PAIN When the subject of âpainâ can be completely understood, then we can understand âlife,â too. That the medical profession has many effective anti-pain medications, and excellent anesthesia for both surgery and non-surgical cases, is a testament to increasing understanding of pain. The fact that pain can also be effectively managed without medication and without other physical manipulations such as acupuncture or pressure, should add to the measure of success which we, as a species, have amassed in the management of pain. Instead, however, this has only added to our confoundment on the subject. Patient walks in with a deep laceration of his upper lip. Sutures are needed. But before sutures, local anesthesia is necessary to numb the area surrounding the wound so that the wound can be stitched. Patient says, âNo way, local anesthetic injectionâ Why? Because the patient is literally âmortallyâ afraid of needles (actually, needle sticks). I suppose an option is the use of general anesthesia (which means, putting the patient out completely); but the risks of general anesthesia far outweigh the benefits in this case. The other option would be to NOT stitch the wound at all (I shudder when I imagine the potential cosmetic results, and the risk of infection!). But, he has a suggestion: an answer. âDoc, how about hypnosisâput me under hypnosis and stitch me up?â What? I placed the patient under hypnosis, and thus placed myself in the land of amazement and marvel. Stitch after stitch, patient remained pain free. There were a few drops of tears in his half-closed eyes. There was no winceâcorrection: I was the one doing all the wincing for both of us: do you know how sensitive the upper lip is? I brought him out of hypnosis after the repair was completed; he was no worse for the wear. How is it that one can be so afraid of the pain of a needle stick, yet be able to undergo wound suturing without anesthesia under hypnosis? Life can be deep: so can pain. There is phantom pain where the brain is fooling one, but the pain is still real. There is psychological or emotional pain, even psychic pain, whose depth no one can plumbânot yet. And, there is vicarious painâa father-to-be feeling some of the labor pains of his spouse (of course, it canât be the same: he does not have it in him). Pain, Just like life. I tried to feel the pain of my patientsâenough to empathize and understand a little more of what they were going through. I once thought allowing it all the way might impair my professional judgment as to what needed to be done for the principle pain-sufferer. I found out later that it did not. Such practice of feeling one's patient's pain only enhanced the therapeutic relationship. Yet, I couldnât get myself to feel vicarious labor. Too painful, I decided. If to understand pain is to understand life, consider this: there seems to be no pain at all when in the active phase of the death and dying processâthat is, well before death occurs. In summary: even though there are effective options for pain control, pain is not well understood. There is a tremendous opportunity to manage pain effectively and completely using innate and inner personal resources as opposed to external agentsâif we can come to know how to tap into this. Can you imagine a world, or life, without pain?

[ Thu, 22 Dec 2005 10:06:00 GMT ]

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