In lizardinlaw's WU she says, "We do not understand the shift from acute pain to chronic pain, yet. The shift is in the brain. I think that we are too quick to mask and block pain rather than use the information." Pain is a complicated and important component of both health and healthcare and I would like to add some thoughts from a patient's perspective.

First, we all know that people experience pain differently. Our thresholds for the same objective level of pain vary. I recall a Sports Illustrated article about hockey great Bobby Orr. Late in his career, despite chronic pain in his knees, Orr was still playing at an all-star level. The reporter asked Orr's doctor how much pain Orr's knees were causing. The doctor replied that the average person with Orr's knees would be in a wheelchair full-time. The question is: did Orr not experience the pain others would have felt? Even if we believe the doctor was mistaken in this specific instance, each of us is probably familiar with someone that managed to function in circumstances beyond our understanding. We need to understand how and why.

As lizardinlaw's WU notes there is an emphasis today on asking patients their pain level. From my recent experiences this is usually a numeric scale (e.g., rate your current pain on a scale of 1 to 10). But these numbers are almost meaningless unless we have something descriptive to tie them to and levels of functionality seem the best guideline. What can or can't you do because of the pain you are experiencing? Pain that can't be ignored and that greatly reduces functionality is the pain that has to be managed. This can be totally different than sharp, intense, but episodic or intermittent pain.

In my specific case last fall I knew I had a severe problem and I was eventually diagnosed with cancer in the nasal area. I was in pain, but the most debilitating pain wasn't in the nasal area it was in the cheekbones. For the most part the pain was moderate, but it was constant and intense enough that I couldn't sleep until totally exhausted and then I'd be awake again after just an hour or two. After a week of this I was almost completely non-functional; barely able to think. I was driving myself to doctor's appointments and thinking on each trip that I was probably a more dangerous driver on the roads than a drunk or someone addicted to their phone. I made it my first point of emphasis with both my primary care physician and my ear/nose/throat specialist that this constant, debilitating pain should be the first issue addressed. Neither appeared to appreciate the fact that I was essentially unable to function. The ENT specialist even made the odd comment that he didn't understand why I was in pain.

After three weeks of this I was desperate. Through trial and error I found that massive doses of ibuprofen alleviated the cheekbone pain. When I started seeing a cancer doctor and he found out I was taking 25 to 30 ibuprofen tablets per day (200 mg each) he strongly suggested I cut back. I explained that it was the minimum necessary to keep me functional; able to sleep and work. Extra Strength Tylenol was suggested. I tried, but it was ineffective against the pain I was experiencing. I am not a doctor, but the fact ibuprofen worked while Tylenol didn't is probably a clue as to the direct cause of the pain and probably worth exploring.

My cancer was advanced and required extensive surgery. My nose was removed as well as a portion of the upper lip and 17 lymph nodes. I will start radiation and chemotherapy in a week. After surgery I was prescribed Oxycodone. Yet, the cheekbone pain persists. Fortunately not at the levels prior to surgery, but when I want to be pain-free I don't take the oxycodone I take a couple of ibuprofen.

Through all of this I was asked countless times about pain. And again, the point I'd like to emphasize is that a vague number is not very helpful. I often didn't even know how to answer the question.