EST. May 2000 (AD)


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A Cheerful Guide to Pain and the Management of Agony

By Pamela Miller

It's just an average evening. After working ten hours, reupholstering the couch, and cleaning the air ducts, you have just one more quick task: preparing a pan of chipotle chocolate chip brownies for an office potluck. While you're stirring the batter, you feel a twinge in your back. Could it be that the batter is too thick? Did you pull a muscle pounding the chipotle pepper into a fine powder? What could it be?

Once the pan is placed in the oven, you lie on the floor, hopeful that a few stretches will save the day. And then, there is pain, the kind that makes your neighbors wonder whether you've just been cast in a snuff film. You are in agony. You are supine on the floor. And if you don't force yourself to push past the pain in 22 minutes, the brownies will be ruined.

Pain is our body's way of telling us that something is wrong. Women are often at risk for sudden jolts of mind-numbing, soul-sucking pain. Sometimes the pain is expected, such as childbirth or being forced to circle dance with uncoordinated pre-teens. Sometimes the pain is unexpected, such as forgetting about your prison tattoo the day of your MRI. Let's explore pain in its many forms as an abstract concept, not as something that hurts.

Acute pain is sudden. Breaking an ankle is not a slow process; nor is getting hit in a face with a dart. These things happen to even cautious, adventure-avoidant, types. We learn important lessons from acute pain, such as to listen to people, the ones yelling, "Hey, watch out!" Walking in front of a paper perpetrator at the shooting range usually only happens once.

Chronic pain is, as advertised, the kind of pain that never goes away. There are many types of chronic pain, including the emotional kind. It's hard to be around weepy people. It's your right to tell them you don't want to hear about it. Empathy will just lead to pain for you, so they need to suck it up, walk it off, or clam up. No one really wants to hear about anyone else's pain.

The one exception to this rule is Monthly Pain, such as receiving only half of your spousal settlement. Everyone needs to know about this form of pain, starting with family, clergy, co-workers, and people riding in the same elevator. Go home, apply a heating pad to your lower back, and slowly suck on an umbrella drink. It really does help.

The final category of pain is called the Bad Decision, such as when your new boyfriend has a great idea, and it includes a horse bit and a riding crop. If you don't feel comfortable describing the events leading to the injury to a medical professional, it's probably going to be chalked up as a Bad Decision.

People can live with physical pain, emotional pain, educational pain, extreme diet pain, and social ostracism pain. People can even live with phantom pain. The nebulous forms psycho-traumatic pain are elusive and difficult to cure. Could one equate the mixture of regret and embarrassment that is the bad haircut to bone cancer? How is acute pancreatitis different in terms of severity to a really bad itch?

Scientists devised a pain scale, a 0-10 measure of the person's subjective experience of pain. It's helpful for the patient to know that a score of one is mild pain and a score of ten is a severed limb. Whenever your pain is measured, use the scale to your own personal benefit. The good drugs are only prescribed to people scoring four and above. My standard response to any pain question is 10+++. Then I make an unhappy face in the zero, with a few tears spilling out of the eyes.

It's mind over matter in the world of pain management. If you present as one capable of blocking out pain with pleasant thoughts and an ice pack, then that will be your treatment. If you present as weepy, hunched over, and on the verge of screaming, the pain specialist may offer you an over the counter analgesic. It's only the actual screamers and accomplished thespians who get prescription narcotics.

One has to be careful with certain drug combinations, such as muscle relaxants and narcotics. Taken together, there is a level of relaxation bordering on somnolence, an inability to operate a motorized vehicle, and the sense that the spine and bones have been removed, leaving the person with the tensile strength of a rag doll. This is not a good time to sign any legal paperwork or compose poetry. (This also applies to prose.)

When you are given strict instructions to apply heat, apply cold, apply analgesic creams, go to physical therapy, or rest, you should do so. In addition, you should teach yourself to visualize a happy place, a fully realized respite from pain. It may help to work with an experienced Visualizer to assist you in this journey. One should never judge another person's happy place. If you just love red velvet on the walls, ragtime piano in the background, a too generous splash of lavender perfume, a comfortable four poster bed, and a little paying company with a thick bankroll, that's your prerogative.

There are some easy ways to get your brain to release natural pain blockers. The most effective is to cause damage to another part of your body. Sudden, blunt trauma usually does the trick. Chocolate also helps, as does physical affection and soothing music. Getting someone to tell you a happy story set in a New Orleans brothel circa 1911 is often beneficial.

The best method of managing pain is finding out what helped the person in the past. If over the counter pills are no more effective than a peppermint patty, this person will probably require something a bit stronger. If it's not your own physical pain, come equipped with your time-tested methods of self-protection. Fly away in your imagination, drink herbal tea, take a hot bath and tell them to suck it up. Sometimes it hurts just to listen.

Recipe for Chipotle Chocolate Chip Brownies: To your completed (from scratch-not dust from a box) brownie recipe, add 1 teaspoon of cinnamon and 3/4 teaspoon ground chipotle pepper. Add 8 oz of chocolate chip morsels and bake as per original instructions. Don't tell anyone about the added spices.

Copyright © 2007 by Pamela Miller


Pamela Miller saves the world by day, writes by night, and wishes she could find a hotter place to live than Phoenix. The world is simply too cold.