REST AND PAIN: VALUE OF PAIN

When we are thus assailed we may be fortunate to have watching over us an unattractive and much maligned guardian; that is, pain. It has not been inflicted upon us because we have sinned, nor is it just a mean trick played upon us. Hard as it is sometimes for us to be thankful, nevertheless it has been given to us for our good. There are diseases, leprosy for instance, in which pain has been abolished and the patients do themselves serious injury without any warning. Cancer patients would have a much better chance if pain, at the beginning of their disease, would lead them to seek help.

So, the physician should have an understanding of the significance of pain and sympathy for the patient's feeling. When a doctor says, "Your pain is only muscular," it would suggest that the doctor has never had lumbago.

One trouble about underestimating a patient's pain is that the reaction may lead him to build it up beyond its real value. On the other hand the physician must remember that pain is usually an aid in diagnosis and abolishing it quickly may lead to dangerous error. Also, the patient, suddenly made comfortable, may refuse further proper treatment.

Some years ago I saw a young physician with the pain of appendicitis. When I said that we would operate right away he surprised me by remarking that he wasn't sure that he wanted it done. I told the doctor watching him to be sure not to relieve his pain. He took it for about an hour and then decided that he wanted the operation. The appendix was a red-hot one that undoubtedly would soon have become gangrenous. That man's severe pain was a blessing to him.

It is usually easy to handle acute pain either by deadening it with morphine or by getting rid of the cause with the proper procedure. Once an abscess is opened its severe pain is relieved. A broken bone in poor position is exceedingly painful. If there is not relief after the surgeon has set it, he should check carefully to make sure that it is really in good position. I believe that it is rare for a person to become a morphine fiend from the treatment of a single acute case.

With chronic cases it is different. People who become drug addicts have some weakness in their make-up; but chronic illness may be very weakening, even to character. Early in my career I had to take care of a miserable, whining specimen of a man who had been terribly sick over a long period. Several years later an upstanding, two-fisted fellow introduced himself to me as the former patient. I should never have recognized him. Long recovered physically, he showed his true character.

Fortunately there have been developed, in modern times, several procedures to relieve chronic pain, aside from the giving of pain-controlling drugs. The removal of the Gasserian ganglion at the base of the brain has taken away the terrible pain from countless cases of tic douloureux, or neuralgia of the face. In certain kinds of hopeless suffering from cancer, surgeons cut part of the spinal cord for relief. Of late years they have been cutting the front part of the brain in order that the patient may not mind the pain.

In spite of all these developments it has been said that the greatest pain reliever of all is the humble drug aspirin. Few have tic douloureux. Millions have relieved their headaches, the pain of small accidents, and that of rheumatic fever and arthritis, with aspirin.