By Jeff Cowdry, OT, CHT
ApexNetwork Physical Therapy – Ballwin, MO Clinic

If I were to choose between pain and nothing, I would choose pain.
—William Faulkner

Since the majority of people coming to ApexNetwork Physical Therapy have pain of some kind, I thought it would be good to explore several perspectives on pain. Much of what I have learned about pain comes from two of my heroes:  one, an orthopedic surgeon, Paul Brand, MD, the other, Joni Eareckson Tada, author, artist, and speaker.   Dr. Brand emphasizes the physical and mental aspects and Ms. Eareckson Tada emphasizes the spiritual aspects of pain.  The following are some things they have taught me.

Pain is not our enemy—it is a gift.  For example, the most deadly cancers start in areas of our body which have no pain sensors.  No pain signals are available to warn us to seek help.   Likewise, in the dreaded and misunderstood disease, leprosy, tissue destruction and disfigurement are unrelated to anything wrong with the skin itself.  Instead, dead nerve endings cause complete lack of sensation (and, therefore, protection).   A bruise becomes an ulcer, a sprain becomes a fracture—injury adds to injury—usually leading to infection, amputation, and, often, an untimely death.  So it is with uncontrolled diabetes:  associated neuropathy dulls the sense of pain which frequently leads to serious wounds and/or amputations.

In physical therapy, pain is often very helpful.  A therapist is able to use feedback about pain (its location, type, intensity, etc.) to help guide each treatment as well as the overall rehabilitation plan.  Your job as the patient, and our job as the therapist, is together to listen to the pain your injury or condition announces.  Dr. Brand in his book, Pain: The Gift Nobody Wants, states that pain often “whispers before it shouts” (p. 145). We must learn to listen to these whispers which can guide us toward the fastest and the best functional outcome.  Ignoring these messages leads to miscommunications which may lead to under-utilization or over-utilization of stretches or exercises.  I learned this myself while training for a marathon.  I gradually learned which pain messages were important to heed, and which could be managed by “pushing through.”  This helpful skill allowed me to achieve my goals: to finish the race uninjured, and to enjoy the experience. 

Many of us agree that doctors need to listen to us carefully when we describe our pain.  One St. Louis doctor who does this especially well, Robert Hagan, MD, sees people who suffer from very challenging pain conditions.  He pays careful attention to the patient’s description of their pain, how and where it started, how it has progressed, and other data that will lead him to a treatment plan.  Often he orders additional testing or therapy in order to gather more information.  But he always carefully listens and encourages patients to listen to what the body is saying through the language of pain. 

My specialty is in hand therapy.  Dr. Brand, a renowned hand surgeon, has always inspired me.  He spent much of his career researching leprosy and helping restore function in severely damaged and deformed hands.  He also contributed a great deal to the knowledge about diabetes. Some interesting insights on pain from Dr. Brand are included in the next section of this article.  

Excerpts from Dr Brand’s, Pain, The Gift Nobody Wants:

 “The body has millions of nerve sensors, distributed not randomly, but in exact accordance with each part’s need.  A light tap on the foot goes unnoticed, on the groin is felt as painful, and on the eye can cause anguish.“ Page 64-65

“The eye is a thousand times more sensitive to pain than the sole of the foot because it faces particular hazards.  Vision requires that the eye be transparent, thus limiting the number of (opaque) blood vessels immediately available.  Any intruder, even a speck of dirt or thread of fiberglass, poses a threat, because with its limited blood supply the eye cannot easily repair itself.  For protection the eye has such a hair-trigger response that virtually anything touching it causes pain and trips the blink reflex. 

On the other hand, the foot is designed to bear the body’s weight: it has tougher supporting structures, a plentiful blood supply, and a thousand times less sensitivity to pain.  Fingertips can likewise withstand much duress: carpenters would be rare indeed if the gripping fingers fired off pain signals to the brain at every stroke of the hammer.  In each case, a body’s function determines its surrounding structure, and the pain network loyally adapts.”  Page 65

“…I marvel at the built-in wisdom of the body—the higher brain reserves the right to overrule [the] reflex loop under unusual circumstances.  An expert rock climber clinging to a precipice will not straighten his leg when a falling stone hits the patellar tendon; a society matron will not drop a too-hot cup of tea served in Wedgwood china; the survivor of a plane crash will repress reflexes and walk shoeless over shards of glass and hot metal.”  Page 65

Next, I’ve included a recent email publication I received from Joni Eareckson Tada.  I have followed Joni since early in my career when I worked with patients suffering from various forms of paralysis.  Joni, like Dr. Brand, helps many of life’s most desperate people.  She brings her own unique perspective on the subject of pain.

