A good friend of mine recently found out she’s stage IV of a rare type of non-Hodgkins lymphoma. She was hospitalized and had days of tests and biopsies. The first few days, she was on a regular floor, as oncology was full. She was too anxious and upset to sleep and was in a lot of pain from biopsies and an enormously enlarged spleen. The hospitalist refused to give her pain or anxiety meds. She got delusional from lack of sleep. It was nightmarish, and I felt helpless.
Luckily, a bed opened up in oncology. As soon as the oncology staff learned of her pain and anxiety, they started medicating her.The difference was merely night and day. One nurse gave her a kindly lecture on the importance of staying ahead of the pain and said pain impedes healing.
Is that true? And if it is, do the risks of any given patient getting addicted outweigh misery and slower healing?
“Pain impedes healing” is one of those things which follow from a certain logical chain but which haven’t been tested (hard to test anyway). Stress does impede healing (and this comes with a bunch of caveats and subtleties: some stress responses impede healing but not all, and different people react differently to different types of stress), pain is a stress therefore pain impedes healing. Thing is, pain is itself a response to a stress (physical stress, in this case): it’s the body’s reaction to “this part of me is hurt”. And there’s people for whom maintaining a bit of pain can help healing, because if they don’t hurt they treat the damaged part(s) as if they weren’t damaged, thus causing further damage.
It would be good to see some cites on pain impedes healing.
From what I have observed in hospitals lately, due to the opioid kerfuffle, many docs will simply will not prescribe pain meds. Other categories of docs, for example oncologists, do so readily. The disease they are treating is widely recognized as being painful, and doesn’t receive the negative scrutiny. Orthopedic surgeons will prescribe after surgery, but not before. The rules can be arbitrary and not readily understandable to patients.
OP - I am sorry this impacted your friend. It would be a good idea to get her pain management (and anxiety) plan written into her chart, so that if she’s taken off floor again (or discharged) the appropriate medications are available. If she is having trouble managing the conversations with medical staff (entirely understandable), is there anyone available to act as her advocate to help mediate these conversations?
In cases of injury, I can see it being true, but I can’t see a pathway for it being true with other impairments, (although of course that doesn’t mean it’s false). If you’re injured and in pain, the pain could cause you to move around rather than rest and recuperate. After a 31-mile ultramarathon in which I did over 5500 vertical feet, I was afraid that I would be sore the next day due to all the novel muscle movements and the fact that I had only a camping pad in my tent to sleep on, but I had a spare hydrocodone from a recent tooth extraction, so I used it and did not toss and turn despite my slight soreness and having to sleep on a camping pad close to other campers who were surprisingly loud despite just having run themselves. I was not sore the next two days, which was surprising, and I credit the hydrocodone with allowing me to sleep it off: usually I toss and turn due to post-running soreness and/or cramps.
It has been tested in animals at least. When one of our dogs had surgery, I did a deep dive looking into her pain management, which was complex. From what I recall, pain (as well as other forms of stress) causes cortisol to be released from the adrenal glands. Although cortisol helps the body deal with stress, it also impedes healing.
I read studies showing a significant difference in wound strength in dogs that recieved pain medication compared with a group that did not recieve pain meds.
Do any levels of pain release enough cortisol to impede healing? And does it compensate for the extra damage caused when a patient overextends or hits again the same body part that’s already bruised?
Pain has some mechanisms which impede healing. It also has others which help healing. It’s not an either/or, nor something which works the same way for each patient and for all levels of pain. The nurse expressed as an absolute oversimplification something which is in fact a lot more complex than she made it.
Pain is complicated. I’ve been treating pain for over 3 decades, and the more experience I get, the more I realize that our sum knowledge about pain and its management is only a tiny fraction of the whole picture. Pain can retard some healing, and accelerate other healing processes. Pain meds can delay healing in and of themselves. The experience of pain is vastly different, not just from one person to another, but for the same individual over time, depending on other factors going on for them. The mere suggestion to a patient to “rate your pain” has been shown to increase pain, or at least the reporting of its severity.
I’m glad the OP’s friend got good treatment on the oncology unit. Malignant pain like that of cancer generally requires the big guns of pain management; they’re more effective for that type of pain anyway. Similar for severe acute pain. Treatment of chronic pain is far more confusing and complicated, however.
Managing pain patients makes my head hurt. And these days my go-to treatment for those headaches is to sit on my deck and watch Lake Michigan roll by. That works better than any drug, in that situation.
Thanks for the informative replies! Quadcop, a special thanks to you for your usual august and illuminating advice.
My friend was discharged this a.m.! She did OK with the first round of chemo, so they let her go. She’s at home resting now. She lives nearby, so I’ll go back to check on her this afternoon. She had a bunch of meds with her, one for a blood-thinner she has to inject. (Apparently the inflammation from lymphoma causes blood clots. She has a small pulmonary embolism.) Another is an anti-anxiety med.
One of her meds is high dose (100 mg.) prednisone. I’ve been on prednisone for lupus a number of times and hate it; the pain has to be worth the side effects. I recall, though, the docs telling me it slows healing. In her case, the biopsies, two of which were fairly deep (to get at lymph nodes in the back and abdomen), are somewhat healed already, so maybe that’s not a concern.
I know once they got her on pain meds, she was able to move around more, and they said walking was important, so in that regard alone, the painkillers were a huge help. I think also think getting some sleep after they started her on anti-anxiety and sleep meds made a big difference. At least, I’ve always heard sleep promotes healing.
September 2000: Fell from a ladder. Open fracture of L-3. Unresolved due to a missed clue on MRI for 19 months. Then stabilized. The pain in the early months was just spectacular. Deep, bright, sharp. Remarkable. They gave me Bextra, then Celebrex, then Vioxx. For 2 days. Then the story broke about Vioxx ( and its cousins ) and I was taken off of all of them. And just left to deal. No hard pain meds, never touched narcotics. Took more than 5 years to not be in significant pain.
