Walk In With One Problem, Walk Out With Two

In the urgent care examination room, I read a poster on the wall while the nurse took my vitals. There wasn’t much else to do while simultaneously wearing three pieces of medical equipment, trying to hold still for a pulse ox, thermometer, and blood pressure cuff.

This poster outlined the clinic’s policy for pain medication. It was pretty long!

I happened to be in a pretty distracting level of pain myself, due to a sports injury, and it had gotten worse during the hour I had just waited. As a routine part of the exam, the nurse asked me to rate my pain on a level of 1 to 10. I told her ‘4,’ on which I will elaborate.

Then I mentioned the poster and how it put things in perspective for me. I don’t like being in pain, but I also have no interest in a prescription painkiller habit.

“I’d have to be screaming on the floor before I would want painkillers,” I told the nurse. “I have enough to deal with right now. It’s like you walk in with one problem and walk out with two problems.”

She laughed ruefully. Nurses are prone to dark comedy. With her level of experience she likely dealt with patients trying to score extra pills on a daily basis.

I avoid painkillers for many of the same reasons that I avoid sleeping pills. I have a firm conviction that almost all medical issues originate in a person’s daily habits, and a prescription is a short-term fix for what most likely started as a long-term problem. I’ve had sleep issues since I was seven, for instance, and these issues are poorly understood. The most common medical solution for night terrors like mine is a prescription for barbiturates.

Okay, great. Two years later I’ll still have a sleep problem, and also a pill problem. Thanks. (No thanks)

I used to work at a drug rehab. The program was court-mandated, meaning that over 99% of our clients came in to avoid jail time. Many of them were clean-cut and looked like any other suburban business professional. They got busted by having multiple prescriptions at multiple pharmacies. It could happen to anyone, I’m convinced of that.

I had oral surgery a few times this year, and I was not offered painkillers. I didn’t take anything stronger than ibuprofen, even when I had sutures in my mouth and couldn’t eat solid food.

I’d rather spend a week thrashing around in mind-numbing pain than spend years fighting an addiction.

This is a philosophical position, and by no means something that I expect to appeal to anyone but me. Painkillers are there for a reason, and it is possible to die of shock. I don’t blame other people for succumbing to what is a built-in risk of a rational, legal, and standard choice. I know this is a neurochemical thing, not some... “willpower” thing or what-have-you.

I don’t believe in “willpower.”

I do, though, believe in the Pain Scale.

Sitting in a veterinary office one day, I saw a little poster on the wall. It was a pain scale for animals. It impressed me that veterinary science had worked out a way to rate the pain of animals who can’t speak or write. We can tell how they feel by looking at them, by the way they behave.

According to this poster, a ‘10’ for an animal might show up as loss of consciousness, convulsions, and possibly death.

Whoa! I thought. Good point. I know I have never experienced a 10 on the pain scale in my life. It occurred to me that few people probably have, even if they’ve been in labor or had major burns.

The pain scale I’ve seen for humans is subjective. It asks us to rate our pain according to what we have experienced before, or whether we feel it is ‘severe.’

Well heck.

A stubbed toe rates as a 1, according to one scale. Everyone has stubbed a toe at some point, and the universal reaction is to hop around swearing a blue streak. This is one of the three reasons I haven’t owned a coffee table for the past twenty years. We don’t call 911 when we stub our toes, though, because we know it will only hurt that much for a minute or two. Acute but brief and not dangerous.

Chronic pain is what tends to get us into trouble. I started getting migraines the same year I was diagnosed with fibromyalgia, a long time ago when there weren’t any reliable prescription drugs for either condition. Those were some tough years.

I figured out along the way, though, how to avoid flare-ups. Everything I ever did that worked was a permanent, often quite radical, lifestyle modification. I figured a lot of things out accidentally, coincidentally, and sometimes by trial and error. Problems like these are systemic, and they are hard to treat because they are the result of multiple inputs. Changing even three things might not be enough to make a difference, and they might not even be the right three things.

If I’d gotten some prescriptions, I’m convinced that I would not have pushed through and figured out how to leave the pain state. I would have thought of myself as a sick person who needed to take pills forever.

Pain is an invader, but it’s also a messenger. Pain tells us, Hey, whatever you’re doing, knock it off. Pain is an opportunity to learn something.

Not everyone is interested in receiving the message from pain. Emotionally - why do we continue to interact with people who hurt us or betray our trust over and over? Mentally - why do we dig in and double down on ideas after we’re exposed to contradictory evidence? Physically - why do we keep eating foods that make us ill, deprive ourselves of sleep, or ignore doctor’s orders?

When I’m in a difficult situation, I like to ask myself, What would an ordinary person do right now? Sometimes I can say, Okay, that’s what I should do, and other times the response should obviously be, Okay, definitely don’t do that. It depends on whether the standard response seems to lead to good or bad results. If the standard response to pain is to get a prescription for painkillers, and a common response to painkillers is to develop a tolerance, then I want to avoid that common outcome.

When I think of the pain scale, my personal version of it, it helps me to stay in my right mind and think about Future Me. The truth is that Future Me has probably already gotten over this.

1 - stubbed toe, paper cut
2 - headache, common cold
3 - migraine
4 - distracting pain
5 - “better get that looked at” pain
6 - “incapable of doing anything else” pain
7 - involuntary sobbing pain (antibiotic eye drops)
8 - cry yourself to sleep pain (losing a fingernail in a metal door)
9 - uncontrollable screaming
10 - unconscious, seizure, coma

I survived an 8, my personal 8, and that was a level of pain that made me believe that torture works. It also helps me to believe that there are of course worse levels of pain within human experience. Maybe I’ve already experienced the worst pain I will ever feel in my life! At that level, I could still speak, could still get up and walk, could go about my business without pain treatment. I knew that my body can heal, that my brain can eventually tune out pain, that this too would pass. Not a single one of the most painful experiences of my life is bothering me today.

I believe that there is a natural neurochemical response to pain, and that this neurochemistry can be permanently disrupted after even a short period of using various pharmaceuticals. I don’t trust them at all. I trust that I can handle almost any painful experience that comes my way, and that almost anything is easier than fighting an addiction.