Defending pain

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OCTOBER 07, 2013

Last winter, I shadowed a doctor whose name bore an unfortunate resemblance to “quack.” He was a legitimate practitioner, but he also used “alternative” medicine, and his inevitable critics were all too happy to use the pun against him. For me, their criticisms were ill considered. I found the “quack” doctor to be inspiring: Here was someone who had recognized the shortcomings of the predominant western medical tradition and was trying out new, cross-disciplinary methods. His critics seemed to be possessed of the same dogmatic faith; they were so eager to decry in his alternative healing practices. His patients were satisfied — he had clearly been successful in his methods.

I hoped to see the doctor practicing alternatives to what I perceived as the mishaps of conventional medicine: a lack of holistic perspective, overuse of antibiotics and casual prescriptions of potent opiate painkillers. Knowing some of these practices to be harmful, I wanted to see what he chose to do instead.

I had his patients stereotyped: wealthy, granola-munching, wooden-toy-buying yuppies. The first patient who came in didn’t fit the bill.

He was haggard, pale and overweight. From the beginning, you could see that behind his self-deprecating jokes and dismissive shrugs that there was a deep-rooted sadness. This guy had seen the doctor before; I gathered that he had injured himself on the job, and his business had disintegrated. He was on government payout — and a steady stream of opiate painkillers.

The doctor asked him about his life, which he no longer seemed to care much for. He didn’t have enough money to get by, and he spent his time playing video games. Although his relations to his family had fallen apart, it wasn’t really his fault. It was a terrible situation, and he had no drive to fix it — he’d given up.

At the time I was surprised and disappointed that the doctor renewed his opiate prescription, although I saw there wasn’t much he could do. He did give the man some positive mantras to try to improve his outlook on life, but they were tiny Band-Aids on a gaping wound.

I wondered what I would have preferred the doctor to do, though.

Prescription painkillers, opiates such as Vicodin and Oxycontin, are inheritors of a tradition that finds its roots in characters such as Friedrich Surterner, who isolated morphine from opium at age 20, and Alexander Wood, inventor of the hypodermic syringe, whose wife died from an injected morphine overdose.

The problem since the beginning has been that they’re extremely addictive, physically and psychologically.

While it goes without saying that meaningless pain and suffering should always be avoided, pain is very rarely meaningless. Physical pain can be a warning sign from the body that something needs to be changed or injury will occur; this ranges from the finger-in-the-fire example to chronic back pain as a result of poor postural habits.

Nietzsche wrote of pain as the primordial mnemonic device, the fundamental precursor to human learning. Pain is part of what motivates us, what makes us remember — if you’ll pardon Socrates, too — it’s an integral part of pleasure. Forms of emotional pain such as guilt and compassion motivate altruistic deeds and ethical codes.

Perhaps we ought to take it more seriously when we eliminate or dull all pain with powerful prescription opiates.

For the “quack” doctor’s patient, his painkillers were numbing the pain of his injury but enabling his apathy — and in part preventing him from rebuilding his life. It is a pattern I’ve seen in other people’s lives, people I have been close to.

These people have been trained to view their own pain as a symptomatic aberration, something that can be treated with a pill in the same way one might treat a bacterial infection. But pain is not an external infection; it is intrinsic to the body, and in some ways it can act as the body’s voice. An attempt to remove pain without adequate exploration of the possible underlying causes — both physical and mental — often facilitates slow physical degeneration and an ever-worsening addiction that does not assuage but increase a patient’s suffering.

Earlier this month, the FDA responded to a petition by a group of doctors to alter the labeling on strong, extended-release opiates like Oxycontin, attempting to persuade doctors and patients to take the drugs more seriously. Such actions are certainly a step in the right direction, but they leave the problem of how to treat the many pain conditions that don’t warrant stronger drugs. There are elements of alternative medical traditions that show promise, but it seems even open-minded doctors such as the one I shadowed often find themselves at a loss.

Maybe it is up to the patient: to reject his or her pain or to listen to it. Sometimes pain is purposeless, but I think often it is trying to tell you something. It can be hard to own up to it, but for patients such as the one I saw at the “quack” doctor’s office, the message pain is trying to get across might be just the one they need to hear.

Image courtesy of dwmjr1985.

Contact Micah Fry at 


OCTOBER 07, 2013