Pain is Obligatory, but Suffering is Optional

Old medical books refer to the case of a maid who was witnessed removing a dish from the oven and, placing it on the master’s wooden table, caused it to erupt into flames. Not a medical noteworthy case unless you consider that she was able to carry the extremely hot dish with her own bare hands without any display or complaint of pain, perhaps an early description of congenital insensitivity to pain.

With the exception of some unfortunate people who are genetically unable to perceive pain, all of us will have to deal with it sooner or later. Labor, headaches, kidney stones, cuts and bruises, there is no escape from greater or lesser pains. As sensations go, pain is the only one that causes aversion; without suffering, pain is just another sensory modality like hearing or taste. A remarkable example of this dichotomy lies in a not too distant past, when lobotomies and cingulotomies were used in the treatment of severe intractable pain. Following brain surgery, patients described little change in the pain, but most did express a substantial decrease in the emotional, aversive reaction to it.

On the other side of the spectrum, a breakdown in the filtering ability of the frontal lobes can immensely magnify the suffering engendered by pain. The source could be an inherent defect, such as a genetic predisposition to catastrophizing, or induced, such as being handed an incurable diagnosis, family problems or financial difficulties that can color and enhance pain. Without treatment and without hope, many patients fall into a cycle of despair and progressive deterioration, eventually establishing permanent changes in the circuitry of the brain, leading to truly intractable cases.

In all of medicine, there is probably no greater or nobler goal than the relief of pain, an unattainable objective unless we can alleviate suffering too. While physicians have been entrusted as the gatekeepers of pain, many of us hold this awesome power and privilege somewhat grudgingly, having signed up originally to deliver babies or to treat hypertension.

Less drastic than lobotomies, simpler methods can be utilized by physicians in the treatment of pain and suffering, but is none more effective or universal than kindness. Buried under layers of medical technology and bureaucracy, we often forgo the human touch, the kind word, the uninterrupted listening that can transform a desperate situation into a bearable one. On a different level, when sick, we crave the same grooming that other primates bestow upon each other, the calming, reassuring, warm attention of another human being to ourselves and to our bodies.

Sure, opiates, antidepressants and nerve blocks are great, but a pain specialist’s office is often full of poor souls who have already failed the conventional, textbook medical care provided by numerous other doctors. The time we spend writing a new, perhaps ineffective prescription, may be better utilized listening clockless and without malice, intent on grooming our patients, removing angst instead of insects, leaving in its place some hope. We can’t fix everybody, but suffering may, indeed, be optional.

© Dr. Moacir Schnapp and Dr. Kit Mays