How can one prove that oneself is suffering from physical pain to someone else? i.e. without medical instrumental analysis?
Take a hypothetical situation such as the following:
You have a horrible migraine headache. The pain is debilitating you. There are no “visible” symptoms. You have to leave work to go home and lie down. Your boss doesn’t believe you have a headache. Your boss asks you to prove that you have a headache, and if you do so, he will let you go home. How can you prove you are in pain?
In the case of a migraine, lying on the floor and writhing around are good bets.
Seriously though, one of the problems of pain management is getting someone to believe that you are in pain. Also some people can tolerate a lot more pain than others. It is sad to realize that more people will be understanding if you just have a cough, rather than having a migraine, which is almost always more debilitating.
As for the migraine, unless you had a CAT scan or an MRI machine in your office, your boss is just going to have to take your word for it.
A company once advertised a “headache test” on NBC (I believe it was during Saturday Night Live). You simply placed a medium sized sample of blood in the centrifuge, let it spin for an hour, and placed small drop on a diagnostic strip. Blue means that you do have a headache, green means that you do not and pink is inconclusive (try again later with a larger blood sample). I am sure that you can find links at NBC’s website. It made many of my family members feel better to find out that they did not in fact have a headache.
What exactly does that ‘headache test’ test for? Endorphins? Headaches are actually just a symptom, and they can be caused by a number of disorders. Most common is simple mental stress leading to muscle cramps. Also, intense light can bring on a headache. Any number of drugs can (alcohol springs to mind). And migranes, the granddaddy of all headaches, are caused by chemical imbalances, IIRC. Bottom line: I doubt one simple test like the one you describe could accurately diagnose a headache unless it looked for some side effect, like an increased level of endorphins. (Definition for those not in the know: Endorphins are the brain’s painkillers. They are released following any pain to keep you going long enough to get out of trouble. Thing is, the brain ODs itself easily, giving you a case of the heaves. The most insidious kind of painkillers, opiates, look a lot like endorphins chemically. That’s why they work so well. That’s also why you get addicted [your endorphin-production centers get screwed up].)
Be that as it may, there’s no way to prove pain on the spot. However, I would think you have seen a doctor about this at some point and he diagnosed the problem.
Get a note from him if it becomes necessary. Personally, I can’t fathom an employer telling me to prove that I was not feeling well.
Try this: sometime in the near future (after a particularly large greasy lunch) tell your boss you are feeling sick to your stomach. When he tells you to prove it tell him you can’t, go back to your work for a brief while, down a little ipecac, and go back to his office and puke all over his floor.
tell him “I’ll stop when you can prove this hurts you.” Then bite on his nose really really hard. Do this for about five minutes, and then i think he’ll get the point and let you go home.
The best way you can prove that nobody can prove their pain to another is human behavior. Why would you slaughter people if they could make their suffering known to you? Why would you abuse others if they could make you feel what they felt? Yet both has happened throughout history. Human empathy is a wonderful thing but it is based on a shaky foundation: Our understanding of others. Some people completely lack this understanding (enter Jack the Ripper or a severely autistic person). It’s a good thing most of us have it.
My OP was PURELY hypothetical and not based on any actual experience. I just wanted to present a situation to illustrate my concept. If nobody can “see” your pain, e.g. a broken bone that has jutted out through your flesh, then how are they to know you are actually in pain? They just have to take your word for it.
people like bosses, insurance companies, etc, tend to be skeptical for good reason and you can blame it on all the people who lie and cheat. You think lying and cheating have no ulterior effects? Think again. Every time someone lies, it weakens the believability of all other statements.
When my boss or my insurance company demand solid proof, I do not blame it on them as much as on all the liars who tried to cheat the system in the past.
Just this weekend an SUV was rear-ended in front of my house by a small car. The impact was minimal, there was no damage to the SUV and only a little damage to the fender of the other car.
Yet, the driver of the SUV comes out holding his neck and talking about whiplash. The police were called, the ambulance was called… they came and it took them like 10 seconds to determine the guy was just making the whole thing up… but other cases are not so clear and we all pay for them…
As a person who lives with daily pain, sometimes excruciating, I have to deal with situations where I am in pain at work. I think the reality is you can expect a certain amount of understanding and compassion on the part of your boss and peers (I take my shoes off every instant I can to help alleviate my pain and it seems a bit odd in meetings) , but it isn’t their job to accommodate your pain beyond reasonable measures. As ** Gatsby** said, getting a doctor to vouch for your condition will probably get more leeway than just saying you are in pain. Maybe you will just have to decide if you really want the job if you can’t get enough accommodations for your pain. I know when I was looking for work recently, I turned down several opportunities that involved travel because I have found that traveling is especially painful for me. I knew it would be unrealistic to expect an employer to make the accommodations I’d need to be able to travel without aggravating my pain so I didn’t even try to get the jobs.
Also as ** BobT** said, pain thresholds differ. I know I would be unimpressed with someone who just had a mild headache (NOT a migraine) and wanted to go home, because of the pain I routinely have at work.
If someone calls their headache ‘mild’, then sure, going home doesn’t make much sense.
The real problem is the relativism of pain threshholds.
Neurologists, in dealing with patients with pain and trying to adjust their pain medications to give adequate relief, have the patients rate their pain on a scale of 1-10, with 1 being very mild and 10 the worst pain you can possibly imagine.
