No Pain…No Pain

Want to talk a bit about pain this week.  Not the losing the World Series, or breaking up with your girlfriend or even the world of pain in the Big Lebowski kind of pain.  I’m talking about the pain of ankle sprains, metatarsal fractures, and bunion surgery (not as bad as you’d think, or so I’m told).  And the most important aspect of the pain: identifying and controlling it adequately.

As many of you know, pain is the sensation our bodies use to indicate that something is not right, which makes it a most important sensation, and the loss of that sense can lead to even bigger issues, such as those seen in diabetics with nerve loss.  Any insult to the skin, soft tissues or bones will automatically trigger a stimulus in the brain identifying the location and intensity of injury.  While the threshold of stimulus is essentially the same in most people - barring any underlying nerve damage - the tolerance to pain varies greatly.  Which means that while the causes of pain are about the same in everyone, the level of pain is very subjective, determined by the level of injury, personal tolerance, mood and feeling of the individual and psychological and social factors.  In short, pain is as bad as you think it is, and it is also the most important factor I use in determining the level of pain.

So what does all this mean for my NYC podiatry patients who are in pain?  There are many very effective analgesic agents that are designed to control pain, from over the counter anti-inflammatory agents to powerful narcotics.  Any acute pain needs to be adequately treated, which means you the patient not being concerned about taking enough medication to feel comfortable.  For chronic pain, I generally work to treat the underlying condition wherever possible, thereby reducing the need for long-term pain control.  For instance, after foot surgery, I generally prescribe a narcotic type of pain medicine, and will transition to something a bit lighter after the first week, based on patient’s response.  However, if the pain is not being treated adequately for the first few days, we work to identify the problem and properly treat it.

So if you are in pain, my dear NYC podiatry patients, don’t be shy about taking medicine.  It’s ok to feel comfortable, and not to fear side effects or long-term dependency issues if you’re using the medicine for short-term in a controlled setting.  In this case, not much gain from the pain.

See you in the office.

Ernest Isaacson

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