

   Most analgesics reach a plateau or a ceiling after a certain dose and increasing the dose further fails to provide any extra relief. Taking a handful of acetaminophen or aspirin tablets is unlikely to provide any better relief than conventional doses, and is much more likely to increase the incidence of side effects.

6. Orientals have a higher pain threshold.

   There is little difference in the ability of different human beings to feel pain. A pinprick to a Korean infant evokes the same aversive response as in a Colombian child. As children grow, however, the cultural differences in demonstrating pain, or pain behavior, become more apparent. Some societies frown upon pain behavior as a sign of weakness, a conduct one should be ashamed of, while stoicism is cultivated as a moral virtue. As a result, Orientals may receive inadequate management of painful conditions such as fractures or cancer.

7. Any pain not relieved by high doses of morphine must be psychological.

   Not true. Despite the awe that the name morphine inspires as an almost universal pain reliever, there are many painful conditions that fail to respond even to powerful opiates. Such is the case of pain originating from damaged nerves or spinal cord injuries, when analgesics often fail to provide relief, unless used in doses high enough to cause stupor.

8. Cancer pain is the most severe.

   Although a frequent source of intense suffering, cancer pain is not primarily different from other conditions affecting the same region. For instance, the severity of the pain from a kidney stone or from cancer involving the kidney and urinary tract should be similar.

   The main difference lies in the meaning of the pain for the individual. While one is temporary and likely to get better soon, the other may signify that the disease is hopelessly progressing. For the successful treatment of cancer and other painful conditions, it is necessary to address the suffering and fear that comes with it.

© Dr. Moacir Schnapp and Dr. Kit Mays

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