Today I didn't know what to blog about, so I called Mel at the clinic and asked him what he could tell me about pain, since I always seem to be in it. These are the highlights of our conversation:
"I'd love to help, sweetheart," he said.
"Oh, thank you, honey. Make it simple for me, okay?" I asked. And now you will see why I stressed that.
"Pain is usually a reflex arc," he said. "Every part of a pain response is a two-part. There is the afferent and there is efferent. Afferent is affect, and efferent is effect and--"
"Wait! Honey? What was it you just said?"
"The classic is you put your hand on a hot stove and you don't know it's hot. Pain is the afferent response. As a result of the brain feeling pain, it triggers you to pull your hand back, therefore it's efferent--or the effect. It's what the muscles do in response. So a reflex arc doesn't require a higher brain function."
"Um. Mel? Mel? Honey! Wait, I can't keep up! I can't type that fast--"
"--so treating pain is a process of cause and effect. You just have to remove what's causing the pain. It isn't usually as simple as taking a hand off the hot stove. The cause of most pain is not nearly as obvious. The best thing is to figure out what's causing the pain."
"Okay, wait, I have afferent and efferent. How do you spell those?"
"If you take away the cause, you take away the pain. While you're trying ot figure it out, you give pain blockers, which are narcotics--not something the doctor will willingly give you. Ultram is a newer pain med that works pretty well and doesn't have as much of an abuse potential, so the docs are more likely to give it to you. However, if you already take narcotics for pain--"
"Mel? Mel! Slow down! I have reflex arc for the second time. Is there another word for--"
"If you can't adequately block the pain, then you distract. That is how a tens unit works. It comes from the term trans cutaneous electrical nerve stimulation. It substitutes one pain for another, but the electrical stimulation distracts them from the old pain."
"Hold it. Wait. I'm trying to type this quickly, honey. What did you just--"
"Lidocaine, on the other hand, kills pain as an anesthetic. It doesn't block nerve endings, but it numbs them. It doesn't last long, so it doesn't work well for long-standing pain."
"Okay, lidocaine. Is that spelled with an e at the end, or--"
"General anesthesia puts the brain to sleep--another way of killing pain for surgery, though of course you can't use that for chronic pain. Epidurals are versions of lidocaine, going for bigger nerves to anesthetize, so it's a regional anesthesia."
"There! That's the word I want. Chronic pain. I need to know how to treat chronic pa--"
"For chronic pain, if you have a tens unit and use it daily, that could help distract from the pain. Capzacin has a distracting agent in it that burns the skin, but the burn tends to go away if you can stand it long enough."
"All right! Now we're on a roll!"
"Benzocaine is a topical lidocaine, so that's used for sunburns or toothache. Ambesol and Orajel are toothache benzocaines."
"How can that help with chronic pain?"
"A classic example for fixing pain is to liken it to a broken bone--not to gross anyone out-- that's out of place, when you reset it, lining the bone up is probably as good at pain control as blasting the patient with pain medi--"
"No, honey, please go back to the chronic pain treat--"
"It's the same with dislocations. It hurts when something is dislocated, and it hurts getting it back into place, but the body wants you to know about the problem with a lot of pain. You fix it, you're better. Like a thorn in the foot. You don't take pain meds for the thorn in the foot, you remove the thorn."
"Okay, honey." Sigh. "I love you! Thanks for helping. See you soon! Remember, I have an appointment for you to adjust my back today."
"Oh. Okay, sweetheart. Is that all you needed?"
"Yeah, once I get it sorted out."
So, girls, you got that? You slog through those brainiac words and decipher them. My job here is done.