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No Pain, No Gain … Really?

Our view of pain impacts how we discuss pain management.

FROM THE EXECUTIVE EDITOR
Jim Thomas

"No pain, no gain" became a popular phrase among fitness types in the early 1980s, but we understood several concepts about pain long before Jane Fonda tagged it onto a series of exercise videos.

In grammar school, as I stood prepared to take my punishment from a ruler-wielding nun, I heard her utter, "This is going to hurt me more than it's going to hurt you." I doubt this is true, I said to myself, but if it is, it's because she has poor form on her backswing. Don't construe this an indictment against the good sisters. In 1960's Philadelphia, everyone hit kids: parents, teachers, coaches, neighbors, shop owners and of course, other kids.

One lesson I learned about pain was that it's in the nerves of the beholder. A friend could hit harder than any authority figure might and it didn't hurt nearly as much.

The worst pain

The worst pain came at the hands of doctors. It wasn't just about the needles. It was about the anticipation (the shot usually came at the end of the visit) and the lack of control (you sat undressed on a cold exam table).

As a kid, no pain was as great as that inflicted by the dentist who prodded, poked, pinched and drilled. Think Laurence Olivier in the "Marathon Man" asking Dustin Hoffman, "Is it safe?"

On one visit in my teens, the dentist began to drill and then realized he didn't offer me novocaine. "I can stop and give it to you," he told me, "but it's going to take awhile for it to numb your gums, and it's a small cavity, so let's just continue and get you out of here quicker." Ten minutes of excruciating pain followed. He then said, "Most people wouldn't sit through that. They would have made me stop. You did very well." I would have loved for him to stop but when someone operates a piece of power equipment in my mouth, I tend to remain very quiet and still.

The visit taught me a valuable lesson: It was time to find a new dentist.

What can you do?

I find that most clinician have their own methods of managing patients' pain and I can add little that would improve these skills. Let me say that patients have some expectation of pain when they visit a doctor. Eyedrops may sting and bright lights may cause photophobia. But we live in a time of kid-friendly doctors, no-pain dentistry and pain-free surgery. Minimizing pain is a good strategy for attracting and retaining patients. Think of it as the one area where you won't want to exceed your patient expectations. OM