Summer 2016. Beginnings of Right hip pain. Summer 2017. Bone-on-Bone diagnosis. Different than the spinal facture. But equally intrusive. Made me angry, irrational, unable to do much work. Self-medicated with Excedrin or Naproxyn Sodium. Replacement occurred Feb 2018.
From the date of surgery for roughly 12 days I was on a slowly tapering regimen of narcotics. I tapered and left them behind. Recovery has not bee optimal and I have pain with every step. Violent fall injuring Left knee hasn’t helped things.
Pain IS complicated. That cute chart, going from 1-10, asking you to self-measure pain? Please. After a while with my surgeon, I got into the habit of answering him right away. Then I’d answer him again a little while later.
The first reply was from the gut. I answered, knowing I’d get a certain level of concern and attention, from the surgeon and staff. I then made myself think about the level of pain that day and frequently I adjusted down a few ticks.
I know what an 8 is. I’ve never experienced a 10, although I suspect on the day when I fractured my spine it was probably a 9. When I would go to see him and say it was a bad day, an 8, I had to then really think about it.
I don’t use any pain management medications beyond OTC pills. They all are dangerous long-term, but they keep the worst of the pain at bay. CBD also does seem to be helping, past the placebo level.
People go down rabbit holes. I eat my pain, I’m fatter than I’ve ever been. Understanding how SO many people can get addicted, well, I understand it very well now.
But I would rather be an angry distracted person who isn’t lost to opiates. Your mileage may well vary.
Back to Qadgop’s comment: Pain CAN NOT BE MEASURED. Or quantified. But it is surely real.
Dear God, such misery! I’m so sorry you’ve had to deal with pain so long. What OTC meds are you using? A doc told me acetaminophen is VERY dangerous long-term. That stuff will kill your liver. Pain is so difficult, though, that people have to do whatever works. I have a dear friend who manages pain from the polio virus (which he got as a baby and seemingly recovered from until in his fifties) with CBD, the only thing that works for him.
I hate that 1-10 pain chart. When I’m in pain, it’s never accurate. But when I’m NOT in pain, it’s also inaccurate, as memory tends to have an analgesic effect–for me, at least. And really, what’s a 7? Or an 8? I refuse now to give them a number. I’ll say, “I can talk over it,” or “I can think over it, but talking takes all I’ve got” or “I can read a book but can’t recall anything I’ve read due to the pain.” When I had appendicitis, I said, “I’d be moaning right now, but it seems rude.” How do we make pain, which is complex and subjective, into an objective, measurable phenomenon?
Extremely high doses of prednisone are commonly used in lymphoma, and certain types of leukemia as well. For reasons that are still unknown, they inhibit the growth of those cancer cells, and sometimes reduce the side effects of other meds used to treat it. They will taper off the dose soon.
Thanks much, but I understand prednisone is used in treating certain cancers of the blood because inflammation plays a big role in this type of cancer, and prednisone is good at alleviating inflammation. Docs are not tapering her off. She’s on daily doses of 100 mg. of prednisone for five day with no tapering. Sometimes docs have tapered me off, and sometimes, if the course runs less than a week, they haven’t. I guess 5 days isn’t long enough to require tapering.
I think I can explain this, at least as it applies to me. I’ve had juvenile rheumatoid arthritis since toddler-hood or before. Back then arthritis was seen even by the medical community as an “old person’s disease” so I was treated like some kind of a freak. At any rate, I’m 55 now, and it’s long been technically in remission but I still ache from it. At this stage of life/disease I don’t get flareups in individual joints but it feels more like general aching in all my bones. It varies in intensity randomly but constantly. I’ve long ago learned how to “tune it out” until the intensity becomes such that it pushes past my mental “corral” and I become aware of it. I’ll often realize that I feel really grumpy for no reason, until the point where it pushes forward (or sometimes when I realize I’m being a crank I’ll pause to reflect on why). That’s when I realize that I’m in actually a fair amount of pain and was trying my best to ignore it (but failing since it affected my mood).
I suspect that having a patient like me rate the pain causes them to look inward to analyse their internal condition and realize they’ve been mentally blocking it out but now that they’ve looked, holy cow does it hurt!
If you think the 1-10 pain chart is bad, try rating thirst on a 1-10 scale.
In college, I picked up extra money as a normal control in clinical studies. I didn’t mind moderate discomfort if the pay was good enough. In one study I was intentionally dehydrated (no fluid by mouth for 8 hours, then I received 1.8% saline (hypertonic).
Over time I had to rate my thirst. I swear I started out at 9, but things just kept getting worse. I had to repeatedly make room for my thirst getting worse. It was pretty awful.
Medical marijuana may not reduce your pain as much as some people claim (and more than others claim), but from my standpoint, the one thing it does best is distract you from that pain. And that is worth far more than the price of admission to me.
I recently read the book American Overdose by journalist Chris McGreal
I can’t find the exact quote, but he spoke with some surgeons about the post-surgical use of opiates for pain.
Some surgeons thought they were being overused by hospitals and impaired healing. Opiates impair respiration and inhibit deep breathing, possibly contributing to an increased risk of pneumonia. They slow the digestive tract at a time when it is important to keep things moving. And, if overused, they made the patients less physical active and the surgeons wanted to see patients up and moving around as soon as possible. A little bit of pain medication may actually help with the last part, though, but if it’s overused it makes things worse. It’s all about balance.
I will continue to look through that book for this section, IIRC it had some statistics regarding painkillers and post-surgical pneumonia.
If there are actual mechanisms by which pain impedes healing, I’d like to read about them.