There is enormous variability between individuals’ ratings of what would seem to be similar pain (i.e. similar incisions from brain surgery ought to yield similar ratings of the incisional pain - but don’t.) The pain scale, however, is actually a very consistent way to evaluate an individual patient’s pain over time.
And YES, malingerers suck. And it’s so hard to differentiate. I know Psych gets called in alot in pain cases; the problem is, though, that there’s a stigma to Psych’s being called in for a consult. It’s horrible if you’re in real pain to suspect that you aren’t believed, and that everyone thinks the etiology of your pain is entirely psychological (‘supratentorial’ is the snide doctor-speak way of conveying it.) However, being in chronic pain can cause anxiety, stress, mood changes, depression…
Wanderer, if you don’t mind my asking, what is the source of your chronic pain? (I ask both solicitously and out of intellectual interest - as I prepare to enter medical school, I’m doing a student internship in the Pain and Palliative Care Service of a hospital’s Neurology Dept. Am learning ALOT about pain - doesn’t that sound like a strange hobby?)
MSK, you just answered your own question. There is no visual way to indicate to someone else that you are experiencing pain. Given the hypothetical situation that’s been presented though, I would just work slower than I normally do in hopes that that would convince my boss to let me leave. Like, really really slow.
If that still doesn’t convince him, I’d still work slow so that I don’t increase the pain, but then I’d see a doctor about it and get him to write me a note indicating that I experience migraines when under pressure and may need to be excused from any strenuous activities.
Actually Paradocs, I have a problem that might be right up your alley. I have peripheral neuropathy in my feet. The sheath covering the nerves in my feet is breaking down, and the exposed nerve is dying. I have shooting pains and walking, standing and wearing shoes is painful. I take Neurontin to sleep but it dopes me pretty badly so I don’t take anything for pain during the day. It is a condition caused by something else rather than being a diesease, but in my case the doctors haven’t been able to come up with the reason for the condition so I am stuck with the pain. Usually it is caused by diabetes or liver disease, but I don’t have either.
Well not THE answer but as good as one gets. The correct reply when asked to validate your pain should go something like this…
“According to all prominent experts in the field of pain management, Pain is what the sufferer SAYS it is, no more, no less. Most intelligent people already know this. Only a moron would ask for ‘proof’. Now since I know you’re not a moron, I think this discussion is over. Glad to be of assistance.”
BTW to wanderer–Have you tried anti-siezure type meds such as depakote or tegratol/ antidepressants such as amitriptyiline, or topical creams with capsacain (the same ingredient in hot pepper oils)? The theory with the topical treatments is that the oils sort of exhaust the neurotransmitters and you don’t feel the pain anymore.
This home remedy was given to me by a very prominent physician. It couldn’t hurt to try if it gives some relief. Take 2 oz of cold cream (cheap is OK) mix with 1 oz of Cayenne pepper powder. Apply to the affected area as desired. You may adjust the proportion of cream to pepper as desired. i.e. add more pepper if not hot enough or less pepper if too strong. Wear socks or something to protect clothes,sheets and stuff. It will stain the skin temporarily, but if it works, it’s worth it. It goes without saying that you should wear rubber gloves when applying the cream and never–I repeat never-- let this stuff come into contact with your more delicate tisues such as eyes, nose,privates etc.
Oddly, as a migraine sufferer, I have never had problems with people asking me to prove my pain. I guess complaining from about the age 3 on was sufficient. That and the writhing around works.
Basically, it’s like any other Turing Test like thing. You can’t prove you’re sentient, but people assume it because of the way you act. When in pain, people act differently, do things that wouldn’t make sense where they well (like lying down in dark quiet rooms with nothing to do when there are lots of fun things to do available). If someone is acting like they are in pain, usually they are. I admit, it’s easy to fake, I could fake a migraine and no one would know… but I think most people don’t.
and remember, pain is relative, too. When I got 2nd degree burns covering my torso, the immediate onset pain was beyond belief. 24 hours later, is was less than the immediate onset, but still pretty strong. 3 more days, pain was much less. BUT if I had that same level right now, I’d think it was beyond belief again.
one thing that DID drive me nutso at the time: Here I was with blisters measuring 4 inches across and 8 to 10 inches long, covering my entire back/torso from bra line to pantie line (boiling water was spilled on me), and at the er, they gave me TWO shots of demerol (ummmmmmmm, demerol…), then sent me home with 6 tylenol 3’s (enough to last exactly 24 hours if I took them 4 hours apart, which, frankly, I did, 'cause the pain would wake me up), was told to come back to the er to get the bandages changed, went back, expected more painkillers, they said “no, we don’t want you to get hooked”. (insert assorted cussing here). Excuse me??? I work with junkie ex-offenders, knew specifically one had come into THAT er told them her “pelvic bones hurt” (???) and walked away with a 14 day supply of tylenol threes, and yet, here I am with a VISIBLE painful injury and no drug history and they give me a measly 6 pain killers???
Try http://www.panetics.org/ out of interest. A quantitative measurement for pain is given here - it’s called the dukkha. A dukkha is like a calorie with respect to heat. Level one is barely noticeable and nine is unbearable, wanting to die. A dukkha is the amount of suffering experienced in one full day by a person who, suffering for the duration of that day is at level one. I still don’t get, though, how you convince someone you are actually having a five dukkha day.bgv