Taken from Joni Eareckson Tada’s:  When Pain Moves In:

“My back is filled with searing pain; there is no health in my body.  I am feeble and utterly crushed; I groan in anguish of heart. I wait for you, O Lord, you will answer, O Lord my God.”     Psalm 38: 7-8, 15

The realization may have been years in the making, or it may have come in one swift, devastating stroke.  But at last you know that pain—your pain, whatever it may be—is here to stay.  Perhaps it is an illness, or a rebellious child, a chronic muscle problem, the death of a loved one, or a severe disability in the family.  Whatever form it takes, it’s the common experience of all people.  Human pain wears a thousand guises. 

After more than four decades of permanent paralysis, I can attest that only a daily, hourly, even momentary placing of our throbbing into His strong hands can protect us from the crippling ravages of fear.  There are countless “fear nots” in scripture, each one of them covering the whole spectrum of human experience.  Every “fear not” can be embraced and impressed on our hearts and repeated in the presence of our adversary. Then we will press to our hearts this poem by Miss Margaret Clarkson, a woman who was bedridden for years with chronic pain:

Lord Jesus, King of Pain,

Thy subject I; Thy right it is to reign:

Oh, hear my cry, and bid in me all longings cease;

save for Thy holy will’s increase.

Thy right it is to reign O’er all Thine own;

then, if Thy love send pain, find there Thy throne,

and help me bear it unto Thee,

 who didst bear death and hell for me.

Lord Jesus, King of pain, my heart’s adored,

teach me eternal gain is love’s reward:

in Thee I hide me; hold me still

till pain work all Thy perfect will.*

*E. Margaret Clarkson, “In Pain,” Grace Grows Best in Winter, (Wm. B. Eerdmans Publishing Company: Grand Rapids, MI), pg. 54

To conclude, I would like to share an experience I had as a student at Rusk Rehabilitation Institute.  One of my patients, Mrs. H., was a full body burn-patient who had been rescued from a house fire.  Mrs. H. incessantly screamed a low, hoarse scream.  She also constantly expressed fear and panic with her arms, hands and eyes as if she were still seeing the fire.  It was very difficult to endure the screaming and her expressions of pain.

One day, Mrs. H. was escorted by an aide to the therapy clinic. Mrs. H. walked toward me in head-to-toe dressings, wearing over-sized tennis shoes, screaming.  I held out my hand to guide her toward her chair and as I turned, Mrs. H. tripped over her shoes and fell to the floor.  I will never forget the large amount of thick, red blood covering the floor, and the bustle of activity to help Mrs. H.   Beyond that I only remember the anguish and guilt I felt for not preventing the fall.   

Later that day my supervisor told me that I needed to visit Mrs. H.  As I walked into her room, I was expecting the worst.  But to my shock, a calm, non-screaming, non-thrashing woman was sitting up in bed saying, “Hello, Jeff.  Please don’t feel bad about what happened.  I am fine.”  I was dumbfounded!  Apparently the trauma from the fall snapped the hysteria induced by the house fire.  I still remember the distinctive screams, but more than that I remember a sedate, pleasant woman, smiling in her unique way, consoling me in my pain.

Pain is a fascinating subject.  We can deal with it on many levels—physical, mental, and spiritual. Philosopher and author, C.S. Lewis wrote, “We can ignore even pleasure. But pain insists upon being attended to.  God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: it is his megaphone to rouse a deaf world.”  (The Problem of Pain).

 I hope some of these insights and stories help you as perhaps you deal with your own pain. I don’t think we will ever grasp the many things pain can teach us.  But I chuckle as I recall something else that C.S. Lewis wrote, “If only this toothache would go away, I could write another chapter on the problem of pain.”

 In the spirit of Lewis’ humility, I close with Joni Eareckson Tada’s prayer in her article, When Pain Moves In:

“When I struggle with pain, dear Lord, teach me to wait on Thee and rememberthe example of Jesus, the King of Pain.”

Endnotes:

Pain: The Gift Nobody Wants, Brand, Paul W.

When Pain Moves In, Joni Eareckson Tada, Joni and Friends International Disability Center, email.

The Problem of Pain, C.S. Lewis

February 20, 2019

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