How Pain Serves as Your Body's Warning Signal by Vicki Rackner MD

Pain is like the warning lights on your car's dashboard. It

alerts you to something that needs investigation. Pain serves an

important function. It's your body's way of saying, "Pay

attention."

We all avoid pain. You wouldn't knowingly slam your thumb in the

car door or touch a hot stove. It's human nature to avoid

situations that cause pain, and we do what we can to rid

ourselves of the pain as soon as possible -- such as taking an

aspirin for a minor headache.

When your pain is severe enough, or worrisome enough -- or lasts

long enough -- you find yourself in your doctor's office. Then,

ideally, you and your doctor figure out what's causing the pain

and fix the underlying cause. The most satisfying encounters for

both you and your doctor occur when the pain points to a clear

diagnosis; you're treated and the disease is cured. A good

example is a cough and pain in the chest when taking a deep

breath leading to the diagnosis of pneumonia that is cured with

antibiotics. But not all pain is solved that easily.

Each of us tolerates pain differently -- even pain from the same

cause. Surprisingly, the patient who would complain the most

bitterly when we injected a local anesthetic that tended to burn

a little was not the frail 80-year-old grandmother, it was the

strapping 25-year-old body builder who said he "wasn't afraid of

nothin." Those are also the patients most likely to faint when

blood was taken.

As a surgeon, I did many "lumps and bumps" operations. Depending

on the patient's tolerance for pain, I could perform the

procedure in my office or in the operating room, where, among

other things, sedation was available. It usually was clear

whether a procedure could be done in the office or required the

support of the operating room staff.

Then there were the judgment calls. It could go either way. If I

looked at the top of a patient's head and saw orange or red, the

patient would go to the operating room. My experience supports

the thinking that redheads are more sensitive to pain.

How do you get pain to move from "pay attention"' to "problem

fixed?"

Your doctor needs help from you when your "pain light" flashes

on. There is no way your doctor can measure your pain. Sure we

can check your heart rate, which tends to beat faster if you're

in pain, or your blood pressure, which also rises. Clues like a

fever or a high white blood cell count that can point to the

cause of the pain; they don't measure your experience of the

pain.

Only you know what your pain feels like.

Sometimes the cause of the pain can be identified before the

doctor even sees you. The broken bone on an X-ray, abnormal blood

thyroid level or malignant prostate cells on a pathology slide

speak for themselves. Sometimes tests will show what is not

causing the pain: a normal EKG usually means that your chest pain

is not from a heart attack, and a normal breast exam, mammogram

and breast ultrasound suggest that breast pain is not caused by

breast cancer.

No test can exclude a medical condition with 100 percent

certainty. Or in medical lingo, tests can have "false negatives"

-- meaning you have the condition even though the test says you

don't. This is another reason you want your doctor to perform a

complete evaluation, and not just make a diagnosis over the

telephone.

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BIO:

Vicki Rackner, MD, president of Medical Bridges, is a board-
certified surgeon who left the operating room to help employees
become active participants in their health care. She is a
consultant, speaker and author of the *Personal Health Journal*,
and author of the lead story for *Chicken Soup for the Breast Cancer
Soul.* Dr. Rackner can be reached at
http://www.MedicalBridges.com or (425) 451-3777.

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